The relationship between occupational classification and low birth weight in a national sample of white married mothers

Summary The relationship between occupational classification and Low Birth Weight singletons (LBW; < 2500 g) was studied in a sample of white married mothers employed in the National Natality Survey 1980 (N = 3300). Univariate analyses included relationship between birth weight and occupation, smoking, alcohol, parity, age, education, prenatal care, weight gain during pregnancy, gestation and sex of the singleton. Occupation was significantly associated with LBW (P < 0.05). The LBW rate was higher among blue collar workers (162 per 1000) compared to white collar workers (132 per 1000). The mean birth weight of singletons among blue collar workers was also significantly lower compared to those among white collar workers (P < 0.057). However, after adjusting simultaneously for the effect of the confounding variables in multiple regression analysis, occupation was no longer a significant predictor of LBW. The extent to which the validity problems may limit the interpretation of the study are discussed.This work was sponsored in part through EPA Grant No. 811173 to the Center for Environmental Epidemiology where S. K. Virji was a doctoral fellow.     

Dietary magnesium intake in a national sample of US adults

Despite the role of magnesium in maintaining health, much of the U.S. population has historically not consumed adequate amounts of magnesium. Furthermore, significant racial or ethnic disparities in magnesium intake exist. Our objective was to provide more recent data about magnesium intake in the U.S. population. We analyzed the 24-h dietary recall data from 4257 participants aged >or=20 y from the National Health and Nutrition Examination Survey 1999-2000. The median intake of magnesium was 326 mg/d (mean 352 mg/d) among Caucasian men, 237 mg/d (mean 278 mg/d) among African American men, 297 mg/d (330 mg/d) among Mexican American men, 237 mg/d (mean 256 mg/d) among Caucasian women, 177 mg/d (mean 202 mg/d) among African American women, and 221 mg/d (mean 242 mg/d) among Mexican American women. Among men and women, Caucasians had significantly higher mean intakes of dietary magnesium than African Americans but not Mexican Americans. Magnesium intake decreased with increasing age (P for linear trend = 0.035 for Caucasians; P for linear trend <0.001 for African Americans and Mexican Americans). Men had higher intakes of magnesium than women for each of the three race or ethnic groups (P < 0.001 in each group). Caucasian men, African American men and Caucasian women who used vitamin, mineral or dietary supplements consumed significantly more magnesium in their diets than did those who did not. Substantial numbers of U.S. adults fail to consume adequate magnesium in their diets. Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.     

The relationship between physical exercise and distress in a national sample of Canadians

This paper presents an empirical examination of the relationship between physical exercise and generalized distress within a stress process framework by examining how chronic strains, self-esteem, mastery, and social support influence this relationship. The analysis employed the 1994 wave of the National Population Health Survey consisting of a sample of 12,636 Canadians between 20 and 64 years of age. Findings suggest that physical exercise is a significant predictor of generalized distress independent of chronic strain, self-esteem and social support. However, mastery mediated the association between physical exercise and distress. Moreover, mastery moderated the relationship indicating that it is a more important resource for people who are inactive.     

The relationship between physical activity and mental health in a national sample of college females

The objective of the present analysis was to examine the relationship between vigorous/moderate or strength training exercise, and mental health in a national sample of college females. Secondary data (n = 22,073) from the National College Health Assessment administered during the Spring 2002 and 2003 semesters were used in a cross-sectional design. Depression, anxiety, suicidal ideation, and perceived health were the dependent variables; and two measures of weekly exercise frequency were the independent variables. Vigorous/moderate exercise was associated with positively associated perceived health and modestly negatively associated with depression. Strength training exercise was positively associated with perceived health and modestly negatively associated with depression, anxiety, and suicidal ideation. These findings support an association between two forms of exercise and several indicators of mental health. Additional longitudinal research is needed prior to endorsing exercise as treatment for mental disorders.     

Comparing outcomes in a statewide program for adolescent mothers with outcomes in a national sample.

One-year outcomes for 1,004 participants in a statewide program for pregnant and parenting teenagers were compared with outcomes for 790 adolescent mothers included in the National Longitudinal Survey of Youth. The program group was substantially younger and included more black women and fewer married teenagers than the national sample. Controlling for these and other baseline differences revealed that program participants were significantly more likely than the national sample to be enrolled in school, to be employed and to have avoided a subsequent pregnancy 12 months later. Several baseline variables, including age at first birth, ethnicity, education and living arrangements, were also predictive of one-year outcomes.     

Infant-feeding attitudes of expectant mothers in Northern Ireland

Northern Ireland (NI) has one of the lowest rates of breast-feeding initiation and duration in both the UK and the industrialized world. This study therefore aimed to explore the relationship between infant-feeding attitudes and feeding intention and outcome in expectant mothers within NI. Expectant mothers (n = 200) were recruited from hospital antenatal booking clinics. Each completed a demographic questionnaire and the self-administered Iowa Infant Feeding Attitude Scale (IIFAS). Participants (n = 192) were followed up after birth through the Northern Ireland Maternity System. The IIFAS distinguished between those mothers who intended to breast-feed (higher IIFAS scores) and those who intended to artificially feed (lower IIFAS scores) as well as between those who breast-fed and those who artificially fed on discharge from hospital. The IIFAS was also able to distinguish between mothers in regard to feeding intention and outcome on the basis of education, socio-economic class, income and marital status. This suggests that the IIFAS could prove useful in the targeting and evaluation of intervention to promote breast-feeding.     

Adult outcomes of binge drinking in adolescence: findings from a UK national birth cohort

AIMS: The aim of the study was to determine outcomes in adult life of binge drinking in adolescence in a national birth cohort. DESIGN AND SETTING: Longitudinal birth cohort: 1970 British Birth Cohort Study surveys at 16 years (1986) and 30 years (2000). PARTICIPANTS: A total of 11 622 subjects participated at age 16 years and 11 261 subjects participated at age 30 years. MEASUREMENTS: At the age of 16 years, data on binge drinking (defined as two or more episodes of drinking four or more drinks in a row in the previous 2 weeks) and frequency of habitual drinking in the previous year were collected. Thirty-year outcomes recorded were alcohol dependence/abuse (CAGE questionnaire), regular weekly alcohol consumption (number of units), illicit drug use, psychological morbidity (Malaise Inventory) and educational, vocational and social history. FINDINGS: 17.7% of participants reported binge drinking in the previous 2 weeks at the age of 16 years. Adolescent binge drinking predicted an increased risk of adult alcohol dependence (OR 1.6, 95% CI 1.3 to 2.0), excessive regular consumption (OR 1.7, 95% CI 1.4 to 2.1), illicit drug use (OR 1.4, 95% CI 1.1 to 1.8), psychiatric morbidity (OR 1.4, 95% CI 1.1 to 1.9), homelessness (OR 1.6, 95% CI 1.1 to 2.4), convictions (1.9, 95% CI 1.4 to 2.5), school exclusion (OR 3.9, 95% CI 1.9 to 8.2), lack of qualifications (OR 1.3, 95% CI 1.1 to 1.6), accidents (OR 1.4, 95% CI 1.1 to 1.6) and lower adult social class, after adjustment for adolescent socioeconomic status and adolescent baseline status of the outcome under study. These findings were largely unchanged in models including both adolescent binge drinking and habitual frequent drinking as main effects. CONCLUSIONS: Adolescent binge drinking is a risk behaviour associated with significant later adversity and social exclusion. These associations appear to be distinct from those associated with habitual frequent alcohol use. Binge drinking may contribute to the development of health and social inequalities during the transition from adolescence to adulthood.     

Changes in energy intakes during pregnancy and lactation in a national sample of US women.

Increases in energy intakes during pregnancy and lactation were evaluated by examining dietary data for 458 pregnant women who participated in the Continuing Surveys of Food Intakes by Individuals conducted in 1985 and 1986. Energy intakes were well below recommendations during all reproductive states; however, increases during pregnancy approximated recommendations, while increases during lactation were low. Postpartum non-lactating intakes did not return to prepregnancy levels for Black women or women with lower incomes.     

Associations of social capital with binge drinking in a national sample of adults: The importance of neighborhoods and networks

BackgroundWhile considerable research on adult binge drinking has focused on social influences, the potential role of social capital has been largely overlooked. This study examines the role of social capital, assessed in terms of both neighborhood and social network characteristics, in understanding adult binge drinking.MethodsAdults ages 30–80 were randomly drawn from the RAND American Life Panel and completed an online survey (analytic sample n = 1383). The main predictor variables were neighborhood cohesion, neighborhood order, and social network density. Associations of social capital with past month binge drinking (any, number of days) were examined, controlling for demographic characteristics.ResultsZero-inflated negative binominal regression analysis indicated that any binge drinking was more likely among adults who lived in highly ordered neighborhoods and who had denser social networks but was negatively associated with neighborhood cohesion. However, binge drinking was more frequent among those who lived in neighborhoods lacking order and who had sparser social networks, but had no association with neighborhood cohesion. Age was not found to moderate associations of social capital with binge drinking.ConclusionsGiven that the associations of social capital with adult binge drinking behavior appear to differ by level of influence and type of drinking behavior, there is a need to gain a more nuanced understanding of these complex associations, including the mechanisms through which they operate.     

Income is a stronger predictor of mortality than education in a national sample of US adults

Low socioeconomic status (SES) is associated with mortality in several populations. SES measures, such as education and income, may operate through different pathways. However, the independent effect of each measure mutually adjusting for the effect of other SES measures is not clear. The association between poverty-income ratio (PIR) and education and all-cause mortality among 15,646 adults, aged >20 years, who participated in the Third National Health and Nutrition Examination Survey in the USA, was examined. The lower PIR quartiles and less than high school education were positively associated with all-cause mortality in initial models adjusting for the demographic, lifestyle and clinical risk factors. After additional adjustment for education, the lower PIR quartiles were still significantly associated with all-cause mortality. The multivariable odds ratio (OR) [95% confidence interval (CI)] of all-cause mortality comparing the lowest to the highest quartile of PIR was 2.11 (1.52-2.95, p trend < or = 0.0001). In contrast, after additional adjustment for income, education was no longer associated with all-cause mortality [multivariable OR (95% CI) of all-cause mortality comparing less than high school to more than high school education was 1.05 (0.85-1.31, p trend=0.57)]. The results suggest that income may be a stronger predictor of mortality than education, and narrowing the income differentials may reduce the health disparities.     

Low birth weight, life style of mothers during pregnancy and chlorinated drinking water

Numerous environmental factors such as smoking habits, alcohol intake, economic and social status, and by-product chlorination present in drinking water can determine adverse pregnancy outcomes like a low weight birth, small for gestational age or preterm delivery. In 1998 the Italian Ministry of University and Scientific Technological Research (MURST) has financed a multicentric study in order to evaluate the association between exposure to by-products chlorination in drinking water during pregnancy and adverse pregnancy outcomes at birth such as preterm delivery and low birth weight. We describe the socio demographics characteristics, personal habits and the health status during pregnancy and exposure to the VOX of 171 women recruited from the Research Unit of Rome and L'Aquila. A case control study with incident cases was performed. Exposure to Chlorination By Products (CBP) and confounding factors for studied outcomes, were assessed by a validated questionnaire. At the same time, collection and analysis of 124 tap water samples were carried out directly at women's home. No association was found between CBPs level and low birth weight or preterm delivery. We found an excess risk statistically significantly between preterm delivery and hypertension (OR = 5.06; IC 95% = 1.70-15.44) an excess risk statistically significantly between low birth weight and smokers (OR = 3.43, IC 95% = 1.15-10.26). The CBPs levels were rather low (range cases = 0.09-6.28 microg/L; range controls = 0.01-6.44 microg/L). The results confirm the literature data and the validity of the epidemiological method adopted. The low CBPs levels, under the Law level, are probably imputable to the good quality of sorgive waters. Considering the CBPs level temporal variability in chlorinated waters, is to be hoped a careful and continues surveillance of the CBPs spike levels for better exposure assessment.     

Body mass index and colon cancer in a national sample of adult US men and women.

The evidence supporting obesity as a risk factor for colon cancer remains inconclusive, especially among women. The author studied the association between obesity and colon cancer in a nationally representative cohort of men and women aged 25-74 years who participated in the First National Health and Nutrition Examination Survey from 1971 to 1975 and were subsequently followed up through 1992. Among the 13,420 persons included in the analytic sample, 222 incident cases of colon cancer were identified. Height and weight were measured during the baseline examination. Compared with participants whose body mass index was less than 22 kg/m2, the hazard ratios were 1.79 (95% confidence interval (CI): 0.87, 3.71), 1.86 (95% CI: 0.86, 4.03), 2.47 (95% CI: 1.14, 5.32), 3.72 (95% CI: 1.68, 8.22), and 2.79 (95% CI: 1.22, 6.35) for participants with a body mass index of 22-<24 kg/m2, 24-<26 kg/m2, 26-<28 kg/m2, 28-<30 kg/m2, and > or = 30 kg/m2, respectively. The hazard ratios were similar for men and women. Subscapular skinfold thickness, but not triceps skinfold thickness, was positively associated with colon cancer incidence among men but not women, after adjustment for body mass index and other possible confounders. These results strongly support the hypothesis that excess body weight is a risk factor for colon cancer among both men and women.     

Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men

BACKGROUND: Few studies have examined the influence of country of birth and acculturation status on indicators of obesity using national samples of Mexican-American women and men. METHODS: We analysed data for 1387 Mexican-American women and 1404 Mexican- American men, ages 25-64, from the third National Health and Nutrition Examination Survey (1988-1994). We examined whether waist circumference and abdominal obesity varied by country of birth and acculturation status (primary language spoken), and whether among those with abdominal obesity, number of associated cardiovascular disease (CVD) risk factors varied by country of birth and acculturation status. RESULTS: Both country of birth and, to a lesser degree, acculturation status were significantly associated with waist circumference and abdominal obesity. Mexican-born women and men had the smallest waist circumference (90.4 cm, 94.0 cm respectively), US-born English-speaking women and men had intermediate waist circumference (93.6 cm, 97.3 cm), and US-born Spanish-speaking women and men had the largest waist circumference (96.9 cm, 97.7 cm), after accounting for age, education, per cent of energy from dietary fat, leisure-time physical activity, and smoking. All women had high prevalences of abdominal obesity, particularly US-born Spanish-speaking women (68.7%). In addition, US-born Spanish-speaking women with abdominal obesity were significantly more likely than their counterparts to have one or more of the following CVD risk factors: high serum insulin, non-insulin dependent diabetes, high blood lipids, and/or hypertension. CONCLUSIONS: These findings illustrate the heterogeneity of the Mexican-American population and suggest that country of birth and lack of acculturation to the majority culture, as well as secondary lifestyle changes, may explain the significant clinical differences observed in abdominal obesity within Mexican-American population subgroups.     

The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.     

Erratum to: Psychometric evaluation of the Cystic Fibrosis Questionnaire-Revised in a national, US sample

Purpose

The psychometric properties of a health-related quality of life (HRQOL) instrument, the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were evaluated in a national, US sample of patients with cystic fibrosis (CF). This is the first psychometric evaluation of the revised version of this instrument.

Methods

The Epidemiologic Study of CF is a national, US multicenter longitudinal cohort study containing CFQ-R and health outcomes data. Developmentally appropriate versions of the CFQ-R were available from 7,330 patients aged 6?C70?years and a proxy version from 2,728 parents of school-age children. The CFQ-R was completed during a ??stable?? or ??sick?? visit before recording health outcomes such as weight, lung function, and pulmonary exacerbations.

Results

There were few floor and ceiling effects and strong internal consistency (Cronbach alpha???0.70) for most scales. The CFQ-R consistently discriminated between patients seen for sick-versus-well visits, and among stages of disease severity based on lung function. As predicted, women with CF reported worse HRQOL than men on scales not related to body image and weight. Strong parent?Cchild agreement was found on scales measuring observable behaviors (respiratory symptoms). Convergence between CFQ-R scales and health outcomes provided evidence of construct validity.

Conclusions

The CFQ-R demonstrated robust psychometric properties and consistent associations with health outcomes in a large national, US sample. Normative data are available to aid in interpretation.     

Serum magnesium and ischaemic heart disease: findings from a national sample of US adults.

BACKGROUND: Animal and human data suggest that magnesium may play an important role in ischaemic heart disease. Few prospective epidemiological studies have related serum magnesium concentrations to mortality from ischaemic heart disease (IHD) or all-causes. METHODS: Data from the National Health and Nutrition Examination Survey Epidemiologic Followup Study were used to examine the association between serum magnesium concentration, measured between 1971-1975, and mortality from IHD or all-causes in a national sample of 25-74-year-old participants followed for about 19 years. RESULTS: The analytical samples for IHD and all-cause-mortality included 12 340 and 12 952 participants, respectively (1005 IHD deaths, 2637 IHD deaths or hospitalizations, 4282 total deaths). Hazard ratios for IHD mortality from proportional hazards analysis comparing the second (1.59-<1.68 mEq/l), third (1.68-<1.77 mEq/l), and fourth (> or =1.77 mEq/1) quartiles of serum magnesium concentration with the lowest quartile were 0.79 (95% CI: 0.58-1.08), 0.66 (95% CI: 0.47-0.93), 0.69 (95% CI: 0.52-0.90), respectively. For all-cause mortality, hazards ratios were 0.82 (95% CI: 0.72-0.93), 0.84 (95% CI: 0.73-0.96), 0.85 (95% CI: 0.75-0.95). No significant interactions between serum magnesium concentration and age, sex, race, and education were observed. CONCLUSION: Serum magnesium concentrations were inversely associated with mortality from IHD and all-cause mortality.     

Leukocyte count, erythrocyte sedimentation rate, and diabetes incidence in a national sample of US adults.

Emerging data suggest that inflammation may play a role in the etiology of diabetes mellitus. Because few prospective studies have addressed this issue, the author examined the relation between leukocyte count and erythrocyte sedimentation rate and diabetes incidence using data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (from 1971-1975 to 1992-1993). Of 8,352 participants included in the analysis, 878 developed incident diabetes during the approximately 20-year follow-up. After adjustment for age, smoking status, systolic blood pressure, cholesterol concentration, use of antihypertensive medication, recreational exercise, non-recreational activity, alcohol use, and body mass index, the hazard ratios from proportional hazards for participants with a leukocyte count of > or = 9.1 x 10(9)/liter compared with participants with a leukocyte count of < or = 5.7 x 10(9)/liter were 1.33 (95% confidence interval (CI): 0.81, 2.19) for men and 1.68 (95% CI: 1.21, 2.34) for women. The adjusted hazard ratios for participants with an erythrocyte sedimentation rate of > or = 26 mm/hour compared with participants with an erythrocyte sedimentation rate of < or = 5 mm/hour were 1.85 (95% CI: 0.97, 3.54) for men and 0.83 (95% CI: 0.47, 1.44) for women. These results provide limited support to the hypothesis that inflammation is an etiologic factor for diabetes.     

Nutritional profile of selected expectant mothers and the cost of pregnancy

The nutritional profile during pregnancy, pregnancy-related expenditures, and pregnancy wastage were analyzed in 316 women attending a maternity or general hospital in Coimbatore, India. The sample included 195 low-income women (under Rs 600/month), 76 middle-income women (Rs 601-1500/month), and 45 high-income women (above Rs 1500/month). 51% of study participants had 3 fewer children; 71% were literate. The pregnancy diet of low-income women was starchy and inadequate in terms of all nutrients except vitamin C. Middle- and high-income women reported a satisfactory intake of all essential nutrients. The mean weight gain during pregnancy for low-, middle-, and high-income women was 6.41 kg, 7.37 kg, and 8.33 kg, respectively, while the mean hemoglobin level was 10.52, 10.74, and 10.96 gm/100 ml, respectively. No study participant was found to be anemic. The rate of pregnancy wastage was 11.8% among low-income women, 7.9% in the middle-income group, and 4.4% among high-income women; mean birthweight was 2.9 kg for low-income mothers and 3.1 kg for the offspring of both middle- and upper-income women. Regardless of income group, all pregnant women spent a substantial amount of extra money during pregnancy on food, clothing, medical examinations, transportation, ceremonies, servants, and delivery charges. These extra expenditures totalled Rs 1295.20 for low-income women, Rs 2913.68 for middle-income women, and Rs 4595.01 for high-income women. Given the fact that Indian women are investing substantial amounts in their pregnancies, increased attention must be given to prenatal care to prevent pregnancy wastage and the waste of scarce financial resources.     

Mortality among diabetics in a national sample

The authors compare the mortality experience of a national sample of diabetic men and women with their nondiabetic counterparts. The study population consists of respondents from the First National Health and Nutrition Examination Survey (NHANES I), conducted in 1971-1975, who were traced in 1982-1984 through the NHANES I Epidemiologic Follow-up Study. Over the nine-year follow-up period, the age-adjusted death rates for diabetic men and women were twice the rates for nondiabetics. About 75% of the excess mortality among diabetic men and 57% among diabetic women was attributable to cardiovascular disease deaths. After adjustment for age, systolic blood pressure, serum cholesterol, body mass index, and smoking, the relative risk of death was 2.3 for diabetic men and 2.0 for diabetic women. The relative risk for diabetics was highest for ischemic heart disease mortality (2.8 for men and 2.5 for women) and lowest for noncardiovascular disease deaths (1.4 for men and 1.1 for women). When subjects who reported having had a heart attack prior to the baseline examination were excluded, the relative risks for ischemic heart disease mortality among diabetics remained substantial (2.4 for men and 2.6 for women). There was little evidence that the relative risk of death for diabetics compared with nondiabetics differed by age or sex, although 95% confidence intervals around these estimates were wide.