Introduction to the special issue: pediatric overweight.
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Adolescent↗
Biomedical subjects
Maureen M Black
Publications and source records attributed to Maureen M Black.
Agreement with satisfaction in adolescent body size between female caregivers and teens from a low-income African-American community.
OBJECTIVE: To describe body size satisfaction and agreement among low-income, urban, African-American adolescents, and female caregivers. METHODS: Two hundred and fifteen adolescent-caregiver pairs completed measures of demographics, anthropometrics, and body size satisfaction. RESULTS: Adolescent-caregiver agreement on body size satisfaction varied by body mass index (BMI) category. Among normal weight adolescents, 61% of adolescent-caregivers agreed that current body size was ideal. Among adolescents at risk for overweight, 38% of adolescent-caregivers agreed that current body size was ideal, and 38% were discordant with adolescents wanting to be thinner and caregivers satisfied with current body size. Among overweight adolescents, adolescent-caregiver agreement was 67%; 52% agreed the adolescent should be thinner and 15% agreed current body size was ideal. CONCLUSIONS: Body size satisfaction is related to BMI category for adolescents and caregivers, but adolescents have a lower threshold. Encouraging caregivers to elicit their adolescents' views on body size satisfaction may enable caregivers to support their adolescents in addressing weight-related issues.
Adolescent↗
Effect of early childhood adversity on child health.
OBJECTIVE: To examine the effect of child abuse and other household dysfunction on child health outcomes. DESIGN: Data from the Longitudinal Studies of Child Abuse and Neglect collected through interviews and questionnaires administered when target children were 4 years old and 6 years old. SETTING: Children in the South, East, Midwest, Northwest, and Southwest United States. PARTICIPANTS: One thousand forty-one children at high risk for child abuse and neglect (3 cohorts derived primarily from among children recruited through social service mechanisms, 1 cohort recruited at birth from among high-risk infants, and 1 cohort recruited from a medical setting). MAIN OUTCOME MEASURES: (1) Association of 7 adverse exposures (3 categories of child abuse [physical abuse, sexual abuse, and psychological maltreatment] and 4 categories of household dysfunction [caregiver problem drinking, caregiver depression, caregiver treated violently, and criminal behavior in the household]) derived from data collected when the child was 4 years old. (2) Indexes of child physical health at age 6 years (caregiver overall assessment of child health and reports of illness requiring medical attention). RESULTS: Two thirds of the sample had experienced at least 1 adverse exposure. One adverse exposure almost doubled the risk of overall poor health (odds ratio, 1.89; 95% confidence interval, 1.02-3.48), and 4 adverse exposures or more almost tripled the risk of illness requiring medical attention (odds ratio, 2.83; 95% confidence interval, 1.10-7.31). CONCLUSION: Adverse environmental exposures, including child abuse and other household dysfunction, are associated with poor child health even at an early age, although our data do not support a dose-response relationship.
Alcoholism↗
Overweight adolescent African-American mothers gain weight in spite of intentions to lose weight.
OBJECTIVE: This study sought to determine how dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were associated with body size among adolescent African-American mothers 1 year after delivery and with changes in body size over the next year. DESIGN: Cross-sectional and longitudinal self-reported measures were collected 1 year after delivery. Weight and height were collected 1 and 2 years after delivery. SUBJECTS: The subjects were 118 low-income, African-American adolescent mothers recruited after the birth of their first child. STATISTICAL ANALYSES: Multivariate analysis of covariance and multivariate regression analysis were conducted to examine predictors of body size 1 year after delivery and changes in body size over the next year. Analyses were adjusted for maternal age, education, breastfeeding history, and intervention. RESULTS: One year after delivery, 33.0% of mothers were overweight (body mass index [BMI] > or =95th percentile) and 23.7% were at risk for overweight (BMI > or =85th and <95th percentile). Mothers consumed a daily average of 2,527 kcal and 4.1 high-fat snacks. A total of 11% of normal-weight mothers, 22% of mothers at risk for overweight, and 44% of overweight mothers reported intention to lose weight, chi(2)=10.8, P<.01. Average maternal BMI z score increased 0.13 (3.9 kg) between 1 and 2 years after delivery, P<.01. Dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were not related to body size or increase in body size. CONCLUSIONS: One year after delivery, overweight among adolescent mothers was common and increased over time. Although nearly half of overweight mothers reported an intention to lose weight, their weight gain did not differ from that of other mothers, suggesting that they lack effective weight-loss behaviors, and may be good candidates for intervention. African-American adolescent mothers have high rates of overweight and snack consumption and may benefit from strategies to identify nutritious, palatable, affordable, and accessible alternatives to high-fat snack food.
Adolescent↗
Iron supplementation in early childhood: health benefits and risks.
The prevalence of iron deficiency among infants and young children living in developing countries is high. Because of its chemical properties--namely, its oxidative potential--iron functions in several biological systems that are crucial to human health. Iron, which is not easily eliminated from the body, can also cause harm through oxidative stress, interference with the absorption or metabolism of other nutrients, and suppression of critical enzymatic activities. We reviewed 26 randomized controlled trials of preventive, oral iron supplementation in young children (aged 0-59 mo) living in developing countries to ascertain the associated health benefits and risks. The outcomes investigated were anemia, development, growth, morbidity, and mortality. Initial hemoglobin concentrations and iron status were considered as effect modifiers, although few studies included such subgroup analyses. Among iron-deficient or anemic children, hemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron-replete children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. In a malaria-endemic population of Zanzibar, significant increases in serious adverse events were associated with iron supplementation, whereas, in Nepal, no effects on mortality in young children were found. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programs may need to be targeted through identification of iron-deficient children.
Anemia, Iron-Deficiency↗
Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.
CONTEXT: Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. OBJECTIVES: There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 years of the adolescent mother's first delivery; (2) to examine whether greater intervention participation increased the likelihood of preventing a second birth; (3) to examine whether second births were better predicted from a risk practice perspective or a family formation perspective, based on information collected at delivery; and (4) to examine how risk practices or family formation over the first 2 years of parenthood were related to a second birth. DESIGN: We conducted a randomized, controlled trial of a home-based intervention curriculum, based on social cognitive theory, and focused on interpersonal negotiation skills, adolescent development, and parenting. The curriculum was delivered biweekly until the infant's first birthday by college-educated, black, single mothers who served as mentors, presenting themselves as "big sisters." The control group received usual care. Follow-up evaluations were conducted in the homes 6, 13, and 24 months after recruitment. METHODS: Participants were recruited from urban hospitals at delivery and were 181 first time, black adolescent mothers (< 18 years of age); 82% (149 of 181) completed the 24-month evaluation. RESULTS: Intent-to-treat analyses revealed that control mothers were more likely than intervention mothers to have a second infant. The complier average causal effect was used to account for variability in intervention participation. Having > or = 2 intervention visits increased the odds of not having a second infant more than threefold. Only 1 mother who completed > or = 6 visits had a second infant. At delivery of their first infant, mothers who had a second infant were slightly older (16.7 vs 16.2 years) and were more likely to have been arrested (30% vs 14%). There were no differences in baseline contraceptive use or other measures of risk or family formation. At 24 months, mothers who had a second infant reported high self-esteem, positive life events, and romantic involvement and residence with the first infant's father. At 24 months, there were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). CONCLUSIONS: A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended > or = 8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6-8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.
Adolescent↗
Heat or eat: the Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age.
OBJECTIVES: Public funding for the Low Income Home Energy Assistance Program has never been sufficient to serve more than a small minority of income-eligible households. Low Income Home Energy Assistance Program funding has not increased with recent rapidly rising energy costs, harsh winter conditions, or higher child poverty rates. Although a national performance goal for the Low Income Home Energy Assistance Program is to increase the percentage of recipient households having > or = 1 member < or = 5 years of age, the association of income-eligible households' receipt of the Low Income Home Energy Assistance Program with indicators of well-being in young children has not been evaluated previously. The goal of the current study was to evaluate the association between a family's participation or nonparticipation in the Low Income Home Energy Assistance Program and the anthropometric status and health of their young children. METHODS: In the ongoing Children's Sentinel Nutrition Assessment Project from June 1998 through December 2004, caregivers with children < 3 years of age in 2 emergency departments and 3 primary care clinics in 5 urban sites participated in cross-sectional surveys regarding household demographics, child's lifetime history of hospitalizations, and, for the past 12 months, household public assistance program participation and household food insecurity, measured by the US Food Security Scale. This scale, in accordance with established procedures, classifies households as food insecure if they report that they cannot afford enough nutritious food for all of the members to lead active, healthy lives. On the day of the interview, children's weight, length, and whether the children were admitted acutely to the hospital from the emergency departments were documented. The study sample consisted only of Low Income Home Energy Assistance Program income-eligible renter households without private insurance who also participated in > or = 1 other means-tested program. RESULTS: In this sample of 7074 caregivers, 16% of families received the Low Income Home Energy Assistance Program, similar to the national rate of 17%. Caregivers who received the Low Income Home Energy Assistance Program were more likely to be single (63% vs 54%), US born (77% vs 68%), and older (mother's mean age: 28.1 vs 26.7 years) but were less likely to be employed (44% vs 47%). Households who received the Low Income Home Energy Assistance Program were more likely to receive Supplemental Nutrition Program for Women, Infants, and Children (85% vs 80%), Supplemental Security Income (13% vs 9%), Temporary Assistance for Needy Families (38% vs 23%), and food stamps (59% vs 37%) and to live in subsidized housing (38% vs 19%) compared with nonrecipients. Children in families participating in the Low Income Home Energy Assistance Program were older than children in nonparticipating families (13.6 vs 12.5 months), were less likely to be uninsured (5% vs 9%), and were more likely to have had a low birth weight < or = 2500 g (17% vs 14%). Families participating in the Low Income Home Energy Assistance Program reported more household food insecurity (24% vs 20%) There were no significant group differences between recipients and nonrecipients in caregiver's education or child's gender. After controlling for these potentially confounding variables, including receipt of other means-tested programs, compared with children in recipient households, those in nonrecipient households had greater adjusted odds of being at aggregate nutritional risk for growth problems, defined as children with weight-for-age below the 5th percentile or weight-for-height below the 10th percentile, with significantly lower mean weight-for-age z scores calculated from age- and gender-specific values from the Centers for Disease Control and Prevention 2000 reference data. However, in adjusted analyses, children aged 2 to 3 years in recipient households were not more likely to be overweight (BMI > 95th percentile) than those in nonrecipient households. Rates of age-adjusted lifetime hospitalization excluding birth and the day of the interview did not differ between Low Income Home Energy Assistance Program recipient groups. Among the 4445 of 7074 children evaluated in the 2 emergency departments, children from eligible households not receiving the Low Income Home Energy Assistance Program had greater adjusted odds than those in recipient households of acute hospital admission on the day of the interview. CONCLUSIONS: Even within a low-income renter sample, Low Income Home Energy Assistance Program benefits seem to reach families at the highest social and medical risk with more food insecurity and higher rates of low birth-weight children. Nevertheless, after adjustment for differences in background risk, living in a household receiving the Low Income Home Energy Assistance Program is associated with less anthropometric evidence of undernutrition, no evidence of increased overweight, and lower odds of acute hospitalization from an emergency department visit among young children in low-income renter households compared with children in comparable households not receiving the Low Income Home Energy Assistance Program. The Low Income Home Energy Assistance Program in many states shuts down early each winter when their funding is exhausted. From a clinical perspective, pediatric health providers caring for children from impoverished families should consider encouraging families of these children to apply for the Low Income Home Energy Assistance Program early in the season before funding is depleted. From a public policy perspective, although this cross-sectional study design can only demonstrate associations and not causation, these findings suggest that, particularly as fuel costs and children's poverty rates increase, expanding the Low Income Home Energy Assistance Program funding and meeting the national Low Income Home Energy Assistance Program performance goal of increasing the percentage of recipient households with young children might potentially benefit such children's growth and health.
Child, Preschool↗
Failure to thrive as distinct from child neglect.
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Child↗
Commentary: mentoring--benchmarks for work performance.
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Humans↗
Defining child neglect based on child protective services data.
OBJECTIVES: To compare neglect defined by Child Protective Services official codes with neglect defined by a review of CPS narrative data, and to examine the validity of the different neglect measures using children's functioning at age 8 years. METHODS: Data are from 740 children participating in a consortium of longitudinal studies on child abuse and neglect; 481 had at least one CPS report prior to age 8. CPS records were reviewed to ascertain both broad CPS types of neglect as well as specific subtypes of neglect using a modified version of the Maltreatment Classification System (MMCS). Frequencies of, and correlations among, the types and subtypes of neglect were examined. The validity of the neglect measures was evaluated by examining their relationships with children's functioning at age 8. RESULTS: The CPS neglect types and MMCS subtypes were moderately correlated, as were the MMCS subtypes of neglect. In general, neglect was only modestly associated with children's functioning at age 8 (r2=1-4%), with few differences between the CPS neglect types and the MMCS subtypes. There were significant associations with children's total and externalizing behavior problems, impaired socialization, and impaired daily living skills. Among the specific subtypes, neglect of children's medical needs was related to externalizing behavior problems, impaired socialization, and impaired daily living skills. Neglect of children's hygiene needs was related to impaired socialization. CONCLUSION: The moderate correlations among CPS and MMCS types and subtypes of neglect and their similar associations with children's functioning suggest that the considerable effort involved in coding neglect subtypes from CPS narrative data may yield limited incremental knowledge regarding the types of neglect children experience and their sequelae. However, the MMCS does offer useful descriptive information on the nature of neglect children experience, and may guide future research and practice on optimal ways to conceptualize neglect.
Child Abuse↗
Longitudinal investigation of the relationship among maternal victimization, depressive symptoms, social support, and children's behavior and development.
This article is a longitudinal investigation of the relationships between maternal victimization, maternal functioning, and children's behavior and development. Participants include 203 mother-child dyads from a low-income population recruited from pediatric primary care clinics. Data are collected when children are 4 and 8 years of age. Child outcomes are evaluated using maternal, teacher, and child self-report and objective measures of cognitive and academic functioning. Maternal victimization history is associated with maternal depressive symptoms, low levels of maternal social support, child internalizing and externalizing behavior problems, and low levels of child socialization. Child behavior problems identified at age 4 are enduring and persist to age 8. The effects of maternal victimization history on both internalizing behavior problems and socialization are mediated by maternal depressive symptoms. The effects of maternal depressive symptoms on externalizing behavior problems, socialization, and anger are mediated by maternal social support. Clinical implications of findings are discussed.
Adult↗
Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants.
BACKGROUND: Iron and zinc deficiency are prevalent during infancy in low-income countries. OBJECTIVES: The objectives were to examine whether a weekly supplement of iron, zinc, iron+zinc, or a micronutrient mix (MM) of 16 vitamins and minerals would alter infant development and behavior. DESIGN: The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies. Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment (HOME) scale. In this double-blind trial, the infants were randomly assigned to 1 of 5 treatment conditions: iron (20 mg), zinc (20 mg), iron+zinc, MM (16 vitamins and minerals, including iron and zinc), or riboflavin weekly from 6 to 12 mo. Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group, with control for maternal education, HOME score, months breastfed, anemia, growth at 6 mo, and change in growth from 6 to 12 mo. RESULTS: Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development. Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement. Two-thirds of the infants were mildly anemic, no treatment effects on hemoglobin concentration were observed, and hemoglobin was not associated with measures of development or behavior. CONCLUSION: The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together.
Anemia, Iron-Deficiency↗
Food insecurity is associated with adverse health outcomes among human infants and toddlers.
The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages < or = 36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998-December 2001. Caregivers of 11,539 children ages < or = 36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child's health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic regression, after adjusting for confounders, food-insecure children had odds of "fair or poor" health nearly twice as great [adjusted odds ratio (AOR) = 1.90, 95% CI = 1.66-2.18], and odds of being hospitalized since birth almost a third larger (AOR = 1.31, 95% CI = 1.16-1.48) than food-secure children. A dose-response relation appeared between fair/poor health status and severity of food insecurity. Effect modification occurred between Food Stamps and food insecurity; Food Stamps attenuated (but did not eliminate) associations between food insecurity and fair/poor health. Food insecurity is associated with health problems for young, low-income children. Ensuring food security may reduce health problems, including the need for hospitalizations.
Aid to Families with Dependent Children↗
Measurement of three major subtypes of child neglect.
This study examines the relationships among three major subtypes of neglect (physical, psychological, and environmental), a summary measure of neglect, and neglect as defined by Child Protective Services (CPS). The predictive validity of the subtypes of neglect assessed when children were 5 years of age was examined using children's behavior at age 6. Study findings include modest to moderate correlations among the neglect subtypes, CPS neglect, and children's behavior. After controlling for CPS neglect, the subtypes remained predictive of children's behavior. The set of three subtypes was more strongly related to children's behavior, particularly maternal report of internalizing problems, than was the summary neglect measure. These findings suggest that considering the subtypes of neglect may enhance our understanding of neglect and lead to interventions tailored to families' specific needs.
Adult↗
Maternal depression, changing public assistance, food security, and child health status.
OBJECTIVE: To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged < or =36 months at 6 urban hospitals and clinics. METHODS: A convenience sample of 5306 mothers, whose children <36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal program participation and changes in federal benefits, child health status rating, child's history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded. RESULTS: PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33-1.88) and hospitalizations during the child's lifetime (AOR: 1.20; 95% CI: 1.03-1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03-2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06-2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33-3.11) than mothers without PDS. CONCLUSION: Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.
Body Weight↗
Cognitive and motor development among small-for-gestational-age infants: impact of zinc supplementation, birth weight, and caregiving practices.
OBJECTIVE: Infants who are born small for gestational age (SGA) are at risk for developmental delays, which may be related to deficiencies in zinc, an essential trace metal, or to deficiencies in their ability to elicit caregiver responsiveness (functional isolation hypothesis). The objective of this study was to evaluate at 6 and 10 months of age the impact of a 9-month supplementation trial of 5 mg of zinc on the development and behavior of infants who were born SGA and to evaluate infants' ability to elicit responsive caregiver behavior. METHODS: A randomized, controlled trial of zinc supplementation was conducted among 200 infants in a low-income, urban community in Delhi, India. Infants were recruited when they were full term (>36 weeks) and SGA (birth weight <10th percentile weight-for-gestational age). Infants were randomized to receive daily supplements of a micronutrient mix (folate, iron, calcium, phosphorus, and riboflavin) with or without 5 mg of zinc sulfate. The supplement was administered by field workers daily from 30 days to 9 months of age. At 6 and 10 months, infant development and behavior were measured in a clinical setting using the Bayley Scales of Infant Development II. Caregiver responsiveness, observed on an Indian version of the Home Observation for Measurement of the Environment scale, was measured during a home visit at 10 months. During both the clinic and home visits, caregivers reported on their infant's temperament. RESULTS: There were no direct effects of zinc supplementation on the infants' development or behavior at either 6 or 10 months. In a subgroup analysis among the zinc-supplemented infants, lower birth weight infants were perceived to be more temperamentally difficult than higher weight infants; in the control group, birth weight was not associated with temperament. Heavier birth weight infants had better scores on all measures of development and behavior at 6 months and on changes in mental and motor development from 6 to 10 months, compared with lighter birth weight infants. Boys had better weight gain and higher scores on mental development and emotional regulation than girls. Infants who were from families of higher socioeconomic status (indexed by parental education, house size, and home ownership) had higher scores on mental development and orientation/engagement (exploratory behavior) than infants who were from families of lower socioeconomic status. In keeping with the functional isolation hypothesis, caregiver responsiveness was associated with infant irritability, controlling for socioeconomic status, gender, birth weight, and weight gain. Responsive mothers were more likely to perceive their infants to be temperamentally easy than less responsive mothers. CONCLUSION: Possible explanations for the lack of effects of zinc supplementation on infant development and behavior include 1) subtle effects of zinc supplementation that may not have been detected by the Bayley Scales, 2) interference with other nutritional deficiencies, or 3) no impact of zinc deficiency on infants' development and behavior. The link between birth weight and irritability among infants in the zinc supplementation group suggests that the response to zinc supplementation may differ by birth weight, with irritability occurring among the most vulnerable infants. Longer term follow-up studies among zinc-supplemented infants are needed to examine whether early supplementation leads to developmental or behavioral changes that have an impact on school-age performance. The relationship between infant irritability and low maternal responsiveness lends support to the functional isolation hypothesis and the importance of asking caregivers about infant temperament.
Birth Weight↗
Special Supplemental Nutrition Program for Women, Infants, and Children participation and infants' growth and health: a multisite surveillance study.
CONTEXT: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security. OBJECTIVE: To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants < or =12 months of age, at 6 urban hospitals and clinics. DESIGN AND SETTING: A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 though December 2001. PARTICIPANTS: A total of 5923 WIC-eligible caregivers of infants < or =12 months of age were interviewed at hospital clinics and emergency departments. MAIN OUTCOME MEASURES: Weight-for-age, length-for-age, weight-for-length, caregiver's perception of infant's health, and household food security. RESULTS: Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = -0.23 vs 0.009), short (length-for-age z score = -0.23 vs -0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29-2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance. CONCLUSIONS: Infants < or =12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.
Body Height↗
Use of the Child Abuse Potential inventory as a measure of treatment outcome.
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Adult↗