Biomedical subjects

Peggy Auinger

Publications and source records attributed to Peggy Auinger.

At least 19 recordsLinked to original sources

PubMed2006

Health care utilization and expenditures for children with autism: data from U.S. national samples.

Little is known about the use of medical services by children who have autism (ASD). Provide nationally representative data for health service utilization and expenditures of children with ASD. Cross-sectional survey using the Medical Expenditure Panel (MEPS), and National (Hospital) Ambulatory Medical Care Surveys (N(H)AMCS). A total of 80 children with ASD were identified from N(H)AMCS (weighted sample size (wss) 186,281), and 31 (wss 340,158) from MEPS. They had more outpatient visits, physician visits, and medications prescribed than children in general. They spent more time during physician visits than other children. Annual expenses for children with autism spectrum disorder (6,132 dollars) were more than for other children (860 dollars). Children with ASD have a substantial burden of medical illness.

Adolescent↗

PubMed2006

Potentially protective factors associated with healthful body mass index in adolescents with obese and nonobese parents: a secondary data analysis of the third national health and nutrition examination survey, 1988-1994.

OBJECTIVE: To identify factors potentially protective against obesity in 12- to 16-year-olds with one or two obese parents, and those with no obese parents. DESIGN: A secondary analysis of the Third National Health and Nutrition Examination Survey, 1988-1994. SUBJECTS/SETTING: A nationally representative sample of healthful weight, at-risk, or overweight adolescents with measured heights and weights (n=1,890). Subsamples with any obese parent (body mass index > or =30) and no obese parents (both with body mass index <25) were analyzed. STATISTICAL ANALYSES PERFORMED: Bivariate analyses examined the association of predictor variables (demographics, nutrient intake, and physical activity) on the outcome. Logistic regressions examined the likelihood of being healthful weight. SUDAAN software (release 7.5, 1997, Research Triangle Institute, Research Triangle Park, NC) was used to account for the sample design. RESULTS: Overall, 71% of subjects had a healthful weight, 29% were at risk or overweight. Factors associated with healthful weight included having two nonobese parents (odds ratio [OR]=5.4), only father obese (OR=4.9), only mother obese (OR=3.3), higher reading scores (OR=1.02), lower water consumption (OR=1.8), more exercise programs (OR=2.8), and higher energy intake (OR=2.0). For adolescents with any obese parent, factors potentially protective against obesity included being female (OR=2.2), higher household education (OR=1.1), lower water consumption (OR=2.0), and eating breakfast some days (OR=3.1) or everyday (OR=4.0). For adolescents with no obese parents, potentially protective factors included older age (OR=1.2), not having asthma (OR=2.6), more exercise programs (OR=6.1), and higher energy intake (OR=2.9). All P<.05. CONCLUSIONS: Interventions targeted at adolescents who are at risk because they have parents with obesity should employ a family approach focused on regular breakfast consumption.

Adolescent↗

PubMed2006

The use of Spanish by medical students and residents at one university hospital.

PURPOSE: To describe how medical trainees report communication with Spanish-speaking patients, and to assess trainees' desire to improve their language skills and have those skills formally evaluated. METHOD: A questionnaire was mailed to all fourth-year medical students and non-first-year residents in family practice, pediatrics, medicine, medicine-pediatrics, emergency medicine, and obstetrics-gynecology at the University of Rochester School of Medicine and Dentistry in 2004 (N = 263). RESULTS: The response rate was 92% (241/263). Each respondent had at least one year of clinical experience at the hospital. Of the 83% (199/241) who reported less than conversational Spanish language skills, 53% had taken a history and/or provided medical advice directly to Spanish-speaking patients without any form of interpretation. When an interpreter was used, professional interpretation services were used less frequently than other forms of interpretation (42% versus 58%, p < .05). Analyses were performed on the 68% (164/241) who reported having at least rudimentary Spanish skills: 85% reported that they would probably or definitely participate in further individual language training, 70% expressed at least possible willingness to have their Spanish formally evaluated, and 80% predicted that it is at least possible that they will use their Spanish as attending physicians. CONCLUSIONS: At the time of this study, this hospital's medical students and residents from multiple specialties used inadequate Spanish language skills to provide direct medical care despite the availability of professional interpretation services. Most of these trainees were motivated to improve their Spanish and would welcome evaluation of their language skills.

Communication↗

PubMed2006

Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children.

OBJECTIVE: The purpose of this study was to examine the association of exposures to tobacco smoke and environmental lead with attention deficit hyperactivity disorder (ADHD). METHODS: Data were obtained from the National Health and Nutrition Examination Survey 1999-2002. Prenatal and postnatal tobacco exposure was based on parent report; lead exposure was measured using blood lead concentration. ADHD was defined as having current stimulant medication use and parent report of ADHD diagnosed by a doctor or health professional. RESULTS: Of 4,704 children 4-15 years of age, 4.2% were reported to have ADHD and stimulant medication use, equivalent to 1.8 million children in the United States. In multivariable analysis, prenatal tobacco exposure [odds ratio (OR) = 2.5; 95% confidence interval (CI), 1.2-5.2] and higher blood lead concentration (first vs. fifth quintile, OR = 4.1; 95% CI, 1.2-14.0) were significantly associated with ADHD. Postnatal tobacco smoke exposure was not associated with ADHD (OR = 0.6; 95% CI, 0.3-1.3; p = 0.22). If causally linked, these data suggest that prenatal tobacco exposure accounts for 270,000 excess cases of ADHD, and lead exposure accounts for 290,000 excess cases of ADHD in U.S. children. CONCLUSIONS: We conclude that exposure to prenatal tobacco and environmental lead are risk factors for ADHD in U.S. children.

Adolescent↗

PubMed2006

Full breastfeeding duration and associated decrease in respiratory tract infection in US children.

OBJECTIVE: The American Academy of Pediatrics recommends exclusive breastfeeding for an infant's first 6 months of life. When compared with exclusive breastfeeding for 4 months, greater protection against gastrointestinal infection, but not respiratory tract infection, has been demonstrated for the 6-month duration. The objective of this study was to ascertain if full breastfeeding of > or = 6 months compared with 4 to < 6 months in the United States provides greater protection against respiratory tract infection. METHODS: Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional home survey conducted from 1988 to 1994, was performed. Data from 2277 children aged 6 to < 24 months, who were divided into 5 groups according to breastfeeding status, were compared. Children who required neonatal intensive care were excluded. SUDAAN software was used to account for the complex sampling design. Logistic regression adjusted for confounding factors. Outcome measures included adjusted odds of acquiring pneumonia, > or = 3 episodes of cold/influenza, > or = 3 episodes of otitis media (OM), or wheezing in the past year or acquiring first OM at < 12 months of age. RESULTS: In unadjusted analyses, infants who were fully breastfed for 4 to < 6 months (n = 223) were at greater risk for pneumonia than those who were fully breastfed for > or = 6 months (n = 136) (6.5% vs 1.6%). There were not statistically significant differences in > or = 3 episodes of cold/influenza (45% vs 41%), wheezing (23% vs 24%), > or = 3 episodes of OM (27% vs 20%), or first OM at < 12 months of age (49% vs 47%). Adjusting for demographic variables, childcare, and smoke exposure revealed statistically significant increased risk for both pneumonia (odds ratio [OR]: 4.27; 95% confidence interval [CI]: 1.27-14.35) and > or = 3 episodes of OM (OR: 1.95; 95% CI: 1.06-3.59) in those who were fully breastfed for 4 to < 6 months compared with > or = 6 months. CONCLUSIONS: This nationally representative study documents increased risk of respiratory tract infection including pneumonia and recurrent OM in children who were fully breastfed for 4 vs 6 months. These findings support current recommendations that infants receive only breast milk for the first 6 months of life.

Birth Weight↗

PubMed2006

Do parenting and the home environment, maternal depression, neighborhood, and chronic poverty affect child behavioral problems differently in different racial-ethnic groups?

OBJECTIVE: To determine whether the processes through which parenting practices, maternal depression, neighborhood, and chronic poverty affect child behavioral problems are similar or different in minority and nonminority children in the United States. METHODS: Data from 884 white, 538 black, and 404 Latino families with children who were 6 to 9 years of age in the National Longitudinal Survey of Youth were analyzed. The outcome, child behavioral problems, was measured using the Behavior Problems Index externalizing and internalizing subscales. The effects of chronic poverty, neighborhood, maternal depression, and parenting on the outcome were analyzed using multigroup structural equation modeling. RESULTS: Chronic poverty affected child behavioral problems indirectly through the other variables, and parenting practices had direct effects in each racial/ethnic group. The effects of maternal depression were partially mediated through parenting in the white and Latino samples but were direct and unmediated through parenting practices in the black sample. Neighborhood effects were present in the white and black samples but were not significant for the Latino sample. CONCLUSIONS: Chronic poverty, neighborhood, maternal depression, and parenting practices have effects on child behavioral problems in white, black, and Latino children, but the processes and mechanisms through which they exert their effects differ among the groups. The differences may be related to social stratification mechanisms as well as sociocultural differences in family and childrearing practices.

Black People↗

PubMed2006

Short-term persistence of high health care costs in a nationally representative sample of children.

OBJECTIVES: Little is known about the persistence of health care costs in children. Determining whether children with high health expenses continue to have high expenses over time can help in the development of targeted programs and policies to decrease costs, plan equitable health insurance strategies, and provide insights into the effects of costly conditions on families. The objectives of this study were to (1) identify the characteristics of children who are in the top 10th percentile for health costs, (2) investigate whether those in the top percentiles for costs in 1 year continue in the same percentiles the next year, and (3) identify factors that predict whether a child stays in the top percentiles. METHODS: Data from 2 consecutive years (2000-2001) of the Medical Expenditure Panel Survey were analyzed. Changes in a child's position in the expenditure distribution were examined. An estimated multivariate model conditional on insurance was developed to predict the true resource costs of providing services. Statistical analyses, including logistic-regression and multivariate linear-regression modeling, were done to account for the weighted sampling used in Medical Expenditure Panel Survey. RESULTS: A total of 2938 children were included in the survey for both years. In 2000, the top 10% of the children accounted for 54% of all costs. They had a mean total expenditure of 6422 dollars with out-of-pocket expenditures of 1236 dollars; 49% of the children in the top decile in 2000 persisted in the top decile in 2001, whereas 12% dropped into the bottom half. Children who had been in the top 10% in 2000 were 10 times more likely than other children to be in the top 10% for 2001. Other characteristics in 2000 that predicted membership in the top decile for 2001 included age (11-15 and 16-17 years), having any insurance (public and private), being positive on the standardized Children With Special Health care Need screener, and having a functional limitation. CONCLUSIONS: Almost half of the children in the top 10% for costs in 2000 persisted in the top 10% in 2001. Older children, children with special health care needs, and children with functional limitations were more likely to be in the top decile. These findings do not support the belief that black and Latino children who are on Medicaid account for a disproportionate share of costs or expenditures. Because the children who were among the top 10% used health care services in a variety of inpatient, emergency department, outpatient, and ancillary venues, providing care coordination throughout the entire health care system is important to address both the cost and the quality aspects of health care for the most costly children. Targeted programs to decrease expenditures for those with the greatest costs have the potential to save future health care dollars. Assessment of the factors that predict persistence of high expenditures can be used to help in the planning of equitable health insurance strategies such as catastrophic care, carve-outs, reinsurance, and risk adjustment. Clinicians should review regularly the extent of care coordination that they are providing for their high-need and high-cost patients, especially preteens and adolescents. Studies that examine the persistence of expenditures over longer periods and include assessment of quality of care are needed.

Adolescent↗

PubMed2006

Predictors of partner abuse in a nationally representative sample of adolescents involved in heterosexual dating relationships.

This article's goals are to identify the characteristics of abusive heterosexual dating relationships among adolescents. Using the National Longitudinal Study of Adolescent Health dataset, an analysis of 4,441 heterosexual relationships was completed using logistic regression models (SAS PROC GENMOD). The associations between being verbally and physically abused were examined with respect to the following relationship characteristics: involvement in sexual intercourse or pregnancy with the relationship partner, description of the relationship as a "special romantic relationship," duration of the relationship, age at relationship initiation, and age difference between partners. The findings indicate that involvement in a sexual or "special romantic" relationship was associated with greater likelihood of being abused in both genders. Increased length of time in the relationship was associated with verbal abuse in both genders. Involvement in a pregnancy was associated with being verbally and physically abused among males. It is thus concluded that relationship characteristics play an important role in the development of abusive relationships among adolescents.

Adolescent↗

PubMed2005

Tobacco smoke exposure is associated with the metabolic syndrome in adolescents.

BACKGROUND: The metabolic syndrome predicts future coronary artery disease and type II diabetes and often emerges in childhood. Tobacco smoke potentially contributes to insulin resistance in this syndrome. This study evaluates the association of environmental tobacco smoke (ETS) exposure and active smoking with the prevalence of the metabolic syndrome in US adolescents. METHODS AND RESULTS: Data from 2273 subjects 12 to 19 years of age were examined from the National Health and Nutrition Examination Survey III (NHANES III, 1988 to 1994). Serum cotinine levels, presence of household smokers, and self-report of smoking were used to determine ETS exposure and active smoking. The metabolic syndrome was defined as having > or =3 criteria from the National Cholesterol Education Panel definition. Bivariate and multivariable analyses were conducted. Among adolescents, 5.6% met the criteria for metabolic syndrome, and prevalence increased with tobacco exposure: 1.2% for nonexposed, 5.4% for those exposed to ETS, and 8.7% for active smokers (P<0.001). In adolescents at risk for overweight and overweight adolescents (body mass index above the 85th percentile), a similar relationship was observed: 5.6% for nonexposed, 19.6% for those exposed to ETS, and 23.6% for active smokers (P=0.01). In multivariable logistic regression analyses among all adolescents, ETS exposure was independently associated with the metabolic syndrome (ETS exposure: odds ratio, 4.7, 95% CI, 1.7 to 12.9; active smoking: odds ratio, 6.1; 95% CI, 2.8 to 13.4). CONCLUSIONS: Considering that tobacco and obesity are the 2 leading causes of preventable death in the United States, these findings of a dose-response, cotinine-confirmed relationship between tobacco smoke and metabolic syndrome among adolescents may have profound implications for the future health of the public.

Adolescent↗

PubMed2005

Iron deficiency, prolonged bottle-feeding, and racial/ethnic disparities in young children.

BACKGROUND: Childhood iron deficiency is associated with behavioral and cognitive delays. Few studies have explored the relationship between prolonged bottle-feeding and iron-deficiency anemia among toddlers. OBJECTIVE: To examine the association between prolonged bottle-feeding and iron deficiency in a nationally representative sample of children ages 1 to 3 years. DESIGN AND METHODS: The National Health and Nutrition Examination Survey III provides data on the feeding practices of children 1 to 3 years old and contains measures of iron status including transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. The prevalence of iron deficiency and duration of bottle-feeding were determined for black, white, and Mexican American toddlers. Bivariate and multivariate analyses were performed to examine the association between bottle-feeding duration and iron deficiency. RESULTS: Among 2121 children ages 1 to 3 years, the prevalence of iron deficiency was 6% among whites, 8% among blacks, and 17% among Mexican Americans (P< .001). With increasing duration of bottle-feeding, the prevalence of iron deficiency among all children increased (3.8%, bottle-fed < or =12 months; 11.5%, bottle-fed 13-23 months; and 12.4%, bottle-fed 24-48 months [P< .001]). At 24 to 48 months of age, 36.8% of Mexican American children were still bottle-fed, compared with 16.9% of white and 13.8% of black children. In multivariate analyses, bottle-feeding for 24 to 48 months and Mexican ethnicity were associated with iron deficiency (odds ratio, 2.8; 95% confidence interval, 1.3-6.0; and odds ratio, 2.9; 95% confidence interval, 1.5-5.6, respectively). CONCLUSIONS: Children with prolonged bottle-feeding and Mexican American children are at higher risk for iron deficiency. Screening practices and nutritional counseling should be targeted at these high-risk groups.

Black or African American↗

PubMed2005

Intimate partner abuse and the reproductive health of sexually active female adolescents.

PURPOSE: The purpose of this study was to determine the associations between verbal and minor physical abuse by an intimate partner and reproductive health behavior. METHODS: Logistic regression analyses of 1996 cross-sectional data from 973 sexually active, dating female adolescents surveyed for wave II of the National Longitudinal Study of Adolescent Health Public Use Dataset examining the relationship between abuse by an intimate partner and reproductive health. We measured verbal (insulted in public, sworn at, or threatened with violence) and minor physical (threw something at them, pushed them, or shoved them) abuse by any intimate partner during the past 18 months and by any current intimate partner. Reproductive health variables included condom use with most recent intercourse, contraception use with most recent intercourse, history of sexually transmitted infection, and history of pregnancy. RESULTS: After adjusting for sociodemographic factors, number of intimate partners, and history of forced sexual intercourse, the current involvement in a verbally abusive relationship was associated with not using a condom during the most recent intercourse (odds ratio, 1.56; 95% confidence interval, 1.02-2.40), and both a history of involvement and current involvement in a physically abusive relationship were associated with a history of pregnancy (odds ratio, 2.50; 95% confidence interval, 1.47-4.17; and odds ratio, 3.57; 95% confidence interval, 1.85-6.67, respectively). Neither verbal nor physical abuse were associated with the other reproductive health outcomes. CONCLUSIONS: Physical abuse by an intimate partner is associated with pregnancy and current involvement in a verbally abusive relationship is associated with decreased condom use among sexually experienced female adolescents. Health care providers should be attentive to the association between abuse and pregnancy among adolescents.

Adolescent↗

PubMed2005

High self-esteem among adolescents: longitudinal trends, sex differences, and protective factors.

PURPOSE: To better characterize self-esteem and to identify factors in early adolescence associated with high self-esteem in later adolescence. METHODS: The National Education Longitudinal Study provided a random, nationally representative sample of 8th grade adolescents who completed surveys in grades 8, 10, and 12 (n = 16,489). We measured changes in self-esteem, and high versus low self-esteem. By using the Developmental Assets Model, predictor variables were selected to include intrinsic developmental assets (e.g., decision making) and extrinsic assets (e.g., safety). Logistic regression with separate modeling for sex identified assets that were predictive of high self-esteem, controlling for sociodemographic factors. RESULTS: Boys versus girls were more likely to report high self-esteem in all grades (all p < .001). For girls, factors predictive of high self-esteem in grade 12 were as follows: African-American (odds ratio [OR] = 2.06) or Hispanic (OR = 1.52) race/ethnicity, positive family communication (OR = 3.03), safety (OR = 1.50), and high self-esteem (OR = 3.03). For boys, factors were family income being above the federal poverty level (OR = 1.50), positive family communication (OR = 2.40), safety (OR = 1.41), religious community (OR = 1.21), and high self-esteem (OR = 3.01) (all p < .05). CONCLUSIONS: Fewer adolescent girls than boys report high self-esteem. Adults may foster self-esteem in adolescents by providing positive communication through supportive and caring relationships.

Adolescent↗

PubMed2005

Preventive counseling at adolescent ambulatory visits.

PURPOSE: To evaluate factors that independently predict counseling for diet, exercise, sexually transmitted diseases (STDs), pregnancy, smoking, and injuries at adolescent well visits, and compare these rates to the frequency of counseling at adolescent acute visits. METHODS: The 1997-2000 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys were combined for patients aged 11-21 years. Acute visits were identified by ICD-9 code for: sexual health, obesity, asthma, injury, and well care. Bivariate analyses were used to determine differences in relevant counseling provided at acute visits compared with well visits. Logistic regression was used to assess factors that predict counseling on each of the above topics at well adolescent visits. RESULTS: Of 23,378 adolescent ambulatory visits, 1508 (6.5%) were for well care. Only 0.8% of visits were for obesity, 3.7% for sexual health, 2.6% for asthma, and 13% for injuries. Counseling was more frequent at acute than well visits for diet (72% vs. 28%), exercise (52% vs. 23%), human immunodeficiency virus/sexually transmitted diseases (HIV/STD; 14% vs. 6.2%), and family planning (FP) (24% vs. 10%), (all p values < .05). Pediatric clinicians were more likely than other specialists to provide counseling for diet (OR 2.3), HIV/STD (OR 2.7), FP (OR 2.9), tobacco use (OR 2.8), and injury prevention (OR 4.7). Blacks received less exercise counseling than Whites (OR 0.4), and counseling about sensitive issues (STDs, family planning) occurred more often in older adolescents (OR 1.3). CONCLUSIONS: Despite recommendations, more counseling occurs at acute rather than well visits, and still does not reach all those adolescents in need. There remains much room for improvement in physicians' adherence to national guidelines for adolescent care.

Adolescent↗

PubMed2005

Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents.

We used the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to investigate the relationship between environmental tobacco smoke (ETS) exposure and cognitive abilities among U.S. children and adolescents 6-16 years of age. Serum cotinine was used as a biomarker of ETS exposure. Children were included in the sample if their serum cotinine levels were less than or equal to 15 ng/mL, a level consistent with ETS exposure, and if they denied using any tobacco products in the previous 5 days. Cognitive and academic abilities were assessed using the reading and math subtests of the Wide Range Achievement Test-Revised and the block design and digit span subtests of the Wechsler Intelligence Scale for Children-III. Analyses were conducted using SUDAAN software. Of the 5,365 6- to 16-year-olds included in NHANES III, 4,399 (82%) were included in this analysis. The geometric mean serum cotinine level was 0.23 ng/mL (range, 0.035-15 ng/mL); 80% of subjects had levels < 1 ng/mL. After adjustment for sex, race, region, poverty, parent education and marital status, ferritin, and blood lead concentration, there was a significant inverse relationship between serum cotinine and scores on reading (beta = -2.69, p = 0.001), math (beta = -1.93, p = 0.01), and block design (beta = -0.55, p < 0.001) but not digit span (beta = -0.08, p = 0.52). The estimated ETS-associated decrement in cognitive test scores was greater at lower cotinine levels. A log-linear analysis was selected as the best fit to characterize the increased slope in cognitive deficits at lower levels of exposure. These data, which indicate an inverse association between ETS exposure and cognitive deficits among children even at extremely low levels of exposure, support policy to further restrict children's exposure.

Adolescent↗

PubMed2005

Inadequate access to care among children with asthma from Spanish-speaking families.

Despite substantial asthma prevalence and morbidity, children from Spanish-speaking families are at high risk of inadequate maintenance therapy. The reasons for this remain unclear. The objective of this study was to compare patterns of asthma morbidity and access to care of children with asthma from Spanish-speaking and English-speaking families. Cross-sectional data from a nationally representative sample of children with asthma 2-17 years of age were analyzed from the 1999 National Health Interview Survey, conducted in both English and Spanish, with the preferred language identified at the time of the interview. Among the 1,228 children with asthma (physician-diagnosed asthma by parent report), 66 (3%) were from Spanish-speaking families and 1,162 (97%) were from English-speaking families. In a logistic regression model adjusting for gender, insurance, poverty (above or below the federal poverty level, based on reported family income and the U.S. Poverty Threshold produced annually by the Census Bureau), and race/ethnicity, children with asthma from Spanish-speaking families were one-third less likely to have a usual health care provider (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.1-0.8) than children with asthma from English-speaking families. Latino ethnicity was not independently associated with diminished continuity of care. These data indicate that children with asthma from Spanish-speaking families are less likely to experience continuity of health care than their counterparts from English-speaking families. Differences in continuity of care may contribute to inadequate asthma maintenance therapy among these children.

Asthma↗

PubMed2005

Screening and counseling associated with obesity diagnosis in a national survey of ambulatory pediatric visits.

OBJECTIVE: To examine clinician-reported diagnosis of obesity and frequency of blood pressure assessment and diet and exercise counseling during ambulatory visits made by children and adolescents. METHODS: The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey 1997 to 2000 were combined for visits to clinicians of 2- to 18-year-olds. Well-child visits (WCVs) were examined for frequencies of obesity diagnosis, blood pressure screening, and diet and exercise counseling in relation to patient and clinician characteristics. Multivariate models examined the relationship of patient and visit characteristics with diet and exercise counseling. RESULTS: Of the 32 930 ambulatory visits made by 2- to 18-year-olds in 1997-2000, obesity was diagnosed at 0.78% of all visits and 0.93% of WCVs. Blood pressure assessment was reported in 61.1% of WCVs with obesity diagnosis compared with 43.9% of WCVs without obesity diagnosis. WCVs with obesity diagnosis had higher diet counseling rates (88.4% vs 35.7%) and higher exercise counseling rates (69.2% vs 18.6%). Diet counseling was reported for 88.4% and exercise counseling was reported for 69.2% of visits with an obesity diagnosis compared with 35.7% and 18.6% during WCVs without a diagnosis of obesity. In multivariate analyses, factors associated with diet counseling at WCVs were diagnosis of obesity (odds ratio [OR]: 12.9; 95% confidence interval [CI]: 3.0-55.3), being seen by pediatricians (OR: 2.5; 95% CI: 1.6-3.9), 2- to 5-year-olds compared with 12- to 18-year-olds (OR: 0.7; 95% CI: 0.5-1.0), and self-pay compared with private insurance visits (OR: 0.6; 95% CI: 0.4-0.9). Associations with exercise counseling were similar to those for diet counseling, but exercise counseling occurred less frequently in visits by black youths compared with white youths (OR: 0.5; 95% CI: 0.3-0.8). CONCLUSIONS: Clinicians may overlook obesity during WCVs. Programs to increase obesity diagnosis could improve diet and exercise counseling rates, but even with diagnosis of obesity, significant opportunities for screening and intervention are missed.

Adolescent↗

PubMed2004

Lactation among adolescent mothers and subsequent bone mineral density.

OBJECTIVE: To investigate the association of breastfeeding during adolescence with bone mineral density (BMD) during young adulthood. METHODS: Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional survey conducted from 1988 through 1994, was performed. The BMDs for 5 regions of the proximal femur as measured by dual energy x-ray absorptiometry were compared for 5 groups of women aged 20 to 25 years (n = 819); the groups included those who had been: (1) adolescent mothers and had breastfed (n = 94), (2) adolescent mothers and had not breastfed (n = 151), (3) mothers who first gave birth as adults and breastfed (n = 67), (4) mothers who first gave birth as adults and had not breastfed (n = 89), and (5) nulliparous (n = 418). SUDAAN software was used to account for the complex sampling design of the National Health and Nutrition Examination Survey. Adjusted mean differences in BMD were estimated using least-squares linear regression. RESULTS: During young adulthood, women who breastfed during adolescence had higher adjusted BMDs, which was statistically significant in 4 of the 5 regions, than those who had not breastfed (total proximal femur area difference, 0.049 gm/cm(2) [95% confidence interval, 0.002-0.095]) and BMDs equivalent to nulliparous women (total proximal femur area difference, 0.024 gm/cm(2) [95% confidence interval, -0.023 to 0.071]). Adjusting also for obstetric variables, women who breastfed during adolescence had higher BMDs in all 5 regions compared with their peers who had not breastfed (total proximal femur area difference, 0.053 gm/cm(2) [95% confidence interval, 0.029-0.077]). CONCLUSIONS: In this nationally representative sample, breastfeeding by adolescent mothers was associated with greater BMD in the proximal femur during young adulthood. Lactation was not found to be detrimental and may be protective to the bone health of adolescent mothers.

Absorptiometry, Photon↗

PubMed2004

Body piercing and high-risk behavior in adolescents.

PURPOSE: To evaluate the association of body piercing with sociodemographic factors, peer substance use, and high-risk behaviors. METHODS: Cross-sectional analysis using Wave II of the National Longitudinal Study of Adolescent Health (Add Health) Public Use Dataset, a nationally representative, school-based sample of 4337 adolescents, aged 13-18 years, surveyed in 1996. The major predictor variable was body piercing at locations other than the ears. The outcome variables were selected from five areas of high-risk behaviors including sexual intercourse, substance use (problem drinking, smoking, and marijuana use), violent behavior (fighting and inflicting injuries), antisocial behavior (truancy, shoplifting, and running away), and mood problems (depression, suicidal ideation and suicide attempts). The association between body piercing and peer substance use was also examined. RESULTS: Females (7.2% vs. 1.5%) and older adolescents were more likely to report piercing (all p's <.01) In linear regression analysis, controlling for sociodemographic factors, body piercing was significantly associated with higher levels of peer substance use (beta = 1.40 [99% CI.57-2.23]). In logistic regression analyses, controlling for sociodemographic factors, piercing was associated with sexual intercourse (OR = 4.5 [99% CI 2.1-10.0]), smoking (3.1 [1.6-5.9]), marijuana use (3.0 [1.6-5.9]), truancy (2.6 [1.3-5.3]), running away from home (3.0 [1.2-7.2]), suicidal ideation (2.5 [1.2-4.9]), and suicide attempts (3.0 [1.2-7.5]). CONCLUSIONS: Clinically, body piercing may serve as a marker for higher levels of peer substance use and potential problem behavior.

Adolescent↗