Growth charts for ethnic populations in UK.
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Body Height↗
Biomedical subjects
S Chinn
Publications and source records attributed to S Chinn.
Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances.
BACKGROUND: There is evidence from some studies that people living in homes with gas stoves and other unvented gas appliances experience more respiratory symptoms than those who use other fuels for cooking and heating, but other studies have found no such association. We have investigated whether the use of gas appliances is associated with an increased risk of respiratory symptoms and whether sensitisation to common environmental allergens modifies any such association. METHODS: A stratified random sample of 15,000 adults aged 20-44 years, living in three towns in East Anglia, UK, were sent a questionnaire on asthma and hayfever. From those who responded, a random sample of 1864 were invited to complete an extended questionnaire that included questions on use of gas appliances, to give blood samples for measurements of total IgE and specific IgE to common allergens, and to undergo tests of respiratory function, 659 women and 500 men agreed to an interview. The association of the use of gas appliances with respiratory symptoms, total IgE, specific IgE, and respiratory function was assessed by logistic and multiple regression models. FINDINGS: Women who reported they mainly used gas for cooking had an increased risk of several asthma-like symptoms during the past 12 months including wheeze (odds ratio 2.07 [95% CI 1.41-3.05]), waking with shortness of breath (2.32 [1.25-4.34]), and asthma attacks (2.60 [1.20 -5.6]). Gas cooking increased the risk of symptoms more in women who were atopic than in non-atopic women but the difference did not reach significance (p . 0.05). Women who used a gas stove or had an open gas fire had reduced lung function (forced expiratory volume in 1 s [FEV1]) and increased airways obstruction (FEV1 as a percentage of forced vital capacity) compared with women who did not. These associations were not observed in men. INTERPRETATION: In East Anglia, the use of gas cooking is significantly associated with subjective and objective markers of respiratory morbidity in women but not in men. Women may be more susceptible than men to the products of gas combustion or they may have greater exposure to high concentrations of these products because they cook more frequently than men.
Adult↗
Measuring atopy in a multi-centre epidemiological study.
Skin prick tests are used as a measure of atopy in epidemiological studies, but results may be influenced by the fieldworker performing the test. In a multi-centre epidemiological study the method of reporting the results should consider the need for comparability of findings from different centres. Data on over 1000 subjects from three English centres of the European Community Respiratory Health Survey were analysed to determine whether allergen wheal should be adjusted for histamine wheal, and what cutoff diameter gave the most comparable results. No consistent relation between allergen wheal diameter and histamine wheal diameter was found for any fieldworker or allergen. A cutoff of > 0 mm for a positive result gave a more consistent relation with the corresponding specific IgE value between fieldworkers than either a cutoff of > or = 3 mm or the use of the mean wheal diameter. While this result is not immediately generalisable to studies using different skin prick test reagents, the method of analysis to determine the appropriate criterion of reporting can be used in other epidemiological studies.
Adult↗
Family Credit and uptake of school meals in primary school.
BACKGROUND: In April 1988, Family Credit families lost their right to free school meals. They were compensated by an increase in Family Credit of 65p per child per schoolday, subsequently uprated by the retail price index. Families on Income Support continued to be entitled to free school meals. The impact of this legislation on the uptake of school meals has not been documented. METHODS: The uptake of school meals by Family Credit and income Support families over a decade was examined in two samples, each consisting of about 7000 English primary school children, one of "inner city' children and the other more representative of the whole population. RESULTS: The change in legislation resulted in an immediate drop in uptake by Family Credit children of around 30 per cent in both samples. By ethnic group, 42 per cent of the Asian Family Credit children changed from school meals compared with 10 per cent of the Afro-Caribbean children. Income Support children continued to have high uptake of about 90 per cent. By the early 1990s, half of the Family Credit children were not taking school meals, and the price of school meals was more than the allowance in 81 per cent of the areas in the representative sample, and in 45 per cent of the inner city areas. CONCLUSION: Uptake of school meals is very sensitive to changes in welfare policy. Monitoring the impact of these changes on children's health and welfare in families with low resources continues to be an important activity.
Child↗
Factors related to total cholesterol and blood pressure in British 9 year olds.
STUDY OBJECTIVE: To assess which factors are associated with total cholesterol concentration and blood pressure in 9 year olds, and to examine the extent to which a report of a heart attack in a close relative identifies children with a high total cholesterol value or high systolic blood pressure. DESIGN: This was a cross sectional study. SETTING: The analysis was based on 22 study areas from a representative English sample, 14 areas from a representative Scottish sample, and 20 areas from an inner city sample. PARTICIPANTS: There were 1987 children aged 8 or 9 whose blood pressure was measured and 1662 children whose total cholesterol was assessed. MEASUREMENTS AND MAIN RESULTS: Blood pressure was measured using the Dinamap 1846 automated sphygmomanometer and cholesterol using the Lipotrend C. Multiple regression analysis was used to examine the independent associations with each of the outcome variables. Either weight for height or sum of skinfolds measured in four sites was highly associated with the outcome measures in the study (p < 0.001). Fatter or overweight children had higher blood pressure and higher cholesterol concentrations. Child's height was also associated with the outcome measures in most of the analyses, but was positively related to blood pressure and negatively associated with cholesterol value. There was an association between diastolic blood pressure and area of residence as represented by the regional health authority (RHA), but the association was not the same as the association reported between coronary heart disease, standardised mortality ratio, and RHA. Children with low birth weight and those with shorter gestation had higher systolic blood pressure (p < 0.05 and p < 0.01 respectively), but not diastolic blood pressure. A report of a premature heart attack in a parent or a grandparent was not associated with higher cholesterol or blood pressure. CONCLUSIONS: Reducing obesity in children, together with the avoidance of smoking, may be an appropriate action to prevent coronary heart disease in adulthood. A report of heart disease in a close relative is an ineffective means of identifying children at greater risk of high cholesterol or blood pressure without other measurements from relatives.
Blood Pressure↗
Exercise-induced bronchoconstriction by ethnicity and presence of asthma in British nine year olds.
BACKGROUND: The prevalence of exercise-induced bronchoconstriction among British children by ethnicity has not been studied. METHODS: Peak expiratory flow rate (PEFR) was measured before and after an exercise challenge test using a cycle ergometer in 593 nine year olds from Scottish and inner city English schools. Logistic regression analysis was carried out to assess the association between changes in PEFR with exercise by reported asthma, ethnicity, and sex. RESULTS: The probability of exercise-induced bronchoconstriction was greater among the asthmatics than in either the children without asthma attacks or wheeze, or in the children with only wheeze (p < 0.01). Asian children were 3.6 times more likely to have exercise-induced bronchoconstriction than white inner city children, and also were more likely to have exercise-induced bronchoconstriction than those from the other ethnic groups (p < 0.01). CONCLUSION: Exercise challenge can assess the prevalence of asthma in the community and detect under-reporting of asthma in ethnic minorities.
Black or African American↗
Adjustment of reported prevalence of respiratory symptoms for non-response in a multi-centre health survey.
BACKGROUND: Estimation of non-response bias by modelling prevalence as a function of the number of mailings required to achieve a response, or of the cumulative response, has been advocated, but the models have not incorporated age and sex, differential response rates by age and sex, or season of response. METHODS: The effect on age-sex standardized prevalence of estimating non-response bias using a variety of models was investigated using data on nine symptom and medication questions from 13,007 subjects in the three English centres of the European Community Respiratory Health Survey. Comparison was made of goodness of fit and the prediction of responses in a 25% follow-up sample with the observed values. RESULTS: Despite low response rates in Cambridge and significant decreases in prevalence with additional mailings or increasing cumulative response in Norwich, there were only small effects on estimated age-sex standardized prevalences. No model was consistently better for any centre or question. CONCLUSIONS: The models are useful for exploring the sensitivity of estimated prevalence to non-response bias, but should be used with caution to adjust estimates. Ideally first mailings should be staggered over the whole year so that mailing and season are not confounded, and sufficient mailings or other contacts carried out for the whole sample to ensure a high response rate.
Adult↗
Monitoring the growth of children: conclusions from a long-term study.
BACKGROUND: The National Study of Health and Growth (NSHG) was set up in 1972 to monitor the growth of primary school children. Areas were selected in England and Scotland by stratified random sampling. Schools within these areas were visited annually until 1982, biennially thereafter, resulting in a mixed longitudinal design. The reasons for the original design and the study as it has operated are reviewed, with advantages and disadvantages compared to the monitoring system now to be implemented by the Department of Health. METHODS: Description of the statistical and interpretive problems of monitoring rates of growth and a comparison of the response rates achieved in the two types of monitoring. RESULTS: Although the design of the NSHG was selected in order to monitor rates of growth this presents statistical problems. The usable information is contained in trends in attained height rather than in rates of growth. This study has achieved an average response rate of over 95%; less than 78% can be expected from the proposed survey of households. CONCLUSIONS: The small loss of efficiency of the mixed longitudinal design compared with repeated cross-sectional studies is more than compensated for by its high response rate and the comparability of data over time, neither of which can be guaranteed by the proposed survey.
Body Height↗
Interpretation of measured red cell mass and plasma volume in adults: Expert Panel on Radionuclides of the International Council for Standardization in Haematology.
Four European centres provided height and weight data on 202 males and 204 females undergoing red cell mass (RCM) and plasma volume (PV) measurements. For these populations, the RCM and PV predictions by the various published methods were compared. It was shown clearly that predictions based solely on body weight were inappropriate, particularly because approximately half of the male and female populations could be regarded as overweight or obese. Although there was reasonable agreement in the prediction values given by the formulae based on both height and weight, it was not possible to establish which formulae could be recommended. For that reason, the published literature containing normal RCM and PV measurements were re-examined. RCM data for 283 males and 171 females and PV data for 100 males and 67 females were included. Measurements were standardized for variables such as trapped plasma in the PCV, exclusion of buffy coat in the PCV and calculation of PV at zero time. As a result of this analysis, prediction formulae based on surface area for RCM and PV with 98/99% reference ranges have been established.
Adult↗
The association of age, gender and smoking with total IgE and specific IgE.
BACKGROUND: Smoking has been identified as a risk factor for atopy but there are difficulties in interpreting many of the previous studies because the subjects who have been studied have not been representative of the entire population and because there is confounding between gender and smoking. OBJECTIVE: To investigate the association of age, gender and smoking with total IgE and specific IgE to house dust mite, grass and cat. METHODS: A stratified random sample of 20-44 year olds living in three centres in East Anglia and registered with a local general practitioner had blood taken for total immunoglobulin E (IgE) and specific IgE. A smoking history was obtained from a structured interviewer-led questionnaire. RESULTS: Among non-smokers geometric mean total IgE was higher in men than women but unrelated to age. Smoking explained less than 1% of the variation in total IgE. Smoking was associated with an increased risk of sensitization to house dust mite (odds ratio 1.59; 95% confidence interval 1.02-2.48) but a decreased risk of sensitization to grass (odds ratio 0.45; 95% confidence interval 0.28-0.71) and cat (odds ratio 0.47; 0.24-0.94). CONCLUSION: Men aged 20-44 years have higher total IgE levels than women of the same age. In young adults smoking explains little of the variation in total IgE and its association with sensitization to common allergens varies between allergens.
Adult↗
Cross sectional stature and weight reference curves for the UK, 1990.
The current reference curves of stature and weight for the UK were first published in 1966 and have been used ever since despite increasing concern that they may not adequately describe the growth of present day British children. Using current data from seven sources new reference curves have been estimated from birth to 20 years for children in 1990. The great majority of the data are nationally representative. The analysis used Cole's LMS method and has produced efficient estimates of the conventional centiles and gives a good fit to the data. These curves differ from the currently used curves at key ages for both stature and weight. In view of the concerns expressed about the current curves and the differences between them and the new curves, it is proposed that the curves presented here should be adopted as the new UK reference curves.
Adolescent↗
Body mass index centile charts to assess fatness of British children.
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Anthropometry↗
Physical fitness of 9 year olds in England: related factors.
STUDY OBJECTIVE: To examine the influence of social factors, passive smoking, and other parental health related factors, as well as anthropometric and other measurements on children's cardiorespiratory fitness. DESIGN: This was a cross sectional study. SETTING: The analysis was based on 22 health areas in England. PARTICIPANTS: The subjects were 299 boys and 282 girls aged 8 to 9 years. Parents did not give positive consent for 15% of the eligible sample. A further 25% of the eligible sample did not participate because the cycle-ergometer broke down, study time was insufficient, or they were excluded from the analysis because they were from ethnic minority groups or had missing data on one continuous variable. MEASUREMENTS AND MAIN RESULTS: Cardiorespiratory fitness was determined using the cycle-ergometer test. It was measured in terms of PWC85%-that is, power output per body weight (watt/kg) assessed at 85% of maximum heart rate. The association between children's fitness and biological and social factors was analysed in two stages. Firstly, multiple logistic analysis was used to examine the factors associated with the children's ability to complete the test for at least four minutes. Secondly, multiple linear regression analysis was used to examine the independent association of the factors with PWC85%. In the logistic analysis, shorter children, children with higher blood pressure, and boys with a larger sibship size had poorer fitness. In the multiple regression analysis, only height (p < 0.001) was positively associated, and the sum of skinfold thicknesses at four sites (p = 0.001) was negatively associated with fitness in both sexes. In girls, a positive association was found with pre-exercise peak expiratory flow rate (p < 0.05), and there were negative associations with systolic blood pressure (p < 0.05) and family history of heart attack (p < 0.05). In boys an association was found with skinfold distribution and fitness (p < 0.05), so that children with relatively less body fat were fitter. Social and health behaviour factors such as father's social class, father's employment status, or parents' smoking habits were unrelated to child's fitness. CONCLUSION: Height and obesity are strongly associated, and systolic blood pressure to a small extent, with children's fitness, but social factors are unrelated.
Blood Pressure↗
Factors associated with weight for height and skinfold thickness in British children.
STUDY OBJECTIVE: To examine the associations of social and biological factors with measures of obesity in children. DESIGN: The study had a cross sectional design. SETTING: The analyses were based on data from two national study of health and growth cross sectional surveys. The "representative sample" comprised 1990 data from 22 English areas and 1990-91 data from 14 Scottish areas; the "inner city sample" comprised 1991 data from 20 English areas. PARTICIPANTS: The subjects were primary school children aged mainly 5-11 years living in England and Scotland. The "representative" sample included 10,628 children--6463 living in England and 4165 living in Scotland. The "inner city" sample included 7049 children--2183 white, 1124 Afro-Caribbean, 2696 Indian subcontinent, and 1046 from other groups. Due to missing values on continuous variables, 8374 children were included in the analyses. MEASUREMENTS AND MAIN RESULTS: The relation between social environment and childhood overweight was studied using several indicators of obesity. Triceps, subscapular, the sum of triceps and subscapular skinfolds, and weight for height were used as dependent variables. The analyses were carried out in two stages. Firstly, multiple linear regression analyses were used to assess the factors associated with dependent variables treated as continuous. Secondly, multiple linear logistic regression analyses were used to examine the association between independent factors and overweight and fatness defined as binary variables. Birth weight, mother's body mass index (BMI), and father's BMI were consistently associated (p < 0.001) in all models and were the variables that contributed most to the explained variation in the dependent variables. In the multiple regression analyses there was a consistent interaction between the effects of ethnic origin and family size on each outcome variable. In the logistic regression analyses the interaction was not significant, and highly significant associations between both overweight and fatness with the number of children were shown. Ethnic group was not significantly associated with overweight but it was with fatness. The strengths of the remaining significant associations were slight and inconsistent in relation to the dependent variables or the type of analysis. CONCLUSION: Very few variables were associated with measures of overweight and fatness. The only useful factor that was highly associated with all measures of fatness was the parents' BMI. Strategies to prevent childhood obesity should be aimed at the total population and special emphasis should be placed on families in which one or both parents are overweight.
Birth Weight↗
Trends in the prevalence of asthma in Scottish and English primary school children 1982-92.
BACKGROUND: Some doubts exist as to whether the increase in the prevalence of asthma is real or an artefact. The 10 year trend of asthma up to 1993 in England and Scotland was therefore assessed. METHODS: Information on asthma and bronchitis attacks, occasional wheeze, and persistent wheeze in the last 12 months, was obtained using a self administered questionnaire completed by the parents. Exactly the same questions were asked in 14 study areas in Scotland and 22 study areas in England in 1982 or 1983 and in 1992 or 1993 in 5-11 year old children. RESULTS: The numbers of children with data for all respiratory illness were 5556 (85.2%) and 5801 (87.1%) in England and 3748 (90.4%) and 3738 (90.4%) in Scotland in 1982 and 1992, respectively. There was a significant increase in asthma attacks (approximately three times more in 1992 than in 1982) and occasional wheeze (30-60% more in 1992 than in 1982) in both sexes in England and Scotland. Persistent wheeze also increased in both countries, but the increase was significant only in England (30-40% more in 1992 than in 1982). CONCLUSIONS: The study coincides with others that suggest that the increased prevalence of asthma may be due, in part, to changes in diagnostic behaviour. However, the continuing increase of persistent wheeze in the total sample suggests that part of the increase is real. There was no difference in the increase of persistent wheeze between Scotland and England, but the trend was only significant in England.
Asthma↗
Genetic and environmental influences on growth.
OBJECTIVES: To provide an overview of the factors associated with growth in primary school children in England and Scotland and to provide information about the secular trend of growth in the last 20 years. SETTING: Representative English and Scottish samples and an English inner city sample. METHODS: The study had a mixed longitudinal design from 1972 to 1994. Between 8000 and 10,000 children participated in each survey. Height was measured in at least 95% of the children in most surveys, and 75% to 85% of parents provided information about family background. Main results are based on published information. Multiple regression was used for most of the analyses. RESULTS: Parents' height, child's birth weight, mother's age at child's delivery, ethnic background and, in white children, family size are the only factors markedly associated with height. Variables that have traditionally been used to assess the possible effect of social conditions were generally not associated with height. The height increase was more marked in Scotland than England over the period 1972 to 1990, and the differences in height of children in the two countries is now minimal. CONCLUSIONS: Most factors cannot be neatly classified as purely genetic or environmental, but seem to indicate that genes are relatively more important. Social factors usually assessed in growth studies do not have an important effect on growth. The marked increase of height over time indicates that the environment and social conditions have allowed children to grow taller. Sibship size is the only factor that was shown to be related to the secular trend in growth.
Adult↗
Trends in weight-for-height and triceps skinfold thickness for English and Scottish children, 1972-1982 and 1982-1990.
Data from the 1972, 1982 and 1990 surveys of the National Study of Health and Growth were used to calculate changes in height, weight, triceps skinfold thickness and weight-for-height index for children aged between 4.5 and 11.99 years. There were data for 7887, 6396 and 6420 white English children in the 3 years respectively, and data for 1586, 1191 and 1317 Scottish children. Increases in all measurements were found from 1972 to 1990, except for weight-for-height in English boys, and were generally greater from 1982 to 1990 than from 1972 to 1982. Approximately a third of the increases in weight-for-height and triceps skinfold thickness from 1972 to 1990 were associated with increases in parental body mass indices and decreases in family size. No consistent differences in trends were found between social groups. Greater trends were found for girls and for Scottish children, and Scottish boys are now heavier and fatter than their English counterparts. Trends in weight-for-height and fatness may have implications for future trends in coronary heart disease, and lessen the likelihood that the targets for reductions in obesity in the White Paper Health of the Nation will be met. Preventive measures should be directed at the entire population.
Body Height↗
Response to venepuncture for monitoring in primary schools.
The feasibility and acceptability of collecting blood from children by venepuncture was assessed in a sample of 593 children from seven primary schools in Canterbury. Venepuncture is necessary to obtain blood for the measurement of haemoglobin, ferritin, and cholesterol in line with Department of Health surveys in England. Return of consent forms was 87%; 75% of parents in the total sample allowed their child to be tested. Response rates differed between schools. Only 4% of eligible children refused to participate at the time of testing. In 22 (3.7%) children a blood sample could not be obtained or the volume was insufficient for analysis. There was a significant difference in the failure rate between phlebotomists. Venepuncture in the school setting was technically feasible and acceptable. The reluctance of some groups in the community to participate may bias the sample.
Bloodletting↗