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Purpose: To determine the prevalence and correlates of missing meals among adolescents. Design: The 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study. Setting: School based. Participants: A nationally representative sample of 11 429 high school students. Measures: Breakfast, lunch, and dinner consumption; demographics; measured and perceived weight status; physical activity and sedentary behaviors; and fruit, vegetable, milk, sugar-sweetened beverage, and fast-food intake. Analysis: Prevalence estimates for missing breakfast, lunch, or dinner on ≥1 day during the past 7 days were calculated. Associations between demographics and missing meals were tested. Associations of lifestyle and dietary behaviors with missing meals were examined using logistic regression controlling for sex, race/ethnicity, and grade. Results: In 2010, 63.1% of students missed breakfast, 38.2% missed lunch, and 23.3% missed dinner; the prevalence was highest among female and non-Hispanic black students. Being overweight/obese, perceiving oneself to be overweight, and video game/computer use were associated with increased risk of missing meals. Physical activity behaviors were associated with reduced risk of missing meals. Students who missed breakfast were less likely to eat fruits and vegetables and more likely to consume sugar-sweetened beverages and fast food. Conclusion: Breakfast was the most frequently missed meal, and missing breakfast was associated with the greatest number of less healthy dietary practices. Intervention and education efforts might prioritize breakfast consumption.

Purpose:Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics.Design:Cross-sectional survey.Setting:DocStyles survey, 2014.Participants:A total of 1510 practicing US physicians.Measures:Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral.Analysis:Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics.Results:Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68).Conclusion:Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.

The increasing stroke burden in the world strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new effective primary prevention strategies with larger effect size are needed. In this article, we reviewed the latest stroke epidemiology literature with the emphasis on the recent Global Burden of Disease 2013 Study stroke burden estimates from 1990 to 2013, highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies, and outline new developments in primary stroke and CVD prevention. We also suggested key priorities for the future, including comprehensive prevention strategies that target people with all levels of CVD risk, implementation of an integrated approach to promote health behaviors and reduce health disparities, capitalizing on information technology to advance prevention approaches and techniques, and incorporation of culturally appropriate education about healthy lifestyle into standard education curricula early in life. Given the already immense and fast increasing burden of stroke and other major noncommunicable diseases (NCDs) which threatens worldwide sustainability, governments could develop and implement an emergency action plan addressing the primary prevention of NCDs.