Low-Level Symptoms of Depression in Mothers of Young Children are Associated with Behavior Problems in Middle Childhood

Objectives Examine the association between mothers’ low- and high-level depressive symptoms in early childhood and children’s behavior problems in middle childhood. Methods We used data from 1844 families in a multi-site, longitudinal study beginning when children were 14 months and continuing to age 11 years. Children’s internalizing and externalizing behavior problems at age 11 were assessed using the child behavior checklist for ages 6–18. Mothers’ scores on the Center for Epidemiological Studies-Depression Scale when children were 14 months were used to classify them into three groups: ‘no depressive symptoms’, ‘low-level depressive symptoms (below the clinical cut-off)’ and ‘clinically significant depressive symptoms (above the clinical cut-off).’ Results Mothers were racially/ethnically diverse, including Caucasian (38.9 %), African-American (34.4 %), Hispanic (21.6 %), or other (5.1 %). More than one-third (39.2 %) were teenaged mothers, and 46.0 % did not complete high school. Of the 1844 families, 1172 had age 11 child outcome data. Logistic regression analyses controlling for family demographics revealed a significant association between early maternal depressive symptoms and later child behavioral outcomes. Both low level and clinically significant symptoms were associated with internalizing and externalizing behavior problems. For example, children whose mothers had low-level depressive symptoms were twice as likely to have clinically elevated internalizing problems compared with children whose mothers never had symptoms of depression. Conclusions Children whose mothers experience low-level depressive symptoms early in their development have increased risk for later behavioral problems, suggesting a possible need for new screening and intervention strategies for mothers with lower than clinically elevated symptoms.     

Factors Associated with Active Smoking,Quitting, and Secondhand Smoke Exposure among Pregnant Women in Greece

Background

Pregnant women are exposed to tobacco smoke through active smoking and contact with secondhand smoke (SHS), and these exposures have a significant impact on public health. We investigated the factors that mediate active smoking, successful quitting, and SHS exposure among pregnant women in Crete, Greece.

Methods

Using a cotinine-validated questionnaire, data were collected on active smoking and exposure to secondhand smoke from 1291 women who had successfully completed the first contact questionnaire of the prospective mother-child cohort (Rhea) in Crete during the 12th week of pregnancy.

Results

Active smoking at some time during pregnancy was reported by 36% of respondents, and 17% were current smokers at week 12 of gestation. Those less likely to quit smoking during pregnancy were those married to a smoker (OR, 1.76; P = 0.008), those who were multiparous (1.72; P = 0.011), and those with young husbands. Of the 832 (64%) nonsmokers, almost all (94%, n = 780) were exposed to SHS, with the majority exposed at home (72%) or in a public place (64%). Less educated women and younger women were exposed more often than their better educated and older peers (P < 0.001). Adjusting for potential confounders, parental level of education, age, and ethnicity were the main mediators of exposure to SHS during pregnancy.

Conclusions

Active smoking and exposure to SHS are very prevalent among pregnant women in Greece. The above findings indicate the need for support of population-based educational interventions aimed at smoking cessation in both parents, as well as of the importance of establishing smoke-free environments in both private and public places.Key words: smoking, cessation, pregnancy, fetal health, passive smoking, SHS     

Psychopathology Symptoms are Associated with Prenatal Health Practices in Pregnant Women with Heavy Smoking Levels

Purpose

Smoking during pregnancy may be linked to other problematic prenatal health behaviors in women. We examined interrelationships among prenatal smoking, prenatal health behaviors and mental health. The objective of this study was to examine factors that may contribute to variations in prenatal health practices among women who smoke during pregnancy.

Methods

Birth mothers from an adoption study (N?=?912) were interviewed about prenatal smoking, health behaviors, and mental health symptoms at 5 months postpartum.

Results

One-quarter of participants (N?=?222) reported smoking 6 or more cigarettes daily for at least 1 trimester. For mothers who smoked more than 6 cigarettes daily, higher levels of antisocial behaviors (β?=????.14, p?=?.03) and depressive symptoms (β?=????.17, p?=?.03) were associated with less frequent prenatal folate use; antisocial behaviors and depressive symptoms were not associated for prenatal folate use among women who did not smoke more than 6 cigarettes daily. For mothers who did not smoke more than 6 cigarettes daily, more depressive symptoms were associated with fewer prenatal care visits (β?=?.12, p?=?.01). Antisocial behaviors and anxiety symptoms were not associated with prenatal care visits in either group of mothers.

Conclusions for Practice

Maternal antisocial behaviors and depressive symptoms during pregnancy may be markers for poorer adherence to recommendations for folate supplementation among women who smoke 6 or more cigarettes daily during pregnancy, independent of adequacy of prenatal care.

     

Factors Associated with Healthcare Visits by Young Children for Nontoxic Poisoning Exposures

Poison control centers have been shown to be a cost-effective alternative to healthcare visits for poisoning exposures, yet emergency departments (ED) and urgent care centers (UCC) continue to be frequently accessed for poisoning exposures in young children. We sought to identify predictors of young children who obtain healthcare for a nontoxic poisoning exposure. Poisoning exposure cases for children ≤5 years old who sought ED, UCC, or clinic care between 2001 and 2005 from an urban regional pediatric hospital system were identified from poisoning ICD-9 codes in the hospital administrative data and from a poisoning designation in the National Electronic Injury Surveillance System (NEISS) data. Cases (n = 2,494) were reviewed and categorized as either toxic or nontoxic. Toxic exposures were those with more than minimal potential for clinical effects. Most cases were between 1 and 2 years old, male, White, enrolled in Medicaid, sought ED care, had no referring physician, and brought to the facility by a parent/guardian. Logistic regression analysis revealed that the odds of seeking healthcare for a nontoxic poisoning exposure were significantly greater if the child was African American, enrolled in Medicaid, had a non-medication related poisoning, and was brought to the healthcare site by a parent/guardian. Healthcare costs and unnecessary use of healthcare resources for nontoxic poisoning exposures could be reduced by educating parents and providers of children at high risk for inappropriate healthcare visits for nontoxic poisonings to initially contact the poison control center (1-800-222-1222).     

Indoor Charcoal Smoke and Acute Respiratory Infections in Young Children in the Dominican Republic

The authors investigated the effect of charcoal smoke exposureon risks of acute upper and lower respiratory infection (AURIand ALRI) among children under age 18 months in Santo Domingo,Dominican Republic (1991–1992). Children living in householdsusing charcoal for cooking (exposed, n = 201) were age-matchedto children living in households using propane gas (nonexposed,n = 214) and were followed for 1 year or until 2 years of age.Fuel use and new episodes of AURI and ALRI were ascertainedbiweekly through interviews and medical examinations. Householdindoor-air concentration of respirable particulate matter (RPM)was measured in a sample of follow-up visits. Incidences ofAURI and ALRI were 4.4 and 1.4 episodes/child-year, respectively.After adjustment for other risk factors, exposed children hadno significant increase in risk of AURI but were 1.56 times(95% confidence interval: 1.23, 1.97) more likely to developALRI. RPM concentrations were higher in charcoal-using households(27.9 µg/m³ vs. 17.6 µg/m³), and ALRI risk increasedwith RPM exposure (10-µg/m³ increment: odds ratio = 1.17,95% confidence interval: 1.02, 1.34). Exposure to charcoal smokeincreases the risk of ALRI in young children, an effect thatis probably mediated by RPM. Reducing charcoal smoke exposuremay lower the burden of ALRI among children in this population. air pollution, indoor; biomass; charcoal; Dominican Republic; particulate matter; respiratory tract infections; smoke; wood     

Factors Associated with Never Being Screened for Colorectal Cancer

Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29 % of respondents had never been screened for CRC. In the adjusted model, 36.6 % of US adults age 50–59 years and 29.1 % of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2 %) reported never being screened than members of other racial and ethnic groups. Nearly 37 % of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29 % reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC.     

Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children

Children living in Sub-Saharan Africa are vulnerable to developmental delay, particularly in the critical first five years due to various adverse exposures including disease and nutritional deficiencies. Anemia and iron deficiency (ID) are highly prevalent in pregnant mothers and young children and are implicated in abnormal brain development. However, available evidence on the association between anemia, ID and neurodevelopment in sub-Saharan Africa is limited. Using data from the Entebbe Mother and Baby Study prospective birth cohort, we examined the effect of maternal and child hemoglobin (Hb) levels and child iron status on developmental scores in 933 and 530 pre-school Ugandan children respectively. Associations between Hb levels, iron status and developmental scores were assessed using regression analyses adjusting for potential confounders. Lower maternal and child Hb levels were associated with reduced psychomotor scores at 15 months, while only lower Hb levels in infancy were associated with reduced language scores. We found no evidence that anemia or ID was associated with cognitive or motor scores at five years. This study emphasizes the importance of managing anemia in pregnancy and infancy and highlights the need for further studies on the effects of anemia and ID in children living in Sub-Saharan Africa.     

The Socio-economic Patterning of Health and Smoking Behaviour among Mothers with Young Children on Income Support

The paper is set against the backdrop of the increase in the number of households in the UK in receipt of means-tested benefits. Focusing on women in households with children, it examines two issues: the limitations of conventional measures of socio-economic position and the contribution that alternative measures can make to the analysis of socio-economic variations in health in claimant households. These issues are illustrated by a British survey of mothers caring for young children on income support. The data point to relative disadvantage within this low-income group and the difficulties of capturing its range and degree within conventional socio-economic measures. Analyses examine the contribution which conventional and alternative indicators of socio-economic position make to predicting the odds of poor health and cigarette smoking among mothers in the survey. We conclude that the use of conventional measures may result in an underestimation of the strength of the association between relative disadvantage, poorer health and smoking behaviour within claimant groups, and that alternative measures need to be developed if the scale and health-impact of disadvantage is to be accurately reflected in surveys of health and lifestyles.     

A Study of Smoking Disparity and Factors Associated With Children Smoking Behavior in the Mountain and City Schools in Taiwan

BACKGROUND:  While higher smoking prevalences have been better described for adults and adolescents in the mountainous areas than in the plain area in Taiwan, no studies have previously examined whether this disparity begins with children in elementary schools. The purpose of this study was thus designed to explore clustering in smoking behavior among elementary school children attending mountain schools compared to those attending city schools.
METHODS:  This study analyzed data obtained by a survey on smoking behavior collected during the School Smoking Survey Project performed in 13 elementary schools of Taoyuan County, Taiwan. Overall, 1585 third and fourth graders (mean age 8.9 years) participated in the study. A multilevel logistic regression analysis was performed to explore the effects of school location on individual smoking behavior among elementary school children while controlling for individual-level characteristics.
RESULTS:  Overall, 34.9% of the elementary school students in the mountain schools reported having tried cigarette smoking compared to only 9.6% of students from city schools. Students attending mountain schools had a greater likelihood of reporting smoking than students attending city schools after controlling for individual-level characteristics (OR = 2.57, 95% CI = 1.10-5.99).
CONCLUSIONS:  A significant individual clustering in smoking behavior was found among third- and fourth-grade children attending mountain schools. The new findings suggest that the adult geographic smoking disparity begins in elementary school. Interventions aimed at reducing smoking disparity in adults need to target elementary schools in high-risk locations.     

Least Explored Factors Associated with Prenatal Smoking

Poor pregnancy and birth outcomes are major problems in the United States, and maternal smoking during pregnancy has been identified as one of the most preventable risk factors associated with these outcomes. This study examines less explored risk factors of smoking among underserved African American pregnant women. A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N = 902) were interviewed at their first prenatal care visit. Survey questions included items related to women’s sociodemographic characteristics as well as their pregnancy history; criminal history; receipt of social services; child protective services involvement; insurance status; and history of substance abuse, domestic violence, and depression. Multiple logistic regression was conducted to calculate odds ratios and 95 % confidence intervals depicting the relationship between these factors and smoking during pregnancy. The analysis reported that maternal age [OR = 1.08, 95 % CI = 1.05–1.12], less than high school education [OR = 4.30, 95 % CI = 2.27–8.14], unemployed [OR = 2.33, 95 % CI = 1.35–4.04], criminal history [OR = 1.66, 95 % CI = 1.05–2.63], receipt of social services [OR = 2.26, 95 % CI = 1.35–3.79] alcohol use [OR = 2.73, 95 % CI = 1.65–4.51] and illicit drug use [OR = 1.97, 95 % CI = 1.04–3.74] during pregnancy were statistically significant risk factors associated with smoking during pregnancy. In addition to the well known risk factors, public health professionals should be aware that criminal history and receipt of social services are important factors associated with smoking during pregnancy. Social service providers such as WIC and prisons and jails may offer a unique opportunity for education and cessation interventions during the preconception or interconception period.     

Teaching Basic Adaptive Skills to Young Children with Disabilities

This article focuses on methods of teaching the basic adaptive skills of toileting and independent eating to young children with disabilities. The early interventionist needs to understand which skills are priorities for the family and involve the family members in their instruction as much as desired. Toileting is a major developmental milestone as it signals independence for the child and less demands on the caregivers. The methods described for teaching toileting skills were: timed toileting, schedule toileting, and the rapid technique. Instruction in self feeding requires a team effort and a knowledge of the sequence of typical development. Methods reviewed for teaching self-feeding were systematic instruction, positioning techniques, and adaptive modifications. Acquisition of self-feeding and toileting skills enables children with special needs to be more independent and facilitates their acceptance in inclusive settings.     

Social Branding to Decrease Smoking Among Young Adults in Bars

Objectives. We evaluated a Social Branding antitobacco intervention for “hipster” young adults that was implemented between 2008 and 2011 in San Diego, California.Methods. We conducted repeated cross-sectional surveys of random samples of young adults going to bars at baseline and over a 3-year follow-up. We used multinomial logistic regression to evaluate changes in daily smoking, nondaily smoking, and binge drinking, controlling for demographic characteristics, alcohol use, advertising receptivity, trend sensitivity, and tobacco-related attitudes.Results. During the intervention, current (past 30 day) smoking decreased from 57% (baseline) to 48% (at follow-up 3; P = .002), and daily smoking decreased from 22% to 15% (P < .001). There were significant interactions between hipster affiliation and alcohol use on smoking. Among hipster binge drinkers, the odds of daily smoking (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.30, 0.63) and nondaily smoking (OR = 0.57; 95% CI = 0.42, 0.77) decreased significantly at follow-up 3. Binge drinking also decreased significantly at follow-up 3 (OR = 0.64; 95% CI = 0.53, 0.78).Conclusions. Social Branding campaigns are a promising strategy to decrease smoking in young adult bar patrons.Tobacco companies1 and public health authorities2–5 recognize young adulthood as a critical time when experimenters either quit or transition to regular tobacco use. Young adults are also aspirational role models for youths.1,6,7 Tobacco companies devote considerable resources to reaching young adults to encourage tobacco use,1,8–11 and young adults have a high prevalence of smoking.12 In California in 2011, young adults had the highest smoking prevalence of any age group, and the Department of Health estimated that 32% of California smokers started smoking between the ages of 18 and 26 years.13 Although they are more likely to intend to quit and successfully quit than older adults,14–17 young adults are less likely to receive assistance with smoking cessation.18,19 Although there are few proven interventions to discourage young adult smoking,20 cessation before age 30 years avoids virtually all of the long-term adverse health effects of smoking.21Tobacco companies have a long history of using bars and nightclubs to reach young adults and to encourage smoking.1,6,9–11,22–24 Bar attendance and exposure to tobacco bar marketing is strongly associated with smoking.25 The 1998 Master Settlement Agreement and Food and Drug Administration regulations that limit tobacco advertising to youths, explicitly permit tobacco marketing in “adult only” venues, including bars and nightclubs.26,27Aggressive tobacco marketing may actually be more intensive in smoke-free bars: a 2010 study of college students attending bars found that students in the community with a smoke-free bar law were more likely to be approached by tobacco marketers, offered free gifts, and to take free gifts for themselves than in communities without a smoke-free bar law.28 Bars and nightclubs also attract young adults who are more likely to exhibit personality traits such as sensation seeking,29 increasing their risk30 independently of receptivity to tobacco advertising; tobacco promotional messages resonate with these personality traits.8,31 Tobacco marketing campaigns are tailored to specific segments of the population defined by psychographics (e.g., values, attitudes, shared interests, such as tastes in music and fashion, and friend groups) and demographic criteria, and they aim to create positive smoker images, identities, and social norms for smoking.1,8 Tobacco marketing campaigns also focus on young adult trendsetters to leverage peer influence to promote smoking.6,10In contrast to the tobacco companies’ efforts, most young adult health interventions take place in colleges or health centers rather than social environments.32–39 Bars and nightclub venues represent an opportunity to reach those at highest risk for long-term smoking morbidity and mortality.40 We evaluated the effectiveness of an intervention to decrease cigarette smoking by countering tobacco industry marketing strategies targeting young adults attending bars and nightclubs in the San Diego, California, “hipster” scene. Because tobacco and alcohol use are strongly linked,41,42 we also examined the effects of the intervention on alcohol use and among binge drinkers. We found a significant decrease in smoking in the community where the intervention took place, including significant decreases among nondaily smokers and binge drinkers, as well as a significant decrease in binge drinking.     

Mothers' Reactions to the Aggressive Play of their Aggressive and Non-Aggressive Young Children: Implications for Caregivers

There is a great deal of concern in child care centers and with parents about both the meaning of aggressive play in young children and how caregivers should respond to it. This article describes a study which measured the differences between the reactions to their children's aggressive play of mothers of aggressive (n = 30) and mothers of non-aggressive (n = 30) young children. Results showed significant differences in the mothers' reactions in the two groups on a number of variables. Mothers of aggressive preschoolers were more likely to stop the aggressive play, to make value judgements and to withdraw when the aggressive play occurred. They were also significantly more likely to make no effort to join in the play or to modulate it if it was escalating or getting out-of-control. Mothers of non-aggressive young children were significantly more likely to join their child in the play, to reflect their child's feelings in the play and to move the child's aggressive play into a more prosocial theme if It became repetitive or very intense. Examples of the play interactions of aggressive children and non-aggressive children are presented. The findings are discussed in light of their significance in terms of the treatment of parents of aggressive young children and optimal responses of childcare providers.     

Environmental Influences Associated with Gambling in Young Adulthood

Social and environmental influences on gambling behavior are important to understand because localities can control the sanction and location of gambling opportunities. This study explores whether neighborhood disadvantage is associated with gambling among predominantly low-income, urban young adults and to explore if we can find differences in physical vs. compositional aspects of the neighborhood. Data are from a sample of 596 young adults interviewed when they were 21–22 years, who have been participating in a longitudinal study since entering first grade in nine public US Mid-Atlantic inner-city schools (88 % African Americans). Data were analyzed via factor analysis and logistic regression models. One third of the sample (n = 187) were past-year gamblers, 42 % of them gambled more than once a week, and 31 % had gambling-related problems. Those living in moderate and high disadvantaged neighborhoods were significantly more likely to be past-year gamblers than those living in low disadvantaged neighborhoods. Those living in high disadvantaged neighborhoods were ten times more likely than those living in low disadvantaged neighborhoods to have gambling problems. Factor analysis yielded a 2-factor model, an “inhabitant disadvantage factor” and a “surroundings disadvantage factor.” Nearly 60 % of the sample lived in neighborhoods with high inhabitants disadvantage (n = 375) or high surroundings disadvantage (n = 356). High inhabitants disadvantage was associated with past-year frequent gambling (odds ratios (aOR) = 2.26 (1.01, 5.02)) and gambling problems (aOR = 2.81 (1.18, 6.69)). Higher neighborhood disadvantage, particularly aspects of the neighborhood concerning the inhabitants, was associated with gambling frequency and problems among young adult gamblers from an urban, low-income setting.     

Factors Associated with HPV Vaccination in Young Males

Human papilloma virus (HPV) affects both men and women; however, recommendations for HPV vaccination among men were not issued in the United States until 2011. The purpose of this study was to describe and compare characteristics of men who did and did not report receiving at least one dose of the HPV vaccine. Data from the ten states that completed the HPV vaccination module in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) were included in the study. Young men ages 18–26 were included (N?=?1624). Categorical variables were compared between those who did and did not receive the HPV vaccine using Chi square. Logistic regression was used to examine the odds of HPV vaccination by the above factors. Only 16.5% of men reported at least one dose of HPV vaccine. Having health insurance, having a primary doctor, and receiving an HIV test were predictive of HPV vaccination. Men in Texas were more likely to report HPV vaccination than all other states. Overall, HPV vaccination is low in men. Targeted interventions for improving HPV vaccination rates in men are warranted, especially for those without health insurance or a routine source of care.     

Factors Associated With Quitting Smoking in Indonesia

Objectives:The aim of this study was to identify factors associated with quitting smoking in Indonesia Methods:Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question “do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?” Logistic regression was performed to identify factors associated with successful attempts to quit smoking. Results:The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables. Conclusions:Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals’ internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.     

Anxiety and Depressive Disorders Are Associated with Smoking in Adolescents with Asthma

PurposeTo evaluate the association between mental health indicators (including meeting criteria for one or more DSM-IV [Diagnostic and Statistical Manual of Mental Disorders—fourth edition] anxiety or depressive disorders) and susceptibility to smoking or current smoking among youth with asthma and to evaluate the impact of smoking on asthma symptoms and self-management.MethodsWe conducted telephone interviews with a population-based sample of 11- to 17-year-old youth and their parents (n = 769). Interview content included questions on smoking behaviors, asthma symptoms and treatment, externalizing behavior, and a structured psychiatric interview to assess DSM-IV anxiety and depressive disorders.ResultsFive percent of youth were smokers and 10.6% indicated that they were “susceptible to smoking.” Smoking was more common among youth with mental health disorders. Anxiety/depressive disorders were present in 14.5% of nonsmokers, 19.8% of susceptible nonsmokers, and 37.8% of smokers. After controlling for important covariates, youth with more than one anxiety and depressive disorder were at over twofold increased risk for being a smoker. Similarly, for each one-point increase in externalizing disorder symptoms, youth had a 10% increase in likelihood of being a smoker and a 4% increase in risk for “susceptibility to smoking.” Youth who were smokers reported more asthma symptoms, reduced functioning due to asthma, less use of controller medicines, and more use of rescue medications.ConclusionsComorbid mental health disorders are associated with increased risk of smoking in youth with asthma. Smoking is associated with increased asthma symptom burden and decreased controller medication use. Interventions for youth with asthma should consider screening for and targeting these behavioral concerns.