Moss JL, et al. - This trial strived to compare the percentages and ranks of adolescent weight-related outcomes among U.S. states. It was concluded that the adolescents in all states could gain an advantage from initiatives to support cancer prevention behaviors, especially physical activity and fruit and vegetable (F&V) consumption. Adaptation could be carried out of the programs, in states that ranked highly on all assessed health behaviors, for dissemination in lower-performing states.

Methods

• The recruitment consisted of 531,777 adolescents (grades 9-12) who completed the Youth Risk Behavior Surveillance System survey in 2011, 2013, or 2015.
• The percentage of adolescents in each state that met guidelines for physical activity, fruit and vegetable (F&V) consumption, and healthy weight status were estimated.
• The states were ranked and estimated the ranks' 95% CI's through a Monte Carlo method with 100,000 simulations.
• Repitition was done of these analyses stratified by sex (female or male) or race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic/Latino, or other).
• Pearson's and Spearman's correlation coefficients inspected the consistency in the percentages and ranks (respectively) across behaviors and subgroups.

Results

• Meeting the physical activity and F&V consumption guidelines was relatively rare among adolescents (25.8% [95% CI = 25.2%-26.4%] and 8.0% [95% CI = 7.6%-8.3%], respectively), while meeting the healthy weight guideline was common (71.5% [95% CI = 70.7%-72.3%]).
• At the state level, statistically similar percentages of adolescents meeting these guidelines were found.
• The states' ranks reported wide CI's, causing considerable overlap (i.e., statistical equivalence).
• For each behavior, states' percentages and ranks were moderately to highly related across adolescent subgroups (Pearson's r = 0.33-0.96; Spearman's r = 0.42-0.96), but across behaviors, only F&V consumption and healthy weight exhibited a correlation (Pearson's r = 0.34; Spearman's r = 0.37).