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PubMedDate not supplied

Diabetes mellitus in children and adolescents.

Until recently, diabetes in children was virtually synonymous with type 1 diabetes mellitus, whereas type 2 diabetes was a disease of middle age and the elderly. Over the past 10-20 years, an alarming increase in the prevalence of type 2 diabetes has been reported from pediatric diabetes centers in North America and elsewhere in the world. Lifestyle factors responsible for the worldwide epidemic of overweight and obesity are responsible for the increase in the prevalence of type 2 diabetes in adults and children. This article briefly discusses the diagnosis and major types of diabetes in children but focuses on aspects of type 2 diabetes in children and adolescents, including demographics, pathophysiology, clinical presentation, screening, prevention and treatment. The identification of children at risk for type 2 diabetes and the implementation of community-wide preventive programs will be essential to reverse the tide. The availability of calorie dense "fast foods," candy, and sugared soft drinks must be restricted in schools and other venues frequented by children. Parents must limit the amount of time their children spend watching television and playing computer games. After-school programs that promote physical activity should be a priority of local and central governmental agencies. Prevention will only succeed if governments and local communities recognize that childhood obesity is an important public health problem and provide an environment that promotes changes in lifestyle that prevent and reverse obesity.

Adolescent↗
PubMed2004

Environmental risk factors (excluding tobacco and microorganisms): critical analysis of old and new hypotheses.

The increase in incidence in both ulcerative colitis and Crohn's disease during the 20th century has led to an abundance of different hypotheses on what sort of exposures are responsible. There has been a special focus on dietary factors, as well as on other exposures introduced on a population-based level, including fast food, cola drinks, toothpaste, antibiotics and oral contraceptives. The aim of this review is to critically assess the results from the different observational studies that have investigated these hypotheses, and also to propose research agendas that should be pursued in the future. The conclusion is that infectious exposures and early bacterial colonization, which are associated with better hygiene early in life and that influence immune function, and possibly oral contraceptives, remain the only exposures of interest for future research into the aetiology of ulcerative colitis and Crohn's disease.

Anti-Bacterial Agents↗
PubMed2006

Association of a traditional vs shared meal decision-making and preparation style with eating behavior of Hispanic women in San Diego County.

OBJECTIVE: To examine the influence of meal decision-making and preparation on Hispanic women's dietary practices. DESIGN: One-on-one structured interviews were conducted, assessing meal decision-making and preparation practices, barriers, and behavioral strategies to eating low-fat and high-fiber diets, fat and fiber intake, demographic, and other psychosocial factors. SUBJECTS/SETTING: The study population included 357 Hispanic women living in the southern or central regions of San Diego County. Participants were recruited via random-digit dialing to a tailored nutrition communication intervention. MAIN OUTCOME MEASURE: Household decision-making style (alone vs with family) by household activity (decides meals, prepares meals, and decides snacks). STATISTICAL ANALYSES PERFORMED: Multiple logistic regressions were used to evaluate associations between the predictors and dependent variable. All models included adjustments for potential confounders, such as marital status, education, employment, age, and acculturation. RESULTS: A positive statistical association between Hispanic women's acculturation level and shared decision-making style was found. Also, Hispanic women in shared decision-making households faced greater psychosocial barriers to healthful eating and reported less healthful eating compared with Hispanic women in traditional households. Women in shared decision-making households were more likely to eat at fast-food restaurants, less likely to engage in behavioral strategies promoting fiber consumption, eat more saturated fat, and encounter more barriers to reduce dietary fat as compared with Hispanic women in traditional households. Acculturation did not attenuate differences in psychosocial and dietary practices between shared decision-making and traditional households. CONCLUSIONS: Study findings suggest intervention efforts should focus on different aspects of healthful eating among Hispanic women in shared-decision, compared with traditional, households.

Acculturation↗
PubMed2004

Adolescent assessment of cardiovascular heart disease risk factor attitudes and habits.

PURPOSE: To assess the attitudes of adolescents regarding cardiovascular heart disease risk factors and determine their potential influence on reported habits: exercise, smoking, and diet, as well as their body mass index (BMI). METHODS: Surveys were distributed to 141 male and 207 female adolescents at two clinic sites that serve a mostly Medicaid or uninsured population. Attitudes for obesity, smoking, and high fat diet were assessed with Likert scales, and habits for exercise, smoking, and fast food consumption were self-reported. Height and weight data were collected as well. Univariate modeling was accomplished with Spearman's rank correlation coefficients, contingency table analysis, and ANOVA. Logistic regression was used for multivariate modeling. RESULTS: The majority of participants agreed that obesity, smoking, and high fat diets may lead to heart disease. Fifty percent of the population exercised three times or less a week. Reported smoking was similar to national averages and increased with age. Participant attitudes were disparate to their reported habits. Occurrence of obesity in the sample was higher than national averages. Smokers, compared with nonsmokers, were 1.9 times as likely to be overweight or obese (p = .05). Participants who had a parent/guardian or grandparent with a history of heart attacks were 2.7 times as likely to smoke (p = .001). CONCLUSION: Adolescents possess knowledge of cardiovascular risk factors as reflected in their attitude assessments; however, their lifestyle choices contradict these beliefs.

Adolescent↗
PubMed2004

An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System.

This paper examines the factors that may be responsible for the 50% increase in the number of obese adults in the US since the late 1970s. We employ the 1984-1999 Behavioral Risk Factor Surveillance System, augmented with state level measures pertaining to the per capita number of fast-food and full-service restaurants, the prices of a meal in each type of restaurant, food consumed at home, cigarettes, and alcohol, and clean indoor air laws. Our main results are that these variables have the expected effects on obesity and explain a substantial amount of its trend.

Adult↗
PubMed2005

Focused interviews with Sudanese Americans: perceptions about diet, nutrition, and cancer.

BACKGROUND: This study explored perceptions regarding diet, nutrition and cancer among Sudanese-Americans; and generated information for response options, components to questions, and actual questions for a pre-conceptualized diet, nutrition and cancer-related questionnaire to be used on this population. METHODS: In a descriptive, qualitative study, data were collected from four focus group discussions with Sudanese-Americans (N = 18). RESULTS: Most participants were fearful of cancer, associating it with death. Stress, genetics, and pesticides in vegetables were given as major causes of cancer. Fatalism towards cancer pervaded among a few participants. Male participants did not believe that dietary factors could be helpful in cancer prevention, while the females believed fried, fatty, smoked and fast foods could lead to cancer. Factors perceived as influencing food choices included money, cultural traditions and social class. Cultural tradition was perceived as the major barrier to changing food habits. Frying, stewing, grilling, boiling and fermenting were the most common food preparation methods reported. CONCLUSION: Perceptions regarding dietary practices, nutrition and cancer among Sudanese-Americans, some of which might have been overlooked were identified. The focus groups generated response options, components to questions, and actual questions for a pre-conceptualized diet, nutrition and cancer-related questionnaire to be used on Sudanese-Americans.

Adult↗
PubMed2004

Factors associated with rear seating of children in motor vehicles: a study in two low-income, predominantly Hispanic communities.

This study examined child seating patterns in two predominantly low-income, Hispanic communities in Massachusetts. The purpose was to determine the factors associated with child rear seating in the community as a whole and for a subset of Hispanic motorists. Five hundred and five vehicles carrying child passengers and no adult other than the driver were observed in parking lots of fast food restaurants and grocery stores. Four hundred and thirty-two vehicle drivers agreed to be interviewed. A child was defined as a passenger younger than age 12 as determined by appearance and height (head below the vehicle headrest when seated). Variables under study included driver gender, age, ethnicity, and educational attainment; driver shoulder belt use; driver perception of passenger-side airbag presence; and the number and ages of children in the car. Overall, 51% of vehicles were observed with all children seated in the rear. In a bivariate analysis, child rear seating was strongly associated with female drivers ( P = 0.01), younger drivers ( P = 0.02) driver shoulder belt use ( P < 0.00), perceived presence of a passenger-side airbag ( P < 0.00), all children in the vehicle <or=6 years old (P < 0.00), and fewer than three children in the vehicle ( P 0.01). Non-Hispanic ethnicity was weakly associated with child rear seating ( P = 0.09). In the multivariate analysis, only the association between child rear seating and all children in the vehicle <or=6 years old remained strong (RR 2.4, 95% CI 1.7-3.3). Factors associated with rear seating were similar between Hispanic and non-Hispanic motorists. Controlling for other factors, the presence of a passenger-side airbag appeared to be more strongly associated with rear seating among non-Hispanics compared to Hispanics (RR 1.5 versus 1.1). Fewer Hispanic motorists drove vehicles with all children in the rear compared with the non-Hispanic motorists (48% versus 56%); this difference appears to be associated with the finding that fewer Hispanic drivers wore their seat belt. For both Hispanic and non-Hispanic motorists, efforts to increase child rear seating should focus on older children, male drivers, and on increasing general motor vehicle safety behavior (e.g. seat belt use). Messages should be culturally appropriate and should emphasize driver seat belt use in conjunction with rear seating and the importance of rear seating regardless of the presence of a passenger-side airbag.

Adult↗
PubMed2001

Development of scales to measure dietary acculturation among Chinese-Americans and Chinese-Canadians.

OBJECTIVE: To develop simple scales to measure a Chinese immigrant's adoption of Western eating patterns (dietary acculturation). STUDY DESIGN AND PARTICIPANTS: Data are from 244 less-acculturated women of Chinese ethnicity living in Seattle, Wash, and Vancouver, British Columbia, Canada. Interviewers collected information on sociodemographic characteristics, acculturation indices, items that reflect Western and Chinese dietary behavior, and consumption of fruits, vegetables, and fat. STATISTICAL ANALYSES: Analysis of variance and linear regression analyses examined associations among dietary measures and acculturation variables, controlling for age, education, and city of residence. RESULTS: We developed 2 scales to assess dietary acculturation: the Western Dietary Acculturation Scale and the Chinese Dietary Acculturation Scale, measuring Western and Chinese eating behavior, respectively. Although the population in this study was a less-acculturated sample, most participants reported some Western dietary practices, such as drinking milk (78%), eating cheese (78%), eating at Western fast-food restaurants (56%), and eating between meals (72%). Younger, highly educated women employed outside the home had the highest Western dietary acculturation scores (P < .001). Women with high scores on the Western scale reported higher-fat dietary behaviors and had increased fruit and vegetable intake since immigration compared to those with lower scores (P < .001). There was good agreement between the dietary acculturation scales and traditional acculturation indicators (P < .001). APPLICATIONS: Nutrition programs for immigrant/minority groups may be more effective if they are tailored to level of dietary acculturation. Therefore, the ability to accurately assess dietary acculturation is an important component of nutrition education, interventions, and counseling in these populations.

Acculturation↗
PubMed1998

Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts.

OBJECTIVE: To evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences. DESIGN AND SETTING: Cross-sectional survey of young adults in Bogalusa, La. SUBJECTS: Twenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white). STATISTICS: Analysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity. RESULTS: Thirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P<.001), and blacks consumed more energy than whites (P<.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P<.0001), protein per 1,000 kcal (P<.05), and saturated fat per 1,000 kcal (P<.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast. APPLICATIONS: Encouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults' diets.

Adult↗
PubMed2003

Field evaluation of two commonly used slipmeters.

A variety of slipmeters have been used to assess the slipperiness of floor surfaces. International standards for the operation of slipmeters describe the protocol for a single measurement. These standards usually do not cover some of the critical elements in safety assessment such as methods for the selection of measurement locations and the necessary number of repeated measurements at each location. Furthermore, most of the slipmeters were evaluated in laboratory settings with new floor surfaces and artificial contaminants. Two commonly used slipmeters, the Brungraber Mark II and the English XL, were evaluated at actual worksites in this experiment. Four floor tiles in each of four different work areas in the kitchens of 18 fast food restaurants were selected for repeated measurements with these two slipmeters. The results indicated that sanding of footwear materials has a significant effect on the outcomes of friction measurements, and the tile-to-tile variations in friction in the same areas of restaurants were also mostly statistically significant. Significant local variation in friction among tiles in the same area could potentially increase the chances of slip and fall incidents. Both slipmeters used in this experiment could potentially have problems in the areas with grease, such as grill and fryer areas, since the build-up of grease during repeated strikes could alter the outcome of friction measured.

Accidental Falls↗
PubMed1994

Escherichia coli O 157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers.

We conducted a retrospective analysis of 37 children with Escherichia coli O157:H7-associated hemolytic-uremic syndrome. The infection was traced to contaminated hamburgers at a fast-food restaurant chain. Within 5 days of the first confirmed case, the Washington State Department of Health identified the source and interrupted transmission of infection. Ninety-five percent of the children initially had severe hemorrhagic colitis. Nineteen patients (51%) had significant extrarenal abnormalities, including pancreatitis, colonic necrosis, glucose intolerance, coma, stroke, seizures, myocardial dysfunction, pericardial effusions, adult respiratory disease syndrome, and pleural effusions. Three deaths occurred, each in children with severe multisystem disease. At follow-up two children have significant impairment of renal function (glomerular filtration rate < 80 ml/min/per 1.73 Hm2); both of these children have a normal serum creatinine concentration. Hemolytic-uremic syndrome is the most common cause of acute renal failure in children, and this experience emphasizes the systemic nature of this disease. Clinicians should anticipate that multisystem involvement may occur in these patients, necessitating acute intervention or chronic follow-up. This outbreak of Hemolytic-uremic syndrome also highlights the microbiologic hazards of inadequately prepared food and emphasizes the importance of public health intervention in controlling Hemolytic-uremic syndrome.

Adolescent↗
PubMed1997

Exposure assessment of heterocyclic amines (HCAs) in epidemiologic studies.

The carcinogenic potential of heterocyclic amines (HCAs) in humans has yet to be established. Epidemiologic studies of colon cancer using crude surrogates for HCAs exposure (e.g., doneness of meat) have produced inconsistent results. To improve exposure assessment of HCAs, we have developed a database of HCA concentrations in commonly consumed meat items cooked by various techniques and degrees of doneness. HCA type and level are dependent on multiple factors, including type of meat (e.g., steak, chicken, bacon), cooking technique (with substantial variability present even within high temperature cooking methods), place of preparation (e.g., home, restaurant, or 'fast-food' restaurant), as well as the degree of doneness and surface browning/charring. We have developed a questionnaire with meat photographs linked to this database, which we are using in a variety of case-control and cohort studies of cancer etiology. In addition, we have carried out a metabolic study of HCA exposure among 66 subjects to identify biomarkers of HCA exposure which may be useful in epidemiologic studies. These studies should help clarify the role of HCAs in human carcinogenesis, and eventually allow an estimation of the cancer burden in the population attributable to these compounds.

Amines↗
PubMed2001

Energy expenditure, physical activity, and obesity in children.

Although there are physiologic and genetic influences on the various components of energy metabolism and body weight regulation, and a major portion of individual differences in body weight can be explained by genetic differences, it seems unlikely that the increased global prevalence of obesity has been driven by a dramatic change in the gene pool. It is more likely and more reasonable that acute changes in behavior and environment have contributed to the rapid increase in obesity and that genetic factors may be important in the deferring individual susceptibilities to these changes. The most striking behavioral changes that have occurred have been an increased reliance on high-fat and energy-dense "fast foods," with larger portion sizes, coupled with an ever-increasing sedentary lifestyle. The more sedentary lifestyle is caused by an increased reliance on technology and labor-saving devices, which has reduced the need for physical exertion for everyday activities. Examples of energy-saving devices that have resulted in a secular decline in physical activity include: Increased use of automated transport rather than walking or biking Central heating and use of automated equipment, such as washing machines, in the household. Reduction in physical activity in the workplace because of computers, automated equipment, and electronic mail. Increased use of television and computers for entertainment and leisure activities. Use of elevators and escalators rather than stairs. Increased concern for crime, which has reduced the likelihood of outdoor playing. Poor urban planning that does not provide adequate biking paths or even sidewalks in some communities. Thus, the increasing prevalence, numerous health risks, and astounding economic costs of obesity clearly justify widespread efforts toward prevention efforts. These prevention efforts should begin in childhood because the behaviors are learned and continue through the lifetime.

Adolescent↗
PubMed2003

Correlates of fruit and vegetable intake among adolescents. Findings from Project EAT.

BACKGROUND: This study aims to identify correlates of fruits and vegetables from within the domains of personal factors (taste preferences, health/nutrition attitudes, weight/body concerns, and self-efficacy), behavioral factors (meal frequency, fast food intake, and weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). This study further aims to identify correlates of home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between availability and taste preferences. METHODS: The population included 3957 adolescents from 31 public middle and high schools in Minnesota. Structural equation modeling was used for model testing. RESULTS: The strongest correlates of fruit/vegetable intake were home availability of fruits/vegetables and taste preferences of fruits/vegetables. The final model explained 13% of the variance in fruit/vegetable intake, 45% of the variance in home availability, and 28% of the variance in taste preferences. Correlates of home availability included social support for healthy eating, family meal patterns, family food security, and socio-economic status. Correlates of taste preferences included health/nutrition attitudes and home availability of fruits/vegetables. A test of interaction effects indicated that when home availability of fruits/vegetables was low, intake patterns did not differ, regardless of taste preferences. In contrast, even when taste preferences for fruits/vegetables were low, if fruits/vegetables were available, intake increased. CONCLUSIONS: Interventions to increase fruit/vegetable intake in adolescents need to target socio-environmental factors such as greater availability of fruits/vegetables.

Adolescent↗
PubMedDate not supplied

Marginal vitamin and mineral intake of Costa Rican adolescents.

BACKGROUND: Although a great deal of attention is given to macronutrient and energy intake in the diet, elements essential to dietary metabolic balance include important micronutrients. Very little information exists on vitamin and mineral intake during adolescence, especially in developing countries. METHODS: The micronutrient intake of urban and rural adolescents aged 12-19 years from the Costa Rican capital city, San José, was evaluated. Prospective 3-day diet records including 2 weekdays and 1 weekend day were used for dietary data. We evaluated the micronutrient intake to determine the nutrient adequacy ratio. RESULTS: Approximately 30% of adolescents did not meet the 70% level of the daily recommended intake (DRI) for vitamin Bl2. Additionally, 40% of the Costa Rican youngsters presented a vitamin A, E, and iron intake of between 30 and 69% of the DRI or recommended daily dose (RDA) for these nutrients. Likewise, approximately 15% of adolescents did not meet 30% of the DRI or RDA indicators for these nutrients. The micronutrients most at risk for inadequate intake were zinc, calcium, magnesium, and folate: more than 25% of the adolescents did not meet 50% of DRI or RDA indications for these micronutrients. Contrariwise, vitamin C, vitamin B6, thiamin, riboflavin, and niacin were the nutrients less at risk for inadequate intake. Fast foods prepared in school cafeterias provided approximately 15-30% of the DRI for vitamins B1, B2, B6, Bl2, and niacin, approximately 18% of the RDA for iron, and over 40% of the RDA for vitamin E. CONCLUSIONS: Nutritional interventions and educational strategies are needed to promote the adoption of healthful eating habits among adolescents.

Adolescent↗
PubMed2003

What does it take to retain substance-abusing adolescents in research protocols? Delineation of effort required, strategies undertaken, costs incurred, and 6-month post-treatment differences by retention difficulty.

Research retention rates vary widely due to practical difficulties that can be exacerbated when participants are minors. This article describes: (1) the range of effort required and type of follow-up strategies used to complete face-to-face follow-up interviews with substance-abusing adolescent research participants; (2) common locations of follow-up interviews; and (3) characteristics of difficult- versus easy-to-retain adolescent participants. Diverse contact strategies and numerous contact attempts were needed to obtain a 94% 1-month and 92% 6-month retention rate among substance-abusing adolescent research participants. About half of the youth did not respond to basic telephone tracking and required enhanced tracking efforts. Approximately 40% of the youth required 6 or more contacts prior to interview completion. The majority of follow-up interviews (60%) were conducted in community settings such as fast food restaurants, constituting the adolescent's preferred interview location. Telephone interviews were infrequent since adolescents wanted privacy and were concerned that a household member would listen to their answers. Those youth proving difficult-to-retain were significantly more likely to report serious problem behavior and poorer outcomes 6-months post-treatment within the alcohol/drug, juvenile justice, family, and educational domains. It was estimated that an additional $85 per participant per follow-up wave (over and above project budgets) was needed to adequately track, locate and interview an adolescent research participant. This expenditure appears reasonable to ensure a reliable/valid data set. Assessing the cost/benefit of different methods used in preventing attrition, identifying the minimum standards that avoid response bias and examining the impact of interviewer/participant alliances on data reliability/validity is discussed.

Adolescent↗
PubMed1999

Monetary versus nonmonetary incentives for TB skin test reading among drug users.

BACKGROUND: In a prior study, we reported that monetary incentives were effective in increasing return for tuberculosis (TB) skin test reading. The purpose of this study was to compare the effects of monetary versus nonmonetary incentives and a theory-based educational intervention on return for TB skin test reading in a sample of newly recruited active injection and crack cocaine users, and to determine the prevalence of TB infection in this sample. METHODS: Active injection drug and/or crack cocaine users (n = 1,078), recruited using street outreach techniques, were skin tested for TB. They were randomly assigned to 1 of 5 experimental treatment conditions: $10 cash, grocery store coupons, bus tokens/fast-food coupons, motivational education, or usual encouragement to return. Nonmonetary incentives had a $10 value, and all incentives were provided at return for skin test reading. RESULTS: Ninety-five percent of those who received $10 returned for skin test reading compared to 86% of those who received grocery store coupons and 83% of those who received either bus tokens or fast-food coupons. In contrast, only 47% of those who received the educational session and only 49% of those who received usual encouragement returned for skin test reading. The prevalence of a positive tuberculin test was 21%, and was similar for crack cocaine and injection drug users. CONCLUSIONS: Nonmonetary and monetary incentives dramatically increased the return rate for TB skin test reading among drug users who are at high risk of TB infection. Nonmonetary incentives were somewhat less effective than monetary incentives.

Adolescent↗
PubMed2002

Legal rights of children.

Children's rights do not seem to evolve--they respond. They respond to modern issues and concerns that are often fed by the media and resolved by politicians who serve adult constituencies. The solutions are typically premised on the beliefs that all children of a certain age and usually of a certain geographic state are alike and that parents know and do best for their children. (When they do not or cannot, the state or other legal guardian steps in). If we are worried about commercial alliances between schools and businesses, such as computer providers or fast food concessionaires, and the possible commercial marketing and exploitation of children through personal data that businesses collect about students and their families, the solution is predictable. As a secondary right, make the schools notify parents when businesses want to gather and use students' personal information, and let them say no [60].

Adolescent↗