TV or not TV: fat is the question.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
S L Gortmaker
Publications and source records attributed to S L Gortmaker.
Issues involved in the definition and classification of chronic health conditions.
The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.
Child↗
Recent trends in the prevalence and severity of childhood asthma.
OBJECTIVE: To examine changes in the prevalence and distribution of childhood asthma and its relationship with various measures of children's health and functioning between 1981 and 1988. It was hypothesized that there would be an increase in the prevalence of asthma, especially among black children, and that available measures would suggest a deterioration in the health and functioning of children with asthma over this period. DESIGN: Analyses of data from the Child Health Supplements to the National Health Interview Survey. SETTING AND SAMPLE: Nationally representative random sample of 15,224 children aged 0 to 17 years in 1981 and 17,110 in 1988. MAIN OUTCOME MEASURES: Changes in (1) the prevalence and distribution of asthma, and (2) among children with asthma, the percentage of children hospitalized, days spent in bed, school days lost in the year prior to survey, and parent ratings and reports of children's overall health status and behavior problems. RESULTS: The estimated prevalence of childhood asthma increased from 3.1% in 1981 to 4.3% in 1988 (P < .0001), with similar increases for children, adolescents, and both sexes. Increases occurred among white children (2.7% to 4.1%; P < .0001) but not black children (5.3% vs 5.1%; not significant). Among those with asthma in 1988 compared with 1981, there was better overall health status (11% vs 24% fair/poor; P < .0001) and fewer with 30 or more days spent in bed in the last year (3.9% vs 7.2%; P < .04). We also observed trends toward a lower rate of hospitalization in the last year (10% vs 14%; P = .07), fewer school days missed (2% vs 6% with > 30 days; P = .08), and a lower rate of extreme behavior problem scores (13% vs 18%; P = .09) in 1988 compared with 1981. Reductions were similar among both black and white children. CONCLUSIONS: These results indicate that the estimated prevalence of asthma among children in the United States increased by almost 40%, and that although the increase occurred exclusively among white children, the prevalence of asthma still remains higher in black children than in white children. There was no support for increasing asthma severity and functional impact among either black or white children with asthma in 1988 compared with 1981. These findings provide no evidence to support the beliefs that asthma prevalence is increasing largely among black children or that the severity of asthma among most children in the United States is increasing.
Adolescent↗
Clinical determinants of the racial disparity in very low birth weight.
BACKGROUND: Although the risk of very low birth weight (less than 1500 g) is more than twice as high among blacks as among whites in the United States, the clinical conditions associated with this disparity remain poorly explored. METHODS AND RESULTS: We reviewed the medical records of over 98 percent of all infants weighing 500 to 1499 g who were born in Boston during the period 1980 through 1985 (687 infants), in St. Louis in 1985 and 1986 (397 infants), and in two health districts in Mississippi in 1984 and 1985 (215 infants). The medical records of the infants' mothers were also reviewed. These data were linked to birth-certificate files. During the study periods, there were 49,196 live births in Boston, 16,232 in St. Louis, and 16,332 in the Mississippi districts. The relative risk of very low birth weight among black infants as compared with white infants ranged from 2.3 to 3.2 in the three areas. The higher proportion of black infants with very low birth weights was related to an elevated risk in their mothers of major conditions associated with very low birth weight, primarily chorioamnionitis or premature rupture of the amniotic membrane (associated with 38.0 percent of the excess proportion of black infants with very low birth weights [95 percent confidence interval, 31.3 to 45.4 percent]); idiopathic preterm labor (20.9 percent of the excess [95 percent confidence interval, 16.0 to 26.4 percent]); hypertensive disorders (12.3 percent [95 percent confidence interval, 8.6 to 16.6]); and hemorrhage (9.8 percent [95 percent confidence interval, 5.5 to 13.5]). CONCLUSIONS: The higher proportion of black infants with very low birth weights is associated with a greater frequency of all major maternal conditions precipitating delivery among black women. Reductions in the disparity in birth weight between blacks and whites are not likely to result from any single clinical intervention but, rather, from comprehensive preventive strategies.
Black or African American↗
Improving the psychological status of children with asthma: a randomized controlled trial.
Children with asthma are at special risk for problems in psychological functioning, as are children with other chronic illnesses. We conducted a controlled trial of a combined education and stress management program among children ages 6 to 14 years with asthma. Eighty-one children were randomly assigned to an intervention or a control group; 56 children completed data collection, 29 intervention and 27 control. Psychological status was assessed by the Child Behavior Checklist (CBCL) before and after the intervention, as were children's knowledge of asthma, stress (as measured by children's life events), and functional status (as indicated by such activities as school attendance, time playing with friends, and daily chore performance). Children in the intervention group had a significant improvement in the total Behavior Problems score (p less than .04) and Internalizing scale (p less than .01) on the CBCL and a significant increase in daily chores (p less than .04) compared with the control group. Before intervention, the two groups had statistically significant positive relationships between negative life events and behavior problems scores. After intervention, children in the control group still demonstrated a significant relationship between negative life events and total and Internalizing Behavior Problem scores, although participation in the intervention group negated that relationship. Children in the intervention group whose knowledge of asthma increased were more likely to report an increase in daily chores (p less than .02). We conclude that the intervention had a beneficial effect on psychological status and on children's daily activities. The effect may have occurred in part by decreasing the likelihood that perceived stress from negative life events led to poorer adjustment.
Adaptation, Psychological↗
HIV-1 seropositivity and behavioral and sociological risks among homosexual and bisexual men in six Mexican cities.
We report on the epidemiology of sexual behaviors, HIV-1 seroprevalence, and condom use in gay and bisexual men in six Mexican cities in 1988 and test the extent to which variations in sexual behavior and sociological risks are responsible for variations in prevalence. Seroprevalence rates among samples in six cities ranged from 2% to 25%. In multiple logistic regression models controlling for city, insertive/receptive behavior (IRB), and meeting partners in bathhouses, the following were independently related to seropositivity (p less than 0.05): city, IRB, syphilis, sex with a person with AIDS, and meeting partners in bathouses. The independent risks associated with categories of IRB were no or almost no activity (odds ratio 1.0), only insertive (3.0), mostly insertive (4.9), mixed (6.0), mostly receptive (3.3), and only receptive (0.9). The condom use rate on last sexual encounter was 30%. The main sexual risk for HIV-1 infection is not exclusively receptive anal sex, but rather mixed behavior. This association may be explained by the infectious state of the partner pools. The sociologic risk variables (national and local partner pools) are better predictors of seroprevalence than behavioral variables, such as the number of partners or use of condoms. These results imply that more effective individual strategies for risk reduction are needed, including better knowledge concerning the risk status of partners.
Adolescent↗
Very low birth weight children: behavior problems and school difficulty in a national sample.
We addressed three questions concerning the behavioral and academic status of low and very low birth weight infants through a secondary analysis of the 1981 National Health Interview Survey--Child Health Supplement: (1) in children born with very low birth weight, what is the risk of behavior problems and school difficulty compared with that in heavier low birth weight and normal birth weight children? (2) What are the correlates of school difficulty? (3) Are behavior problems associated with school difficulty when variables are controlled for these correlates? The analysis revealed that 34% of very low birth weight children could be characterized as having school difficulty, compared with 20% and 14% of the other groups, respectively, and that they were more likely to have higher scores on the hyperactive subscale of the Behavior Problems Index. Although a broad array of sociodemographic factors correlated with school difficulty, very low birth weight and hyperactivity scores contributed independently to the risk of academic problems. We conclude that very low birth weight infants are at risk of having school problems that are in part associated with hyperactive behavior.
Adolescent↗
Re: "Secular trends in body mass in the United States, 1960-1980".
Explore the source record for details and available documents.
Adolescent↗
Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.
Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11,699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions--particularly mental health services--remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.
Adolescent↗
Inactivity, diet, and the fattening of America.
Recent studies have documented an increasing prevalence of childhood and adolescent obesity in the United States. These increases will likely result in increased adult obesity because of the tracking of fatness from adolescence into adulthood and the tendency for adults in the United States to become obese as they age. We have identified television viewing as a strong risk factor for childhood and adolescent obesity. Television viewing is associated with both the onset of obesity and a decrease in the remission of obesity and acts by decreasing activity levels and possibly influencing diet. Logistic regressions also document associations between television viewing and obesity among adults. These relationships are greater than those estimated between measures of vigorous physical activity and obesity and indicate the importance of inactivity, to which television viewing contributes substantially. Population dietary intake data indicated no statistically significant change and perhaps some decrease in mean energy intake among children and youth during the same period that obesity was increasing. These data are consistent with the hypothesis that decreases in activity reduce lean body mass and lower energy requirements. We conclude that multiple intervention approaches involving diet, exercise, and restriction of television viewing and other sedentary activities all appear necessary to halt the fattening of America.
Adolescent↗
A successful experiment to reduce unnecessary laboratory use in a community hospital.
A series of interventions at a 228-bed general hospital provided physicians with feedback at regular intervals concerning the amount of laboratory services employed in treating their patients. Case-mix-adjusted estimates of laboratory tests allowed each physician to compare use of laboratory tests with that of peers in the same department at the same hospital. Physicians with "excess" practice patterns ordered hundreds more laboratory tests than average each year. A multifaceted educational program included the following: 1) meetings were held concerning costs and unnecessary laboratory tests; 2) physicians were given descriptions of their practice patterns relative to their peers as part of both large and small departmental discussions; 3) the feedback was repeated a year later; 4) a consensus conference established guidelines for test ordering; and 5) a sample of patient records was examined for appropriateness of laboratory test ordering. A total of 37% of a sample of tests ordered during the baseline period by physicians with "excess" practice patterns was classified as inappropriate. The intervention resulted in a reduction of 1.8 tests per patient (P = 0.0005). Eight of the nine tests individually showed reductions in use. Charge data from the target hospital showed a statistically significant reduction in laboratory charges per patient in the quarter following program initiation (P = 0.02) and no evidence for change in a group of five comparison hospitals. There was no evidence for reductions in the ordering of essential tests. These results demonstrate a cost-effective approach to reducing unnecessary costs that can be implemented in hospitals with integrated data systems.
Clinical Laboratory Techniques↗
Severity of illness: concepts and measurements.
Explore the source record for details and available documents.
Activities of Daily Living↗
Increasing pediatric obesity in the United States.
Data from four national surveys indicate pronounced increases in the prevalence of pediatric obesity in the United States. Obese children are defined as those with triceps skinfolds greater than or equal to the 85th percentile of children of the same age and sex in 1963 to 1970. Superobese children are those with skinfolds greater than or equal to the 95th percentile. Compared with skinfold data from the 1963 to 1965 National Health Examination Survey, cycle 2, skinfold data from the second National Health and Nutrition Examination Survey, conducted from 1976 to 1980, indicate a 54% increase in the prevalence of obesity among children 6 to 11 years old and a 98% increase in the prevalence of superobesity. Compared with skinfold data from the 1966 to 1970 National Health Examination Survey, cycle 3, skinfold data from the second National Health and Nutrition Examination Survey indicate a 39% increase in the prevalence of obesity among children 12 to 17 years old and a 64% increase in the prevalence of superobesity. Increases occurred among children of all ages and both sexes and for both blacks and whites. Blood pressure data from the four surveys suggest that the share of pediatric hypertension associated with obesity has increased. Such rapid increases in obesity indicate that environmental causes are likely responsible.
Adolescent↗
Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.
The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonatal mortality rates did not increase in the target areas following initiation of RICP, indicating that deaths were not merely being postponed. Nine of ten individual sites showed reductions in infant mortality following program initiation. Birthweight-specific mortality data indicated that the decline was due mainly to reductions in neonatal mortality among low-birthweight infants. No reductions in the incidence of low birthweight were observed in the target areas. Substantial gaps in the delivery of prenatal care remained due to the continuing poverty of the population and the resultant lack of financial coverage for health services. We conclude that improved perinatal medical care can reduce infant mortality in poor rural areas to average levels experienced in the United States, and that the high rates still observed in some rural counties are unnecessary.
Black or African American↗
Do we fatten our children at the television set? Obesity and television viewing in children and adolescents.
The association of television viewing and obesity in data collected during cycles II and III of the National Health Examination Survey was examined. Cycle II examined 6,965 children aged 6 to 11 years and cycle III examined 6,671 children aged 12 to 17 years. Included in the cycle III sample were 2,153 subjects previously studied during cycle II. These surveys, therefore, provided two cross-sectional samples and one prospective sample. In all three samples, significant associations of the time spent watching television and the prevalence of obesity were observed. In 12- to 17-year-old adolescents, the prevalence of obesity increased by 2% for each additional hour of television viewed. The associations persisted when controlled for prior obesity, region, season, population density, race, socioeconomic class, and a variety of other family variables. The consistency, temporal sequence, strength, and specificity of the associations suggest that television viewing may cause obesity in at least some children and adolescents. The potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis.
Adolescent↗
Chronic childhood disorders: prevalence and impact.
Explore the source record for details and available documents.
Adolescent↗
Factors within the physical environment associated with childhood obesity.
The relationship of obesity to environmental factors such as season, region, and population density was examined in children studied during cycle II of the National Health Examination Survey. This survey selected 7119 children aged 6 to 11 yr old from a representative noninstitutionalized sample of the United States population. The prevalence of obesity (triceps skinfold more than the 85th percentile) was significantly more in the Northeast and Midwest than in the West and significantly more in large metropolitan areas than in areas with lower population densities. The prevalence of obesity was generally lowest in the summer and highest in the fall or winter. Each environmental variable was associated with 2- to 3-fold variations in the prevalence of obesity. The effect of region, population density, and season appeared independent of race and socioeconomic status. Similar relationships were found for superobesity (triceps skinfold more than the 95th percentile). These results emphasize that environmental variables significantly affect the prevalence of obesity and could help account for the wide variations in prevalence that have been previously published. Understanding the mechanisms by which the environment affects childhood obesity may improve the effectiveness of community level interventions.
Child↗
Parental smoking and the risk of childhood asthma.
Data from two random population surveys are used to assess the relationship between parental smoking and the prevalence of asthma in children aged 0-17. Data from a 1977 Midwestern urbanized county indicate that, if mothers smoked, the prevalence of parent reported asthma increased from 5.0 per cent to 7.7 per cent (estimated relative risk of 1.5), and the prevalence of functionally impairing asthma increased from 1.1 per cent to 2.2 per cent (relative risk of 2.0). In a more rural Eastern county in 1980, a lower overall prevalence of asthma was noted. However, similar estimated relative risks of asthma (1.8) and functionally impairing asthma (2.4) were found to be associated with maternal smoking. Inconsistent relationships were found between the estimated prevalence of asthma and paternal smoking. When multivariate controls were introduced, the relationships between maternal smoking and asthma persisted. Estimated attributable risks indicate that between 18 per cent and 34 per cent of the asthma reported in these samples can be attributed to maternal smoking. Implications of these findings for primary care physicians are discussed.
Adolescent↗