Accumulated exposure to rural areas of residence over the life course is associated with overweight and obesity in adulthood: a 25-year prospective cohort study

PurposeThis prospective cohort study investigated whether body mass index (BMI) and weight status in mid-adulthood were predicted by trajectories of urban-rural residence from childhood to adulthood.MethodsParticipants aged 7–15 years in 1985 (n = 8498) were followed up in 2004–2006 (n = 3999, aged 26–36 years) and 2009–2011 (n = 3049, aged 31–41 years). Area of residence (AOR) was classified as urban or rural at each time point. BMI and/or weight status was calculated from self-reported weight and height (2009–2011). We tested which of three life-course models (“accumulation,” “sensitive period,” “mobility”) best explained the AOR-BMI and/or weight status association using a novel life-course modeling framework.ResultsAccumulation and sensitive period models best described the effect of AOR on mid-adulthood BMI and weight status. Those with greater accumulated exposure to rural areas had a higher BMI (β = 0.29 kg/m² per time in a rural area, P = .005) and were more likely obese (relative risk = 1.13 per time in a rural area, P = .002). Living in rural areas at ages 26–30 years was also associated with a higher BMI and obesity in mid-adulthood.ConclusionsGreater cumulative exposure to rurality and exposure during the “sensitive period” of young adulthood is associated with obesity in middle-aged adults. This study highlights the important contribution of context to the development of obesity over the life course.     

Family functioning as a mediator between neighborhood conditions and children's health: evidence from a national survey in the United States

This study examines whether the associations between neighborhood conditions and children's health can be indirect and operate through aspects of family functioning. We use data from the 2007 National Survey of Children's Health in the United States with the interviewed parents/guardians as the only source of the data. Our study sample includes 53,023 children aged between 6 and 17 years. Using structural equation modeling, we test both direct and indirect relationships between a family functioning index, a general indicator of children's health status, and three neighborhood factors: neighborhood physical resources, environmental threats, and collective efficacy. Covariates in the analysis include gender, age, income, race, family structure, parental education, and health insurance coverage. All the three neighborhood factors show direct associations with children's general health status, as well as indirect associations mediated by aspects of family functioning. Among the three neighborhood factors, collective efficacy and environmental threats are found to have much stronger associations with children's general health than physical resources. When designing health-promoting neighborhoods for children and families, it may be more efficient for urban planners and health professionals to focus on community programs that reduce environmental stressors and foster neighborhood cohesion than programs that solely improve physical infrastructure. This study also verifies that aspects of family functioning mediate the associations between neighborhood conditions and children's health. It is recommended that both family and neighborhood are critical points for child health intervention.     

Socioeconomic pathways to depressive symptoms in adulthood: evidence from the National Longitudinal Survey of Youth 1979

The existence of a direct effect of early socioeconomic position (SEP) on adult mental health outcomes net of adult SEP is still debated. This question demands the explicit modeling of pathways linking early SEP to adult SEP and mental health. In light of this background, we pursue two objectives in this study. First, we examine whether depressive symptoms in adulthood can be fit in a trajectory featuring both an intercept, or baseline range of depressive symptoms that varied between individuals, and a slope describing the average evolution of depressive symptoms over the years. Second, we estimate the direct and indirect pathways linking early SEP, respondents' education and adult household income, with a particular focus on whether early SEP retains a significant direct effect on the trajectory of depressive symptoms once adult SEP is entered into the pathway model. Drawing from 29 years of cohort data from the National Longitudinal Survey of Youth 1979, a survey that has been following a national probability sample of American civilian and military youth (Zagorsky and White, 1999), we used structural equation models to estimate the pathways between parents' education, respondent's education, and latent growth curves of household income and depressive symptoms. We found that the effect of parents' education was entirely mediated by respondent's education. In turn, the effect of respondent's education was largely mediated by household income. In conclusion, our findings showed that the socioeconomic attainment process that is rooted in parents' education and leads to respondent's education and then to household income is a crucial pathway for adult mental health. These results suggest that increasing educational opportunities may be an effective policy to break the intergenerational transmission of low socioeconomic status and poor mental health.     

Use of the youth risk behavior survey to monitor trends for nutrition and physical activity in a Midwest city school district

BACKGROUND: The Youth Risk Behavior Survey (YRBS) was used by a city school district (approximately 11,000 students) in the upper Midwest to monitor trends for nutrition and physical activity (PA) behaviors both within and between years and to compare with national 2003 data. METHODS: Independent random samples were obtained in 1999 (387 middle school [MS] and 931 high school [HS]), in 2001 (322 MS and 367 HS), and in 2003 (658 MS and 1026 HS). A two-sample test of proportions was used. RESULTS: Within each survey year, a higher proportion of MS compared to HS reported positive behaviors with some exceptions: (1) an increased proportion of HS having daily physical education (PE) and (2) a reduced proportion of HS reporting media time. Within 2003, a lower proportion of district females compared to males (MS and HS) reported participation in many measured behaviors. District trends overtime indicated a reduced proportion: (1) drinking milk (MS and HS), (2) eating breakfast (HS), and (3) watching television (MS). Trends overtime indicated an increased proportion: (1) using computers for fun (MS and HS), (2) participating in moderate PA (MS), and (3) daily PE (HS). District HS compared to national (2003) indicated a higher proportion: (1) drinking milk, (2) getting moderate PA, and (3) taking daily PE. District HS compared to national indicated a lower proportion: (1) at risk of overweight, (2) overweight, and (3) watching television. CONCLUSIONS: Analysis of district YRBS trends provides both a database for informed decisions by the school district and an assessment model for other districts.     

Time-course of adiposity and fasting insulin from childhood to young adulthood in offspring of parents with coronary artery disease: the Bogalusa Heart Study

PURPOSE: Obesity and the attendant insulin resistance/hyperinsulinemia related to coronary artery disease (CAD) morbidity and mortality are well documented. However, information is lacking on the time-course relation of adiposity and fasting insulin from childhood to young adulthood in offspring of parents with CAD, a surrogate measure of future risk.

METHODS: Longitudinal analysis was performed on data collected from the Bogalusa Heart Study cohort with (n = 271) and without (n = 805) a parental history of CAD followed since childhood by repeated surveys from 1973 to 1991.

RESULTS: Lowess smoothing and multivariate analyses using Generalized Estimating Equations revealed that body mass index, triceps, and subscapular skinfolds were consistently higher from childhood to adulthood in offspring of parents with CAD history. Insulin levels during childhood and adolescence were lower in the offspring with affected parents. On the other hand, higher levels of fasting insulin from offspring were associated with positive parental history of CAD after age 20 and this association remained significant even after adjusting for body mass index. There was no significant interaction with race or sex in these relationships.

CONCLUSION: These results indicate that the offspring at high risk for CAD develop excess body fatness beginning in childhood and then later manifest hyperinsulinemia in young adulthood. These observations have important implications for prevention.     

A transition in health status from childhood to adulthood and associated lifestyle risk factors: a 13-year interval follow-up study in South Africa

South Africa is a developing country that also has developed aspects and as a result, has to cope with issues related to both worlds. There has been a definite change in the global patterns of diseases from a situation dominated by infectious diseases to a predominance of non-communicable diseases where the risk factors are largely associated with lifestyle. Results from a follow-up study were used to investigate a transition in health status of the study sample. Questionnaires were used in this historical cohort study, which reviews the health status and lifestyle aspects of young adults who participated as children in the Vaal Triangle Air Pollution Health Study (VAPS) during 1990. In general, the study sample had a higher prevalence of chronic diseases compared to the general South African population. Findings indicate that the transition in health status recorded elsewhere in the world can be demonstrated in this South African group.     

"There is such a thing as too many daughters, but not too many sons": A qualitative study of son preference and fetal sex selection among Indian immigrants in the United States

In response to concerns from feminists, demographers, bioethicists, journalists, and health care professionals, the Indian government passed legislation in 1994 and 2003 prohibiting the use of sex selection technology and sex-selective abortion. In contrast, South Asian families immigrating to the United States find themselves in an environment where reproductive choice is protected by law and technologies enabling sex selection are readily available. Yet there has been little research exploring immigrant Indian women's narratives about the pressure they face to have sons, the process of deciding to utilize sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. We undertook semi-structured, in-depth interviews with 65 immigrant Indian women in the United States who had pursued fetal sex selection on the East and West coasts of the United States between September 2004 and December 2009. Women spoke of son preference and sex selection as separate though intimately related phenomena, and the major themes that arose during interviews included the sociocultural roots of son preference; women's early socialization around the importance of sons; the different forms of pressure to have sons that women experienced from female in-laws and husbands; the spectrum of verbal and physical abuse that women faced when they did not have male children and/or when they found out they were carrying a female fetus; and the ambivalence with which women regarded their own experience of reproductive "choice." We found that 40% of the women interviewed had terminated prior pregnancies with female fetuses and that 89% of women carrying female fetuses in their current pregnancy pursued an abortion. These narratives highlight the interaction between medical technology and the perpetuation of this specific form of violence against women in an immigrant context where women are both the assumed beneficiaries of reproductive choice while remaining highly vulnerable to family violence and reproductive coercion.     

Use of measles supplemental immunization activities (SIAs) as a delivery platform for other maternal and child health interventions: Opportunities and challenges

Measles supplementary immunization activities (SIAs) offer children in countries with weaker immunization delivery systems like India a second opportunity for measles vaccination. They could also provide a platform to deliver additional interventions, but the feasibility and acceptability of including add-ons is uncertain. We surveyed Indian programme officers involved in the current (2010–2012) measles SIAs concerning opportunities and challenges of using SIAs as a delivery platform for other maternal and child health interventions. Respondents felt that an expanded SIA strategy including add-ons could be of great value in improving access and efficiency. They viewed management challenges, logistics, and safety as the most important potential barriers. They proposed that additional interventions be selected using several criteria, of which importance of the health problem, safety, and contribution to health equity figured most prominently. For children, they recommended inclusion of basic interventions to address nutritional deficiencies, diarrhoea and parasites over vaccines. For mothers, micronutrient interventions were highest ranked.