Women’s Lifelong Exposure to Neighborhood Poverty and Low Birth Weight: A Population-Based Study

Objective To determine whether women’s lifelong residential environment is associated with infant low birth weight. Methods We performed race-specific stratified and multivariate binomial regression analyses on an Illinois vital record dataset of non-Latino White and African-American infants (1989–1991) and their mothers (1956–1975) with appended United States census income information. Results Non-Latino White women (N = 267) with a lifelong residence in low-income neighborhoods had a low birth weight (<2,500 g) incidence of 10.1% vs. 5.1% for White women (N = 10,647) with a lifelong residence in high-income neighborhoods; RR = 2.0 (1.4–2.9). African-American women (N = 18,297) with a lifelong residence in low-income neighborhoods had a low birth weight incidence of 17% vs. 11.7% for African-American women (N = 546) with a lifelong residence in high-income areas; RR = 1.5 (1.2–1.8). The adjusted population attributable risk (PAR) percent of LBW for lifelong residence in low-income neighborhoods was 1.6% for non-Latino White and 23.6% for African-American women. Conclusions Non-Latino White and African-American women’s lifelong residence in low-income neighborhoods is a risk factor for LBW; however, African-Americans experience a greater public health burden from this phenomenon.     

A Longitudinal Cohort Study of Body Mass Index and Childhood Exposure to Secondhand Tobacco Smoke and Air Pollution: The Southern California Children’s Health Study

Background:

Childhood body mass index (BMI) and obesity prevalence have been associated with exposure to secondhand smoke (SHS), maternal smoking during pregnancy, and vehicular air pollution. There has been little previous study of joint BMI effects of air pollution and tobacco smoke exposure.

Methods:

Information on exposure to SHS and maternal smoking during pregnancy was collected on 3,318 participants at enrollment into the Southern California Children’s Health Study. At study entry at average age of 10 years, residential near-roadway pollution exposure (NRP) was estimated based on a line source dispersion model accounting for traffic volume, proximity, and meteorology. Lifetime exposure to tobacco smoke was assessed by parent questionnaire. Associations with subsequent BMI growth trajectory based on annual measurements and attained BMI at 18 years of age were assessed using a multilevel modeling strategy.

Results:

Maternal smoking during pregnancy was associated with estimated BMI growth over 8-year follow-up (0.72 kg/m² higher; 95% CI: 0.14, 1.31) and attained BMI (1.14 kg/m² higher; 95% CI: 0.66, 1.62). SHS exposure before enrollment was positively associated with BMI growth (0.81 kg/m² higher; 95% CI: 0.36, 1.27) and attained BMI (1.23 kg/m² higher; 95% CI: 0.86, 1.61). Growth and attained BMI increased with more smokers in the home. Compared with children without a history of SHS and NRP below the median, attained BMI was 0.80 kg/m² higher (95% CI: 0.27, 1.32) with exposure to high NRP without SHS; 0.85 kg/m² higher (95% CI: 0.43, 1.28) with low NRP and a history of SHS; and 2.15 kg/m² higher (95% CI: 1.52, 2.77) with high NRP and a history of SHS (interaction p-value 0.007). These results suggest a synergistic effect.

Conclusions:

Our findings strengthen emerging evidence that exposure to tobacco smoke and NRP contribute to development of childhood obesity and suggest that combined exposures may have synergistic effects.

Citation:

McConnell R, Shen E, Gilliland FD, Jerrett M, Wolch J, Chang CC, Lurmann F, Berhane K. 2015. A longitudinal cohort study of body mass index and childhood exposure to secondhand tobacco smoke and air pollution: the Southern California Children’s Health Study. Environ Health Perspect 123:360–366; http://dx.doi.org/10.1289/ehp.1307031     

Lead Content and Exposure from Children’s and Adult’s Jewelry Products

No abstract available.     

Non-Hispanic White Women’s Exposure to Decreased Neighborhood Income and Small for Gestational Age Births: A Population-Based Study

Maternal and Child Health Journal - The relationship between non-Hispanic White (NHW) women’s decreased neighborhood income between early-life and adulthood, individual risk-status at...     

The Impact of Perinatal Depression on Children’s Social-Emotional Development: A Longitudinal Study

Maternal and Child Health Journal - Objectives This longitudinal population study aimed to investigate if maternal depression at different time points during the perinatal period impacts...     

Exploring Children’s Perceptions of Two School-Based Social Inclusion Programs: A Pilot Study

Background

Although social exclusion among typically developing school-aged children has been well explored, it is under-researched for children with disabilities even though they are at a higher risk for being excluded. While there are a number of different programs available to improve social inclusion at school, the appeal of these programs to children remains unknown.

Objective

The objective of this pilot study was to elicit children’s perceptions of the desirable components of two commonly used social inclusion programs in Ontario, Canada.

Methods

An exploratory mixed methods design (group discussion, observation notes, and a brief questionnaire) was used to provide an in-depth understanding of children’s perceptions of two social inclusion programs: A group-based game (n = 87) and a puppet show (n = 78).

Results

Children in each program reported that several aspects of the content appealed to them including learning about (1) bullying; (2) disability; (3) building friendships and encouraging social inclusion; (4) preventing social exclusion. The desirable aspects related to the format of the game and puppet show included (1) the interactive components; (2) the relevant topics and characters; (3) the length of the programs.

Conclusions

Children’s insights about social inclusion programs should be considered in development and improvements of future programs.     

What Factors Influence States’ Capacity to Report Children’s Health Care Quality Measures? A Multiple-Case Study

Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services’ (CMS) core set of children’s health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin’s multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state’s Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.     

The NYU Children’s Health and Environment Study

European Journal of Epidemiology - The aims of the NYU Children’s Health and Environment Study (CHES) are to evaluate influences of prenatal non-persistent chemical exposures on fetal and...     

Severe Housing-Cost Burden and Low-Income Young Children’s Exposure to Adverse Experiences: A Cross-Sectional Survey of WIC Participants in Los Angeles County

Maternal and Child Health Journal - Substantial literature has documented adverse childhood experiences’ (ACEs) link with poor health in childhood and adulthood. Despite many American...     

Hispanic Parents of Overweight and Obese Children and Their Outcome Expectations for Children’s Television Viewing: A Qualitative Study

ObjectiveExplore parental outcome expectations (OE) regarding children’s television (TV) viewing among parents of overweight or obese children.MethodsQualitative study using semi-structured interviews with 20 parents of 5- to 8-year-old overweight or obese children.ResultsParent’s positive OE for allowing TV viewing were the convenience of using TV for entertainment or as a babysitter. Hispanic parents would limit children’s TV viewing to improve their children’s health, restrict content, and promote other activities. Negative OE such as children misbehavior and the loss of positive OE for allowing TV emerged as reasons parents may not limit TV.Conclusions and ImplicationsAlthough Hispanic parents expected to improve their child’s health by limiting TV, the negative OE may prevent them from doing so. Interventions targeting children’s TV viewing, as a strategy to fight childhood obesity, may be more effective if they promote parent’s positive OE and address parent’s negative OE for children’s TV viewing.     

Occupational Exposure to Benzene and Non-Hodgkin Lymphoma in a Population-Based Cohort: The Shanghai Women’s Health Study

Background

The association between benzene exposure and non-Hodgkin lymphoma (NHL) has been the subject of debate as a result of inconsistent epidemiologic evidence. An International Agency for Research on Cancer (IARC) working group evaluated benzene in 2009 and noted evidence for a positive association between benzene exposure and NHL risk.

Objective

We evaluated the association between occupational benzene exposure and NHL among 73,087 women enrolled in the prospective population-based Shanghai Women’s Health Study.

Methods

Benzene exposure estimates were derived using a previously developed exposure assessment framework that combined ordinal job-exposure matrix intensity ratings with quantitative benzene exposure measurements from an inspection database of Shanghai factories collected between 1954 and 2000. Associations between benzene exposure metrics and NHL (n = 102 cases) were assessed using Cox proportional hazard models, with study follow-up occurring from December 1996 through December 2009.

Results

Women ever exposed to benzene had a significantly higher risk of NHL [hazard ratio (HR) = 1.87, 95% CI: 1.19, 2.96]. Compared with unexposed women, significant trends in NHL risk were observed for increasing years of benzene exposure (p_trend = 0.006) and increasing cumulative exposure levels (p_trend = 0.005), with the highest duration and cumulative exposure tertiles having a significantly higher association with NHL (HR = 2.07, 95% CI: 1.07, 4.01 and HR = 2.16, 95% CI: 1.17, 3.98, respectively).

Conclusions

Our findings, using a population-based prospective cohort of women with diverse occupational histories, provide additional evidence that occupational exposure to benzene is associated with NHL risk.

Citation

Bassig BA, Friesen MC, Vermeulen R, Shu XO, Purdue MP, Stewart PA, Xiang YB, Chow WH, Zheng T, Ji BT, Yang G, Linet MS, Hu W, Zhang H, Zheng W, Gao YT, Rothman N, Lan Q. 2015. Occupational exposure to benzene and non-Hodgkin lymphoma in a population-based cohort: the Shanghai Women’s Health Study. Environ Health Perspect 123:971–977; http://dx.doi.org/10.1289/ehp.1408307     

The Texas Children’s Hospital Immunization Forecaster: Conceptualization to Implementation

Objectives. Immunization forecasting systems evaluate patient vaccination histories and recommend the dates and vaccines that should be administered. We described the conceptualization, development, implementation, and distribution of a novel immunization forecaster, the Texas Children’s Hospital (TCH) Forecaster.Methods. In 2007, TCH convened an internal expert team that included a pediatrician, immunization nurse, software engineer, and immunization subject matter experts to develop the TCH Forecaster. Our team developed the design of the model, wrote the software, populated the Excel tables, integrated the software, and tested the Forecaster. We created a table of rules that contained each vaccine’s recommendations, minimum ages and intervals, and contraindications, which served as the basis for the TCH Forecaster.Results. We created 15 vaccine tables that incorporated 79 unique dose states and 84 vaccine types to operationalize the entire United States recommended immunization schedule. The TCH Forecaster was implemented throughout the TCH system, the Indian Health Service, and the Virginia Department of Health. The TCH Forecast Tester is currently being used nationally.Conclusions. Immunization forecasting systems might positively affect adherence to vaccine recommendations. Efforts to support health care provider utilization of immunization forecasting systems and to evaluate their impact on patient care are needed.Vaccines are widely cited as one of public health’s greatest successes,1 and are estimated to have prevented 42 000 deaths and 20 million disease episodes in the United States in 2009, saving an associated $13.5 billion in direct costs and $68.8 billion in societal costs.2 Timely receipt of vaccines effectively protects children against vaccine-preventable diseases and reduces disease outbreaks.3 Because of these life-saving benefits, vaccines are routinely recommended throughout an individual’s lifetime, with most administered during infancy and early childhood. In the United States, vaccine recommendations are developed by The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts selected by the US Department of Health and Human Services.4 The resulting recommendations are approved and published by the Centers for Disease Control and Prevention (CDC), and are subsequently endorsed by many professional organizations, including the American Academy of Pediatrics, the American Academy of Family Practitioners, and the Pediatric Infectious Disease Society. These recommendations are updated annually.Current vaccine recommendations are complex and require that health care providers consider the child’s age, all relevant precautions and contraindications to vaccination, vaccines that have been previously administered, and the time that has elapsed since the last dose of a specific vaccine was administered. The 2014 US immunization schedule recommends up to 54 doses of vaccine (depending on combination of vaccines utilized) against 16 diseases by age 18 years, with up to 28 doses recommended for routine administration during the first 2 years of life.5 Given this complexity, automated systems that interpret vaccine recommendations in the context of each child’s vaccine history are extremely helpful to health care providers.The advent of electronic health technology, particularly electronic health record (EHR) systems and immunization information systems, has greatly enhanced health care providers’ ability to accurately evaluate their patients’ vaccination histories, and therefore, follow ACIP vaccine recommendations. Both the American Recovery and Reinvestment Act and Healthy People 2020 include provisions that support the meaningful use of EHR systems.6 The Health Information Technology for Economic and Clinical Health Act is included in the American Recovery and Reinvestment Act and outlines objectives to improve health care systems nationally through interoperability and exchange of data among EHR systems.7 Implementation of EHR systems in accordance with meaningful use standards has the added benefit of incentive payments to health care providers and hospitals. These standards continue to be implemented in several phases; the third and last phase is still under development and implementation is scheduled to occur by 2017. One such provision (SGRP 401B) included in stage 3 of meaningful use is directly applicable to vaccine recommendations and specifies that health care providers should have the “capability to receive, generate or access appropriate age-, gender- and immunization history-based recommendations” through the implementation of “an immunization recommendation system that establishes baseline recommendations and allows for local/state variations.”8 These systems are referred to as immunization forecasters.Clinical decision support systems, which are commonly referred to as immunization forecasting systems, utilize information technology to provide health care providers with patient-specific information to improve and enhance clinical care.9 Immunization forecasters employ software algorithms to assess patient vaccination status and recommend the dates and vaccines that should be administered. Immunization forecasting systems operationalize ACIP vaccine recommendations and ensure that accurate and consistent vaccine administration practices are followed. Widespread adoption of immunization forecasting systems has the potential to increase health care provider adherence to ACIP vaccine recommendations in a standardized manner, reduce missed opportunities, and prevent outbreaks of disease associated with underimmunization.10Recognizing the clinical need for a forecasting system and the absence of nationally available, affordable products, a team of experts at Texas Children’s Hospital (TCH) developed an immunization forecasting system that can be used for patients treated within the TCH system and beyond. We describe the conceptualization, development, implementation, and distribution of the TCH Forecaster.     

The Impact of Tobacco Control Policies on Disparities in Children’s Secondhand Smoke Exposure: A Comparison of Methods

To examine the impact of cigarette excise taxes and smoke-free legislation on tobacco use among households with school-age children and adolescents as well as disparities in children’s secondhand smoke exposure. We compare the results from models using causal inference techniques to those from cross-sectional models. We linked families of 6–17-year-olds from the 2003 (N = 67,607) and 2007 (N = 62,768) contacts of the National Survey of Children’s Health with state-level cigarette excise taxes and smoke-free legislation total score (0 [none]–32 [very strong]) in 2001 and 2005. Parents reported whether anyone in the household used tobacco products. In adjusted causal inference models every $1.00 increase in cigarette excise tax between 2001 and 2005 was associated with a 4 percentage point decrease in household tobacco use between 2003 and 2007 (p = 0.008); however, there was no effect of smoke-free legislation on household tobacco use. Significant interactions revealed that cigarette tax increases were only associated with reductions in household tobacco use for parents of white children and, separately, lower income households. In contrast, in adjusted cross-sectional models, a higher smoke-free legislation total score was associated with a lower prevalence of household tobacco use. Stronger cigarette excise taxes decrease tobacco use among households with school-age children and adolescents, but smoke-free legislation at the state level does not change parental smoking. Since cross-sectional models cannot assess the direction of causality, evaluations should employ causal inference methods to help inform policy decisions to reduce disparities in adult smoking and, ultimately, protect children from secondhand smoke.     

Prenatal Exposure to Airborne Polycyclic Aromatic Hydrocarbons and Children’s Intelligence at 5 Years of Age in a Prospective Cohort Study in Poland

Background

In this prospective cohort study of Caucasian mothers and children in Krakow, Poland, we evaluated the role of prenatal exposure to urban air pollutants in the pathogenesis of neurobehavioral disorders.

Objectives

The objective of this study was to investigate the relationship between prenatal polycyclic aromatic hydrocarbon (PAH) exposure and child intelligence at 5 years of age, controlling for potential confounders suspected to play a role in neurodevelopment.

Methods

A cohort of pregnant, healthy, nonsmoking women was enrolled in Krakow, Poland, between 2001 and 2006. During pregnancy, participants were invited to complete a questionnaire and undergo 48-hr personal air monitoring to estimate their babies’ exposure, and to provide a blood sample and/or a cord blood sample at the time of delivery. Two hundred fourteen children were followed through 5 years of age, when their nonverbal reasoning ability was assessed using the Raven Coloured Progressive Matrices (RCPM).

Results

We found that higher (above the median of 17.96 ng/m³) prenatal exposure to airborne PAHs (range, 1.8–272.2 ng/m³) was associated with decreased RCPM scores at 5 years of age, after adjusting for potential confounding variables (n = 214). Further adjusting for maternal intelligence, lead, or dietary PAHs did not alter this association. The reduction in RCPM score associated with high airborne PAH exposure corresponded to an estimated average decrease of 3.8 IQ points.

Conclusions

These results suggest that prenatal exposure to airborne PAHs adversely affects children’s cognitive development by 5 years of age, with potential implications for school performance. They are consistent with a recent finding in a parallel cohort in New York City.     

Media Impacts on Women’s Fertility Desires: A Prolonged Exposure Experiment

Media exposure may have implications for family planning, a public health issue of key importance. Drawing on social comparison theory and social identity theory, a prolonged exposure experiment examined whether media portrayals of women’s social roles affect fertility desires among 166 American, nonstudent, never married, childless women ages 21–35 years old. After sign-up and baseline sessions, participants viewed magazine pages five days in a row. Stimuli presented women in either mother/homemaker roles, beauty ideal roles, or professional roles. Three days later, participants again indicated their number of desired children and time planned until first birth. Exposure to mother/homemaker and beauty ideal portrayals increased the number of desired children across time. Exposure to professional portrayals increased the time planned until 1st birth compared to beauty ideal portrayals—this impact was partially mediated by a shift toward more progressive gender norms (per social identity theory) and assimilation (per social comparison theory).     

Parental Depressive Symptoms and Children’s School Attendance and Emergency Department Use: A Nationally Representative Study

We sought to assess the association between parental depressive symptoms and school attendance and emergency department (ED) use among children with and without chronic health conditions. Secondary analysis of the 1997–2004 National Health Interview Survey, a nationally representative survey. Parental depressive symptoms were measured by three questions assessing sadness, hopelessness, or worthlessness in the past month. Children with and without asthma or attention-deficit/hyperactivity disorder (ADHD) were identified, and their school attendance and ED visits were reported by adult household respondents. Children with information on parental depressive symptoms, health conditions, and services use were eligible. We incorporated weights available in the survey for each eligible child to reflect the complex sampling design. 104,930 eligible children were identified. The point prevalence of parental depressive symptoms was low (1.8 %, 95 % CI 1.7–2.0), but greater among children with asthma (2.7 %, 95 % CI 2.4–3.0) and ADHD (3.8 %, 95 % CI 3.2–4.4) than among other children (1.6 %, 95 % CI 1.5–1.7). After adjustment for potential confounders, children whose parents reported depressive symptoms most or all of the time were more likely to report an ED visit (adjusted incident rate ratio [IRR] 1.18, 95 % CI 1.06–1.32) or school absence (adjusted IRR 1.36, 95 % CI 1.14–1.63) than children whose parents did not. The effect of parental depressive symptoms was not modified by child health conditions. Parental depressive symptoms were adversely associated with school attendance and ED use in children. These results suggest the importance of measuring depressive symptoms among adult caregivers of children.     

Changes in Dietary Intake in Pregnant Women from Periconception to Pregnancy in the Japan Environment and Children’s Study: A Nationwide Japanese Birth Cohort Study

Maternal and Child Health Journal - Nutritional requirements increase during pregnancy. However, relatively few studies have examined longitudinal changes in dietary intake from periconception to...     

COVID-19 and Children’s Well-Being: A Rapid Research Agenda

Maternal and Child Health Journal - Understanding the full impact of COVID-19 on U.S. children, families, and communities is critical to (a) document the scope of the problem, (b) identify...     

Influence of Friends on Children’s Physical Activity: A Review

We examined evidence for friendship influences on children''s physical activity (PA) through systematic searches of online databases in May 2012. We identified 106 studies (25 qualitative) published in English since 2000 that analyzed indicators of friendship influences (e.g., communication about PA, friends’ PA, and PA with friends) among persons younger than 19 years.Children''s PA was positively associated with encouragement from friends (43 of 55 studies indicating a positive relationship), friends'' own PA (30/35), and engagement with friends in PA (9/10). These findings are consistent with friends influencing PA, but most studies did not isolate influence from other factors that could explain similarity.Understanding friendship influences in childhood can facilitate the promotion of lifelong healthy habits. PA with friends should be considered in health promotion programs.Extensive research has linked physical activity to health and inactivity to poor health, especially to obesity and other cardiometabolic problems such as diabetes and cardiovascular disease.1–3 Increases in overweight, obesity, diabetes, and metabolic syndrome among children and adolescents over the past few decades4–7 have stimulated a surge of research into possible contributing factors, including insufficient physical activity.8–10In spite of its health benefits, physical activity is declining around the world.11 In the United States, levels of physical activity in children and adolescents are not sufficient to promote optimal health.12 The Centers for Disease Control and Prevention recommends that children and adolescents be active for at least 60 minutes per day, but in 2009, only 18.4% of adolescents reported this much physical activity and 23.1% of adolescents reported not participating in 60 minutes of physical activity on any day.13,14A factor that may affect health behaviors that has received increasing attention in recent years is social influence. Research has suggested that family, friends, and peers can guide behaviors such as smoking, sexual initiation, and eating behaviors.15–19 Influences from these close contacts can occur through social pressure, social modeling and imitation, social comparison, and behavior approximation.20 However, not all social relations are equally important: the closer and stronger the connection, the broader and stronger the possibilities for influence.21,22 Information transmitted from friends is generally more clearly understood and more likely to be internalized than is information from others, meaning that friends may be more influential than other social contacts,23–26 such as cliques and peer groups.24,27,28Although social influences on physical activity can occur throughout life, they are particularly important to study in children and adolescents, for several reasons. First, childhood and adolescence are a formative period when friends are a primary point of reference29,30 in deciding which behaviors, values, and attitudes are desirable and which activities warrant effort.31–34 Friends have been shown to affect timing of first sexual intercourse, drug use, delinquency, and educational attainment among adolescents.31,32,35–42 Second, physical activity tracks across life: activity levels during adolescence predict adult levels, and active children and adolescents are more likely to become active adults.43 Third, physical activity often decreases during adolescence, so children and adolescents may be the most important age groups to target for interventions to establish lifelong activity levels.44 Finally, the development of successful interventions to increase physical activity in children and adolescents requires an understanding of the unique determinants of physical activity at these ages.Quantifying the extent to which friends can promote or discourage physical activity is critical for understanding why physical activity levels are decreasing and for developing strategies to promote active lifestyles. We reviewed the literature to determine the role of friends in shaping physical activity among children and adolescents.