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S Shea

Publications and source records attributed to S Shea.

At least 73 records · Page 4Linked to original sources
PubMed1994

5-A-DAY: dietary behavior and the fruit and vegetable intake of Latino children.

OBJECTIVES: The purpose of the study was to examine children's intake of fruits and vegetables in relation to the recent national "5-A-DAY" campaign. METHODS: Four 24-hour dietary recalls per child collected from 205 mothers of 4- to 5-year-old urban Latino children were used to analyze average 5-A-DAY fruit and vegetable consumption and examine associations between 5-A-DAY consumption, nutrient intakes, and eating patterns. RESULTS: The reported mean servings per day of fruits and vegetables, as defined by 5-A-DAY criteria, were 1.8 and 1.0, respectively, with only 6.8% (n = 14) of the children averaging five or more servings per day. Fruit juice accounted for 36% of 5-A-DAY servings. There were significant linear trends in intake of vitamins A and C, potassium, iron, cholesterol, protein, and fiber across quintiles of 5-A-DAY intake. There were no differences among quintiles in intake of saturated or total fat or in servings from most non-5-A-DAY food groups. CONCLUSIONS: Latino children's intake of fruits and vegetables falls far short of current recommendations. Fruit juice accounted for a disproportionate amount of 5-A-DAY intake in this population. Sensible 5-A-DAY interventions should take into consideration the existing eating patterns of the target population.

Child, Preschool↗
PubMed1994

The reproducibility of data from a Food Frequency Questionnaire among low-income Latina mothers and their children.

We examined the 3-month and 1-year reproducibility of mothers' and children's dietary intakes of calories and 11 nutrients derived from oral administrations of a food frequency questionnaire to 166 Latina women. One-year correlations generally ranged from 0.40 to 0.55 for both mothers and children. For most nutrients, roughly half the children in the highest (lowest) quartile of intake at baseline were also in the highest (lowest) quartile 1 year later. The food frequency questionnaire has great potential for measuring typical nutrient intakes in these populations.

Child↗
PubMed1994

The rate of increase in blood pressure in children 5 years of age is related to changes in aerobic fitness and body mass index.

OBJECTIVE: To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children. STUDY DESIGN: Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19.7 months. Aerobic fitness was assessed using a treadmill. All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study. SETTING: An inner-city medical center. OUTCOME MEASURES: Blood pressure was measured using an automated Dinamap device. RESULTS: Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P < .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02). CONCLUSION: Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.

Age Factors↗
PubMed1994

Assessing changes in nutrient intakes of preschool children: comparison of 24-hour dietary recall and food frequency methods.

Methods for assessing change in the habitual diet of children are essential for diet intervention studies as well as clinical management. Food frequency questionnaires are a potential alternative to recall and record methods, which require multiple days of data collection for stable individual estimates of habitual intake. Over 3 years, we studied 173 children (93% Hispanic; baseline age 44-60 months) in New York City. We obtained dietary data by interviewing the child's mother. We calculated intakes of nine nutrients, expressed as nutrient densities, as the mean of two administrations of the Willett food frequency questionnaire and the mean of three administrations of the 24-hour dietary recall in years 1 and 3. The two methods consistently estimated the direction of change in mean nutrient density of total and polyunsaturated fat, cholesterol, carbohydrate, and potassium. Changes in nutrient density assessed by the two methods correlated poorly (r < or = 0.15) for all nine nutrients. Cross-classification analysis also showed no relation between change assessed by recall and food frequency methods. Lack of between-person variability could not explain the low correlations, as individual changes in nutrient density were large.

Child Nutritional Physiological Phenomena↗
PubMed1993

The role of "indirect" recognition in initiating rejection of skin grafts from major histocompatibility complex class II-deficient mice.

In vitro studies have revealed several pathways by which T cells can respond to alloantigens, including CD4+ direct responses to allogeneic class II antigens, CD8+ direct responses to allogeneic class I antigens, and CD4+ "indirect" responses to peptides of alloantigens presented in association with responder class II molecules. In vivo studies of skin graft rejection, however, have so far provided clear evidence for the contribution of only the two direct pathways and not for indirect recognition. We have used major histocompatibility complex class II-deficient mice as donors to test the role of indirect recognition in rejection of skin grafts. Class II-deficient skin was always rejected without delay by normal recipients. Removal of recipient CD8+ cells (to leave the animals dependent on CD4+ function) or depletion of recipient CD4+ cells revealed that CD4+ cells were usually involved and sometimes absolutely required in this rapid rejection. Since the donor grafts lacked class II antigens, the CD4+ cells must have recognized donor antigens presented in association with recipient class II molecules. These results therefore indicate that indirect recognition can initiate rapid skin graft rejection.

Animals↗
PubMed1993

Age, sex, educational attainment, and race/ethnicity in relation to consumption of specific foods contributing to the atherogenic potential of diet.

BACKGROUND: We examined which specific foods contributed to the atherogenic potential of diet in population segments defined by age, sex, educational attainment, and race/ethnicity. Data from the 1989 New York State Healthy Heart Program baseline survey were analyzed. METHODS: This telephone survey was conducted in eight communities (total population approximately 1.24 million people) in New York State. Response rate was 65.5% (N = 4,179); 3,606 subjects ages 20 to 64 years who reported their level of educational attainment with self-described ethnicity of white (N = 1,935), black (N = 1,035), or Hispanic (N = 636) were retained in the analysis. Diet was assessed using a 17-item food frequency questionnaire which focused on commonly eaten food high in saturated fat and cholesterol. Connor's cholesterol/saturated-fat index was used as a scale of the atherogenic potential of the diet. RESULTS: Eggs, whole milk, cheese, beef, and butter/margarine were the foods contributing most to the cholesterol/saturated-fat index score in all age-, sex-, and race/ethnicity-specific population segments examined, together contributing a total of 52 to 72% of the cholesterol/saturated-fat index score as measured by the 17-item diet questionnaire. CONCLUSIONS: The implication for public health campaigns directed at reducing the atherogenic potential of diet atherogenicity and for primary care practitioners seeking to influence the diet of patients with high blood cholesterol is that substitutions of less atherogenic food choices for these five foods would appear to be appropriate for most adults.

Adult↗
PubMed1993

Relationship of mothers' food choice criteria to food intake of preschool children: identification of family subgroups.

This study investigated the relationship between potential criteria mothers use to select foods for their children, their food knowledge, and food consumption of their children. Participants were 218 predominantly Latino mothers and their 4 to 5-year-old children. Mothers rated 17 foods in terms of 10 food attributes (how tasty specific foods were to their child, whether they were convenient to prepare, etc.). Within-person correlation coefficients were then calculated between these ratings and reported frequency of consumption of these same 17 foods. These correlations were then used in a k-means cluster analysis to identify six distinct subgroups of families, who had different orientations ranging from "high health" to "high taste." Children in the "high health" groups had diets significantly lower in calories, fat, saturated fat, and sucrose and higher in fiber and vitamin A from 24-hour dietary recalls reported by mothers. Mothers' health knowledge was also correlated with nutrient takes of children. These data indicate that families can be segmented according to the importance of beliefs about healthfulness of foods and that this segmentation predicts quality of diet of children. This study suggests that interventions should be designed to increase mothers beliefs in the importance of health in choosing foods. For those mothers whose food choices are dominated by children's tastes, interventions should be directed at how to prepare healthful foods to taste good to children.

Adult↗
PubMed1993

The Behavioral Risk Factor Surveillance System questionnaire: its reliability in a statewide sample.

The reliability of the Behavioral Risk Factor Surveillance System questionnaire was assessed in a random sample of adults (n = 122) and a separate sample of Black and Hispanic adults (n = 200) in Massachusetts. The questionnaire was administered twice, 21 to 44 days apart, by telephone (210 completed reinterviews, 65% response rate for second administration). There were no statistically significant differences in the distribution of demographic or risk factor variables across administrations. Individual-level reliability (kappa for categorical variables, correlation for continuous variables) for demographic characteristics was more than 0.80 for White respondents and more than 0.60 for Black and Hispanic respondents. Employment and income were reported less consistently than other variables. Reliability coefficients for behavioral risk factors were generally above 0.70. Exceptions were variables with extreme distributions. These data support the use of the Behavioral Risk Factor Surveillance System questionnaire for surveillance and research.

Adult↗
PubMed1993

Is there a relationship between dietary fat and stature or growth in children three to five years of age?

STUDY OBJECTIVE: To determine whether a moderately reduced fat diet affects the stature or growth of healthy preschool children. DESIGN: Cohort study with mean of 25 months of follow-up. SETTING: Primary care pediatrics practice at a large urban medical center. SUBJECTS: A predominantly Hispanic group of 215 children aged 3 to 4 years at baseline. MEASUREMENTS AND MAIN RESULTS: The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C. CONCLUSIONS: These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.

Body Height↗
PubMed1992

Blood pressure reactivity does not correlate with baseline blood pressure or blood pressure change over time in preschool children.

Few studies have examined the relation of blood pressure reactivity to subsequent change in blood pressure of preschool children. The authors investigated relations between measurement-induced reactivity, exercise reactivity, and change in blood pressure over 16 months among 140 preschool children (46-67 months of age at baseline, 50.7% female, 92.9% Hispanic). Within-session measurement-induced reactivity was defined as the change in blood pressure between the first and the mean of the fourth and fifth readings obtained at each of 11 sessions. Between-session measurement-induced reactivity was defined as the change between mean blood pressure at session 1 and the mean of sessions 2 and 3. Both indices of measurement reactivity displayed poor reproducibility. Exercise reactivity was measured using a treadmill on two occasions and was moderately reproducible. There was no association between measurement and exercise reactivity. The change in systolic blood pressure over time was not associated with any measure of reactivity. The mean diastolic blood pressure did not change over the study period. Neither blood pressure reactivity to measurement nor blood pressure reactivity to exercise appeared to be a useful predictor of change in blood pressure in preschool children during a 16-month period.

Blood Pressure↗
PubMed1992

Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population.

BACKGROUND: Hypertensive emergency and urgent hypertension are the most severe forms of uncontrolled hypertension and are now seen predominantly in poor, minority populations. We studied the characteristics of the medical care received by patients with these conditions in order to identify risk factors for severe, uncontrolled hypertension. METHODS: Using a case-control study design, we interviewed 93 patients with severe, uncontrolled hypertension who presented in the hospital emergency room and 114 control patients with hypertension; both groups were seen at two New York City hospitals from 1989 through 1991. All the patients were black or Hispanic. Multiple logistic-regression models were used to adjust for age, sex, race or ethnic background, education, smoking status, alcohol-related problems, and use of illicit drugs during the previous year. RESULTS: After additional adjustment for lack of health insurance, severe, uncontrolled hypertension was found to be more common among patients who had no primary care physician (adjusted odds ratio, 3.5; 95 percent confidence interval, 1.6 to 7.7) and among those who did not comply with treatment for their hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 1.4 to 2.5). Lack of health insurance was marginally associated with severe, uncontrolled hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 0.8 to 4.6) after adjustment for lack of a primary care physician and noncompliance with antihypertensive treatment. Patients without a primary care physician and without health insurance were more likely to have their blood pressure checked and receive prescriptions for blood-pressure medications in emergency rooms than in physicians' offices or clinics. CONCLUSIONS: Characteristics of both the health care system and patients' behavior are associated with severe, uncontrolled hypertension. Improving access to primary care physicians, through health insurance or other means, may be an effective strategy for improving control of hypertension in disadvantaged minority populations.

Adult↗
PubMed1992

Consistency of the Willett semiquantitative food frequency questionnaire and 24-hour dietary recalls in estimating nutrient intakes of preschool children.

A study was performed to determine the utility of the Willett semiquantitative food frequency questionnaire for assessing the habitual diets of preschool children. Children (n = 224) were recruited mainly through a New York City hospital-based pediatric practice during 1986-1987. The children's ages at baseline were 44-60 months; 50% were male, and 91% were Hispanic. Over a 12-month period, the Willett food frequency questionnaire was administered twice to each child's parent, and a 24-hour dietary recall was conducted four times. For energy and eight nutrients, group mean intakes derived from food frequency questionnaires were 1.4-1.9 times higher than those from 24-hour recalls. Group mean estimates of nutrient density of total and saturated fat, potassium, and calcium did not differ between the two methods. Correlations between methods for crude nutrient intakes (unadjusted for energy consumption) ranged from 0.16 (polyunsaturated fat in boys) to 0.60 (potassium in girls). Correlations generally decreased when intakes were adjusted for energy consumption. Adjustment for energy intake and residual intraindividual variability yielded correlations of 0.48 for total calories, 0.35 for total fat, and 0.37 for saturated fat. For intake of energy and nine nutrients, of those children classified into the highest quintile by dietary recall, 28.9-40.9% were so classified by the Willett questionnaire, and 48.9-68.9% were classified into the highest two quintiles. When data were expressed as nutrient densities, agreement was high for potassium and calcium and fair for saturated fat, cholesterol, and protein. The moderately low consistency of nutrient intake estimates across dietary assessment methods in this study may be due, in large part, to residual intraindividual variability in both the recall data and the food frequency data.

Child, Preschool↗
PubMed1992

The Washington Heights-Inwood Healthy Heart Program: a third generation community-based cardiovascular disease prevention program in a disadvantaged urban setting.

The Washington Heights-Inwood Healthy Heart Program (WHIHHP) is part of the New York State Healthy Heart Program, which comprises eight community-based programs in different areas of the state. WHIHHP is directed at a population of approximately 200,000 people, predominantly Hispanic and of low socioeconomic status, living in northern Manhattan in New York City. The initial 3 years of experience are presented. Six potential barriers to diffusion of the community-based disease prevention model in disadvantaged inner city communities are discussed: (a) issues of scale and complexity; (b) adaptation of this model to a "community" without geopolitical boundaries or infrastructure; (c) linguistic and cultural diversity; (d) competing problems; (e) the role of evaluation; and (f) sustainability of the program in a poor community. Strategies for addressing obstacles to model adoption are also described, including program legitimization, building program infrastructure, setting realistic expectations, focusing on one risk factor at a time, defining target population segments, and emphasizing a small number of communication channels. Finally, research issues related to the diffusion of the community-based model are discussed, specifically: (a) Does the model work in disadvantaged urban settings? (b) What are the program effects on social class gradients for risk factors? (c) What are the barriers to program adoption in such settings? (d) What changes in the model will facilitate adoption in such settings? (e) What are the best methods for conducting formative evaluation in such programs? (f) What is the best way to select communities that may be ready to adopt the model? Our initial experience implementing this model in a disadvantaged urban setting supports the feasibility of model adoption. Unanswered questions about efficacy in such settings and regarding research issues related to model diffusion will require additional research investment.

Adolescent↗
PubMed1992

Enrollment in clinical trials: institutional factors affecting enrollment in the cardiac arrhythmia suppression trial (CAST).

Recruitment and Enrollment Assessment in Clinical Trials (REACT), an NHLBI-sponsored substudy of the Cardiac Arrhythmia Suppression Trial (CAST), was conducted to assess factors associated with enrollment in clinical trials. We report on the relationships of institutional factors at CAST sites to patient enrollment. The proportion of CAST-eligible patients enrolling at each CAST site during the REACT study period was defined as the number of subjects enrolled divided by the sum of (1) the number enrolled plus (2) the number of eligibles who refused plus (3) the number of eligibles whose physicians refused to permit CAST personnel to attempt to enroll them. A questionnaire that included 78 questions regarding factors hypothesized to be associated with enrollment was completed between August 1988 and February 1990 by the nurse coordinators at all 112 CAST sites in the United States and Canada. Sixteen items were unanalyzable, and 37 of the remaining 62 were grouped into seven scales. The remaining items were analyzed individually. Enrollment proportions varied widely across the 112 CAST sites (mean 32.7% SD 22.6). Five variables or scales were included in the final multiple regression model (multiple R2 = .39). The most important of these was the proportion of eligible patients at a site cared for by medical staff other than private attending physicians (multiple R2 for this variable alone, .26). This proportion tended to be high in teaching hospitals. Other variables in this model that were associated with higher enrollment proportions included the number of days per week a nurse coordinator was present at the site, the number of nurse coordinator full-time equivalents at the site, fewer other clinical trials for which the nurse coordinator was responsible, and fewer perceived obstacles to enrollment. These findings indicate that enrollment was more successful at hospitals with higher proportions of eligible subjects cared for by fellows, housestaff, and service attending physicians and at institutions with the committed presence of a nurse-coordinator.

Arrhythmias, Cardiac↗
PubMed1992

Correlates of nonadherence to hypertension treatment in an inner-city minority population.

OBJECTIVE: Adherence to treatment is a key factor in achieving blood pressure control among hypertensives. We examined correlates of nonadherence to hypertension treatment in an inner-city minority population. METHODS: Subjects (n = 202) were interviewed as part of a case-control study of severe, uncontrolled hypertension conducted in two New York City hospitals in 1989-91. All subjects were African American or Hispanic. Self-reported nonadherence to drug treatment for hypertension was measured using a five-item scale, and the sample was dichotomized as more (n = 87) or less (n = 115) adherent. Multiple logistic regression analysis was used to adjust for demographic and other covariates. RESULTS: Nonadherence was associated with having blood pressure checked in an emergency room (adjusted odds ratio [OR] = 7.9; 95% confidence interval [CI] = 1.75, 35.77; P < .01), lack of a primary care physician (adjusted OR = 2.9; 95% CI = 1.37, 6.02; P < .01), current smoking (adjusted OR = 2.4; 95% CI = 1.10, 5.22; P = .03), and younger age (adjusted OR = 1.03, 95% CI = 1.00, 1.06; P = .03). CONCLUSIONS: Changing the locus of care for hypertension from emergency rooms to primary care physicians may improve adherence to hypertension treatment in minority populations.

Adult↗