PubMed NHANES

1. Am J Ind Med. 2009 Dec 18. [Epub ahead of print]

Airways obstruction among older construction and trade workers at Department Of
Energy nuclear sites.

Dement JM, Welch L, Ringen K, Bingham E, Quinn P.

Division of Occupational and Environmental Medicine, Duke University Medical
Center, Durham, North Carolina.

BACKGROUND: A study of chronic obstructive pulmonary disease (COPD) among 7,579
current and former workers participating in medical screening programs at
Department of Energy (DOE) nuclear weapons facilities through September 2008 was
undertaken. METHODS: Participants provided a detailed work and exposure history
and underwent a respiratory examination that included a respiratory history,
respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by
International Labour Office (ILO) criteria, and spirometry. Statistical models
were developed to generate group-level exposure estimates that were used in
multivariate logistic regression analyses to explore the risk of COPD in relation
to exposures to asbestos, silica, cement dust, welding, paints, solvents, and
dusts/fumes from paint removal. Risk for COPD in the study population was
compared to risk for COPD in the general US population as determined in National
Health and Nutrition Examination Survey (NHANES III). RESULTS: The
age-standardized prevalence ratio of COPD among DOE workers compared to all
NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range
from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and
duration of DOE employment. Statistically significant associations were observed
for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks
associated with exposures to paints, solvents, and removal of paints.
CONCLUSIONS: Our study of construction workers employed at DOE sites demonstrated
increased COPD risk due to occupational exposures and was able to identify
specific exposures increasing risk. This study provides additional support for
prevention of both smoking and occupational exposures to reduce the burden of
COPD among construction workers. Am. J. Ind. Med. 2009. (c) 2009 Wiley-Liss, Inc.

PMID: 20025074 [PubMed - as supplied by publisher]

2. Anesthesiol Clin. 2009 Dec;27(4):705-19.

Obesity, metabolic syndrome, and the surgical patient.

Levin PD, Weissman C.

Department of Anesthesiology and Critical Care Medicine, Hebrew University
Medical Center, Hebrew University-Hadassah School of Medicine, Kiryat Hadassah,
POB 12000, Jerusalem 91120, Israel.

Republished from:
Med Clin North Am. 2009 Sep;93(5):1049-63.

Contemporary life, with its sedentary lifestyles, fast foods, processed
foodstuff, and desk-bound service employment, is beset by an epidemic of
overweight and obese individuals. The World Health Organization reported that
worldwide a billion adults are overweight and at least 30% of them are obese.
Moreover, increasing numbers of children are obese. In the United States, 2
National Health and Nutrition Examination Surveys of adults aged 20 to 74 years
showed that the prevalence of obesity increased from 15% in the 1976 to 1980
survey to 34% in the 2003 to 2004 survey. Obesity and the metabolic syndrome are
unfortunately becoming increasingly common perioperative issues. The ultimate aim
of caring for such patients is to find ways to minimize the untoward effects of
surgery in patients who are obese or have metabolic syndrome.

PMID: 19942175 [PubMed]

3. Med Clin North Am. 2009 Sep;93(5):1049-63.

Obesity, metabolic syndrome, and the surgical patient.

Levin PD, Weissman C.

Department of Anesthesiology and Critical Care Medicine, Hebrew University
Medical Center, Hebrew University-Hadassah School of Medicine, Kiryat Hadassah,
Jerusalem 91120, Israel.

Republished in:
Anesthesiol Clin. 2009 Dec;27(4):705-19.

PMID: 19665619 [PubMed - indexed for MEDLINE]

4. Appetite. 2009 Jun;52(3):668-74. Epub 2009 Mar 17.

Family circumstance and adolescent dietary behaviours.

Pearson N, MacFarlane A, Crawford D, Biddle SJ.

School of Sport and Exercise Sciences, Loughborough University, Loughborough,
Leicestershire, United Kingdom. N.Pearson@lboro.ac.uk

The available information on the contribution of family circumstance to
adolescent dietary behaviours is inconsistent. Indicators of family circumstance
may impact adolescent behaviours by influencing their daily home environment.
This study examined cross-sectional and longitudinal relationships between
indicators of family circumstance and (i) breakfast skipping and (ii) consumption
of snack food, fast food, fruits and vegetables among adolescents. Dietary
behaviour was assessed using a web-based survey completed by 1884 adolescents
from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2
years later. Five indicators of family circumstance (parental marital status,
maternal education, maternal employment status, number of brothers and number of
sisters) were assessed with a questionnaire completed by parents at baseline
only. Logistic regression was used to examine cross-sectional associations
between indicators of family circumstance and dietary behaviours. Multinomial
logistic regression was used to examine associations between indicators of family
circumstance and 2-year change in dietary behaviours. Individual indicators of
family circumstance were differentially associated with adolescent dietary
behaviours. Cross-sectional and longitudinal associations differed for adolescent
boys and girls highlighting the importance of assessing specific dietary
behaviours and food types individually by gender. This study highlights the
complexity of the relationships between family circumstance and adolescent
dietary behaviours. Future research needs to assess the efficacy of strategies
promoting maternal nutritional knowledge on the dietary behaviours of
adolescents.

PMID: 19501765 [PubMed - indexed for MEDLINE]

5. J Am Diet Assoc. 2009 Apr;109(4):616-23.

Diet quality of preschoolers in Greece based on the Healthy Eating Index: the
GENESIS study.

Manios Y, Kourlaba G, Kondaki K, Grammatikaki E, Birbilis M, Oikonomou E,
Roma-Giannikou E.

Departmentof Nutrition and Dietetics, Harokopio University, 70 El.Venizelou Ave,
17671 Kallithea, Athens, Greece. manios@hua.gr

BACKGROUND: The current study aimed to assess the diet quality of Greek
preschoolers and the potential role of several sociodemographic factors related
to it. METHODS: A representative sample of 2,287 Greek children aged 2 to 5 years
(from the Growth, Exercise, and Nutrition Epidemiological Study In preSchoolers)
was used in this work. Dietary intake data was obtained using a combination of
techniques comprising weighed food records, 24-hour recalls, and food diaries. A
Healthy Eating Index (HEI) score was calculated summing the individual scores (0
to 10) assigned to each one of 10 index components. RESULTS: Eighty percent of
participants had an HEI score <50 (ie, "poor" diet), 0.4% had an HEI score >80
(ie, "good" diet), and the overall mean HEI score was 59. HEI scores were
significantly higher among boys, children aged 4 to 5 years, children
participating in moderate to vigorous physical activities for more than 3 hours
per week, children living in rural or small towns, and those whose mothers were
employed and had higher educational status (>12 years). HEI score was also found
to be strongly associated with several macronutrient and micronutrient intakes.
CONCLUSIONS: Based on HEI scores, the vast majority of Greek preschoolers was
found to have a poor diet. Moreover, low HEI scores were associated with low
levels of physical activity, low vegetable intake, high saturated fat intake,
lower maternal educational level, and unemployment status.

PMID: 19328256 [PubMed - indexed for MEDLINE]

6. Clin J Am Soc Nephrol. 2009 Mar;4(3):645-50. Epub 2009 Mar 4.

The comprehensive dialysis study (CDS): a USRDS special study.

Kutner NG, Johansen KL, Kaysen GA, Pederson S, Chen SC, Agodoa LY, Eggers PW,
Chertow GM.

Rehabilitation/Quality of Life Special Studies Center, United States Renal
DataSystem, Emory University, Atlanta, Georgia, USA.

BACKGROUND AND OBJECTIVES: The Comprehensive Dialysis Study (CDS) aimed to
understand factors contributing to physical, functional, and nutritional health
status among patients starting dialysis. DESIGN, SETTING, PARTICIPANTS, &
MEASUREMENTS: A phone interview survey was conducted with patients from a
geographically stratified national random sample of dialysis units, and quarterly
serum samples were obtained for patients at a preidentified subset of units. The
phone survey collected standardized measures of physical activity, employment and
disability status, perceived health and well-being, and dietary intake. Serum
samples were obtained to measure prealbumin, albumin, creatinine, normalized
protein catabolic rate, and C-reactive protein. To comply with restrictions
required under the Health Insurance Portability and Accountability Act (HIPAA),
dialysis unit personnel could not participate in any research-related activities.
RESULTS: Overall participation rate was 18.5%. One thousand six hundred forty-six
patients affiliated with 295 dialysis units completed the phone survey; 361
patients affiliated with 68 dialysis units also completed a dietary intake
survey, with 269 providing serum samples. Despite challenges in the design and
implementation of CDS, the population was diverse and results should be
generalizable. CONCLUSIONS: Constraints within the dialysis industry and HIPAA
requirements render the assembly of nationally representative cohorts extremely
difficult. Nevertheless, the CDS represents the largest cohort of incident
dialysis patients containing detailed information on self-reported physical
activity and dietary intake and is one of few cohorts simultaneously measuring
laboratory proxies of nutrition and inflammatory status. Data from CDS can be
used to inform the design of interventions addressing several conditions that
affect longevity and health status in ESRD.

PMCID: PMC2653653 [Available on 2010/3/1]
PMID: 19261814 [PubMed - indexed for MEDLINE]

7. Econ Hum Biol. 2009 Mar;7(1):7-17. Epub 2009 Feb 6.

Early childhood length-for-age is associated with the work status of Filipino
young adults.

Carba DB, Tan VL, Adair LS.

University of San Carlos-Office of Population Studies Foundation, Talamban
Campus, 6000 Cebu City, Philippines. carbadel@yahoo.com

Most studies on childhood health and human capital in developing countries
examine how early childhood linear growth relates to later human productivity as
reflected in schooling success. Work status is another important human capital
outcome related to early child health. This study examines the relationship of
linear growth restriction at 2 years of age to work status in young adults who
have, for the most part completed their schooling and further explores whether
this relationship differs by gender. The analysis sample of 1795 was drawn from
participants in the Cebu Longitudinal Health and Nutrition Survey, which followed
individuals from birth to age 20-22 years. Work status in 2005 was represented by
three categories: not working, working in an informal job, and working in a
formal job. Formal work in the Philippines, as in most countries, is associated
with regular hours, higher wages and benefits. Analyses were stratified by gender
and current school enrolment, and adjusted for socioeconomic status and attained
years of schooling. Among males no longer in school, higher length-for-age
Z-score (LAZ) at age 2 was associated with a 40% increase in likelihood of formal
work compared to not working. In females, each 1 unit increase in LAZ was
associated with 0.2 higher likelihood of formal vs. informal work. No significant
associations were observed in the small sample of young adults still in school.
To improve job prospects of young adults, it is important to provide proper
nutrition in early childhood and adequate educational opportunities during
schooling years.

PMCID: PMC2692275 [Available on 2010/3/1]
PMID: 19261549 [PubMed - indexed for MEDLINE]

8. Prev Med. 2009 Mar;48(3):262-6. Epub 2008 Dec 30.

Trends in the prevalence of obesity in employed adults in central-western France:
a population-based study, 1995-2005.

Czernichow S, Vergnaud AC, Maillard-Teyssier L, Péneau S, Bertrais S, Méjean C,
Vol S, Tichet J, Hercberg S.

Unité de Recherche en Epidémiologie Nutritionnelle, Faculté de medicine SMBH,
INSERM U557, INRA U1125, CNAM, UP13, CRNH-IdF, 93017-Bobigny, France.
czernichow@uren.smbh.univ-paris13.fr

OBJECTIVE: The overall trend of obesity prevalence has increased during the last
decades, even in France which has one of the lowest prevalence in Europe. The aim
of this study was to assess, according to socioeconomic status (SES), whether a
shift in the obesity prevalence trends could be observed since the French
National Nutrition and Public Health Program was implemented in 2001. METHODS:
Standardised cross-sectional repeated population-based data from the French
Social Security Health Examination Centers in the central-western region of
France (n=339,882). We examined regression slopes (95% CI) of overall and
abdominal obesity from 1995 to 2005 according to SES. We also compared slopes
within each SES between 1995-2001 and 2001-2005. RESULTS: After standardisation
to the French age distribution, 6.9% of men and 6.4% of women were obese in 1995
and 8.9% and 8.6% in 2005, respectively. Abdominal adiposity concerned 5.6% of
men and 8.5% of women in 1995 and 9.5% and 14.3% in 2005. Obesity prevalence
regression slopes between 1995 and 2005 increased in all SES categories, except
management professionals in both genders and office/service personnel male who
were stable. Significant regression slopes before 2001 became non-significant
afterward in office/service personnel males for obesity prevalence; and for
abdominal obesity in manual workers women and office/service personnel (p=0.05,
in men). CONCLUSIONS: Our data confirm the overall epidemic rise in the obesity
prevalence trends during the last decade, except in management professionals and
office/service personnel men. Obesity prevalence trends in office/service
personnel and manual workers women for abdominal obesity were also observed to
stabilise since 2001. We could hypothesize that the National Nutrition and Public
Health Program may partly be involved in this decreasing trend among
office/service personnel mainly. Policymakers should take into account these data
to assess the effectiveness of obesity prevention public-health strategies in the
future.

PMID: 19162065 [PubMed - indexed for MEDLINE]

9. Int Arch Occup Environ Health. 2009 Jul;82(7):827-32. Epub 2008 Oct 25.

Metabolic syndrome in carbon disulfide-poisoned subjects in Korea: does chemical
poisoning induce metabolic syndrome?

Jhun HJ, Lee SY, Yim SH, Kim MJ, Park KK, Cho SI.

Department of Occupational and Environmental Medicine, College of Medicine, Korea
University, Ansan, Republic of Korea.

OBJECTIVE: Mass carbon disulfide (CS(2)) poisoning was reported at a viscose
rayon factory in Korea. We evaluated the association between CS(2) poisoning and
the prevalence of metabolic syndrome. METHODS: The cases (n = 170) involved
CS(2)-poisoned subjects, who participated in a health examination conducted at a
hospital in Korea in 2005. The controls (n = 170) were selected randomly from the
participants in the third Korean National Health and Nutrition Examination
Survey. Metabolic syndrome was defined as having at least three of following
metabolic abnormalities: abdominal obesity, elevated triglyceride, reduced
high-density lipoprotein cholesterol, elevated blood pressure, and elevated
fasting glucose levels. RESULTS: After adjusting for covariates (age, gender,
education, marital status, alcohol consumption, and smoking), CS(2)-poisoned
subjects had an increased risk of metabolic syndrome (prevalence ratio 1.57, 95%
CI 1.25-1.98). CONCLUSIONS: The findings suggest that CS(2) poisoning may
increase the risk of metabolic syndrome.

PMID: 18953562 [PubMed - indexed for MEDLINE]

10. Food Nutr Bull. 2008 Sep;29(3):221-31.

Seasonality, household food security, and nutritional status in Dinajpur,
Bangladesh.

Hillbruner C, Egan R.

Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts
University, Boston, Massachusetts, USA. hillbrun@hotmail.com

BACKGROUND: The influence of seasonality on food security and nutritional status
is widely accepted. However, research has typically focused on rural households
and has not explored the specific mechanisms underlying seasonal effects.
OBJECTIVE: To investigate the role of seasonality in determining the food
security and nutritional status of low-income urban households and to isolate
specific pathways through which seasonality has its impact. METHODS: Secondary
panel data from CARE/IFPRI were utilized. Three rounds of data were collected
from approximately 600 households in low-income areas of Dinajpur, Bangladesh,
from 2002 through 2003, twice during the monsoon season and once in the dry
season. Household-level surveys collected data on income and expenditure,
employment, urban agriculture, health, and assets. Height and weight measurements
were taken from children between the ages of 6 and 72 months. Paired t-tests and
logistic fixed-effects modeling were then used to explore the role of
seasonality. RESULTS: The prevalence rates of food insecurity, wasting, and
inadequate growth were all significantly higher during the monsoon season as
compared with the dry season. Dietary diversity and lost work due to the weather
were identified as specific pathways through which season affected household food
security. However, mechanisms hypothesized to contribute to seasonal declines in
nutritional status, such as child illness, were not found to be significant.
CONCLUSIONS: Season had a significant effect on both food security and
nutritional status in Dinajpur, with households consistently worse off during the
monsoon season. Initiatives to promote food market development, support
employment during the hunger season, and prevent seasonal declines in nutritional
status should be implemented.

PMID: 18947035 [PubMed - indexed for MEDLINE]

11. Am J Ind Med. 2008 Oct;51(10):748-57.

Gender, precarious work, and chronic diseases in South Korea.

Kim IH, Khang YH, Muntaner C, Chun H, Cho SI.

School of Public Health and Institute of Health and Environment, Seoul National
University, Seoul, Korea.

OBJECTIVE: In view of the growing number of nonstandard workers in South Korea,
this study examined whether nonstandard workers reported poorer health compared
to standard workers and assessed whether there were gender differences in the
association between employment status and chronic health outcomes. METHOD: Data
were taken from a representative-weighted sample of 1,563 men and 1,045 women
aged 20-64, from the 2001 National Health and Nutrition Examination Survey.
Nonstandard employment included part-time work, temporary work, and day labor.
Self-rated health and self-reported chronic disease conditions were used as
health measures. MAIN RESULTS: Nonstandard employment was significantly
associated with higher risk of self-rated health and chronic conditions after
adjusting for socioeconomic position (education, occupational class, and income)
and health behaviors (cigarette smoking, alcohol consumption, regular exercise,
and health examinations). However, the pattern in the relation between
nonstandard work and specific health problems greatly differed by gender. Among
men, nonstandard work arrangements were significantly associated with
musculoskeletal disorders (OR 1.97, 95% CI 1.24-3.19) and liver disease (OR 2.83,
95% CI 1.27-6.32). Among women, nonstandard employment was related to mental
disorders (OR 3.25, 95% CI 1.40-7.56). CONCLUSION: The findings clearly indicate
the need for further study of the observed associations, particularly prospective
and analytical studies. Published 2008 Wiley-Liss, Inc.

PMID: 18704916 [PubMed - indexed for MEDLINE]

12. Public Health Nutr. 2009 Jul;12(7):888-95. Epub 2008 Jul 23.

Is the perception of time pressure a barrier to healthy eating and physical
activity among women?

Welch N, McNaughton SA, Hunter W, Hume C, Crawford D.

Centre for Physical Activity and Nutrition Research, Deakin University, 221
Burwood Highway, Burwood 3125, Australia. nicky.welch@deakin.edu.au

OBJECTIVES: To describe the proportion of women reporting time is a barrier to
healthy eating and physical activity, the characteristics of these women and the
perceived causes of time pressure, and to examine associations between
perceptions of time as a barrier and consumption of fruit, vegetables and fast
food, and physical activity. DESIGN: A cross-sectional survey of food intake,
physical activity and perceived causes of time pressure. SETTING: A randomly
selected community sample. SUBJECTS: A sample of 1580 women self-reported their
food intake and their perceptions of the causes of time pressure in relation to
healthy eating. An additional 1521 women self-reported their leisure-time
physical activity and their perceptions of the causes of time pressure in
relation to physical activity. RESULTS: Time pressure was reported as a barrier
to healthy eating by 41% of the women and as a barrier to physical activity by
73%. Those who reported time pressure as a barrier to healthy eating were
significantly less likely to meet fruit, vegetable and physical activity
recommendations, and more likely to eat fast food more frequently. CONCLUSIONS:
Women reporting time pressure as a barrier to healthy eating and physical
activity are less likely to meet recommendations than are women who do not see
time pressure as a barrier. Further research is required to understand the
perception of time pressure issues among women and devise strategies to improve
women's food and physical activity behaviours.

PMID: 18647424 [PubMed - indexed for MEDLINE]

13. Soc Sci Med. 2008 Sep;67(6):988-1001. Epub 2008 Jul 14.

Explaining gender differences in ill-health in South Korea: the roles of
socio-structural, psychosocial, and behavioral factors.

Chun H, Khang YH, Kim IH, Cho SI.

Institute of Population and Aging Research, Hanyang University, Seoul, Korea.
heeranchun@hanmail.net

This study examines and explains the gender disparity in health despite rapid
modernization in South Korea where the social structure is still based on
traditional gender relations. A nationally representative sample of 2897 men and
3286 women aged 25-64 from the 2001 Korean National Health and Nutrition
Examination Survey was analyzed. Health indicators included self rated health and
chronic disease. Age-adjusted prevalence was computed according to a gender and
odds ratios (OR) derived from logistic regression. Percentage changes in OR by
inclusion of determinant variables (socio-structural, psychosocial, and
behavioral) into the base logistic regression model were used to estimate the
contributions to the gender gap in two morbidity measures. Results showed a
substantial female excess in ill-health in both measures, revealing an increasing
disparity in the older age group. Group-specific age-adjusted prevalence of
ill-health showed an inverse relationship to socioeconomic position. When
adjusting for each determinant, employment status, education, and depression
contributed the greatest to the gender gap. After adjusting for all suggested
determinants, 78% for self rated health and 86% for chronic disease in excess OR
could be explained. After stratifying for age, the full model provided a complete
explanation for the female excess in chronic illness, but for self rated health a
female excess was still evident for the younger age group. Socio-structural
factors played a crucial role in accounting for female excess in ill-health. This
result calls for greater attention to gender-based health inequality stemming
from socio-structural determinants in South Korea. Cross-cultural validation
studies are suggested for further discussion of the link between changing gender
relations and the gender health gap in morbidity in diverse settings.

PMID: 18632197 [PubMed - indexed for MEDLINE]

14. Menopause. 2008 Nov-Dec;15(6):1103-8.

Earlier age at menopause, work, and tobacco smoke exposure.

Fleming LE, Levis S, LeBlanc WG, Dietz NA, Arheart KL, Wilkinson JD, Clark J,
Serdar B, Davila EP, Lee DJ.

Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, Miami, FL 33136, USA. lfleming@med.miami.edu

OBJECTIVE: Earlier age at menopause onset has been associated with increased
all-cause, cardiovascular, and cancer mortality risks. The risk of earlier age at
menopause associated with primary and secondary tobacco smoke exposure was
assessed. DESIGN: This was a cross-sectional study using a nationally
representative sample of US women. A total of 7,596 women (representing an
estimated 79 million US women) from the National Health and Nutrition Examination
Survey III were asked time since last menstrual period, occupation, and tobacco
use (including home and workplace second-hand smoke [SHS] exposure). Blood
cotinine and follicle-stimulating hormone levels were assessed. Logistic
regressions for the odds of earlier age at menopause, stratified on
race/ethnicity in women 25 to 50 years of age and adjusted for survey design,
were controlled for age, body mass index, education, tobacco smoke exposure, and
occupation. RESULTS: Among 5,029 US women older than 25 years with complete data,
earlier age at menopause was found among all smokers and among service and
manufacturing industry sector workers. Among women age 25 to 50 years, there was
an increased risk of earlier age at menopause with both primary smoking and SHS
exposure, particularly among black women. CONCLUSIONS: Primary tobacco use and
SHS exposure were associated with increased odds of earlier age at menopause in a
representative sample of US women. Earlier age at menopause was found for some
women worker groups with greater potential occupational SHS exposure. Thus,
control of SHS exposure in the workplace may decrease the risk of mortality and
morbidity associated with earlier age at menopause in US women workers.

PMCID: PMC2703810
PMID: 18626414 [PubMed - indexed for MEDLINE]

15. J Urban Health. 2008 Jul;85(4):607-18. Epub 2008 Apr 5.

Social determinants, suboptimal health behavior, and morbidity in urban slum
population: an Indian perspective.

Pawar AB, Mohan PV, Bansal RK.

Department of Community Medicine, SMIMER, Surat, India. drabpawar@yahoo.com

Improving the health of urban residents, particularly those living in slum areas,
requires an integrated approach. Appropriate interventions must be based on a
well-grounded understanding of health determinants. Social factors are as
important as physical factors in determining health status and suggest
alternative interventions. Employment, stress, social exclusion, social support,
substance use, nutrition, transport, and conditions during childhood are among
the most important social determinants of health status identified by the
International Center for Health and Society. This paper uses social determinants
of health approach to understand morbidity outcomes for people residing in the
slums of Surat City, India. To quantify suboptimal health behavior and identify
the determinants of health status for this population survey data on household
characteristics, health-seeking behavior, socioeconomic status, food and personal
habits, social life, and physical activity has been used. After controlling for
socioeconomic and demographic factors, logistic regression analysis reveals that
social exclusion, stress, and lack of social support are significantly associated
with morbidity. Thus, understanding of social determinants of health by policy
makers is important as the health sector has a crucial role in addressing
disparities in social determinants.

PMCID: PMC2443249
PMID: 18404392 [PubMed - indexed for MEDLINE]

16. East Mediterr Health J. 2007 Nov-Dec;13(6):1330-42.

Influence of parental and socioeconomic factors on stunting in children under 5
years in Egypt.

Zottarelli LK, Sunil TS, Rajaram S.

Texas Woman's University, Texas, USA.

We assessed the relationship between parental and socioeconomic characteristics
and nutritional status of children under 5 years in Egypt. Data from the 2000
Egypt Demographic and Health Survey were used. A logistic regression technique
was used to estimate the odds of being malnourished. Children whose mothers had a
higher level of education and were >150 cm had a lower risk of stunting than
those of mothers with no education and shorter height (<150 cm). Parental
consanguinity, rural residence, high birth order and short birth interval
significantly increased the odds of stunting. Children aged > 12 months had
greater odds of stunting than those <12 months.

PMID: 18341183 [PubMed - indexed for MEDLINE]

17. Obes Rev. 2008 Mar;9 Suppl 1:113-8.

Physical activity level and its association with metabolic syndrome among an
employed population in China.

Ma G, Luan D, Li Y, Liu A, Hu X, Cui Z, Zhai F, Yang X.

National Institute for Nutrition and Food Safety, Chinese Center for Disease
Control and Prevention, Beijing, China. mags@chinacdc.net.cn

The purpose of the present study was to estimate the association of physical
activity level (PAL) with metabolic syndromes among the employed population in
China. Using data from the 2002 China National Nutrition and Health Survey, the
PAL of 21 834 subjects aged 18-59 years was described, and its relationship with
the risk of metabolic syndrome was studied after adjusting for the relative
effects of smoking, drinking, diet and socioeconomic status. Information on
physical activity was collected by trained investigators using a 1-year physical
activity questionnaire. PAL was classified into four categories: sedentary (PAL
1.00-1.39), low active (PAL 1.40-1.59), active (PAL 1.60-1.89) and very active
(PAL 1.90-2.50). The definition of metabolic syndrome by the International
Diabetes Federation 2005 was applied. The percentage of people being sedentary,
low active, active and very active was 12.3%, 13.7%, 20.1% and 53.9%
respectively. The crude prevalence of metabolic syndrome in the sedentary, low
active, active and very active groups was 9.7%, 6.9%, 5.6% and 4.9% respectively.
After adjusting for the effect of other risk factors, the higher the PAL, the
lower the relative risk of metabolic syndrome as well as the individual metabolic
abnormalities. The risk of overweight/obesity and metabolic syndrome was 50% and
59% less, respectively, in the adults who were very active and whose dietary fat
contributed less than 20% to energy intakes when compared with their counterparts
who were sedentary and consumed more fat (> or = 30% energy). PAL was an
independent risk factor for obesity and multiple metabolic syndrome abnormalities
among the employed population in China. The high-risk population were middle-age
males living in large cities with high incomes who drink alcohol.

PMID: 18307712 [PubMed - indexed for MEDLINE]

18. East Mediterr Health J. 2007 Sep-Oct;13(5):994-1004.

Relation of nitrate contamination of groundwater with methaemoglobin level among
infants in Gaza.

Abu Naser AA, Ghbn N, Khoudary R.

Public Health Laboratory, Ministry of Health, Gaza, Palestine.
Ahmadabonaser@hotmail.com

A descriptive, cross-sectional and analytical study was carried out in 3 areas of
the Gaza Strip, Palestine, in 2002, to determine the factors associated with high
methaemoglobin (Met-Hb) levels in infants and the relationship with nitrate
concentration in drinking water wells. Drinking water sources were likely to be
the main factor for high levels of Met-Hb. Out of 338 infants attending for
vaccination, having supplemental feeding, use of boiled water and age 3-6 months
were associated with high Met-Hb levels. The highest mean Met-Hb level was in
Khan-Younis, where the highest mean nitrate concentration was recorded in
drinking water. The results emphasize the importance of exclusive breastfeeding
for infants < 6 months old, and the choice of a suitable source of water for
these infants.

PMID: 18290391 [PubMed - indexed for MEDLINE]

19. J Immigr Minor Health. 2009 Oct;11(5):342-58. Epub 2008 Feb 6.

Unpacking dietary acculturation among new Americans: results from formative
research with African refugees.

Patil CL, Hadley C, Nahayo PD.

Department of Anthropology - BSB 2102 (MC 027), University of Illinois at
Chicago, 1007 W. Harrison Street, Chicago, IL 60607, USA. cpatil@uic.edu

Epidemiological studies focusing on Latino immigrant health have found links
between acculturation (time and language competency), weight gain, and disease
risk. Since time and language competency are not mechanisms by which diets and
activities change, associations between acculturation and weight change offer
little to public health professionals who aim to develop nutrition and health
interventions. We present a conceptual model and use a mixed-methods biocultural
approach to address the fine-grained details of diet and activity choice for new
arrivals to the USA. The results of our anthropological work with Liberian and
Somali Bantu refugees indicate that, in addition to standard surveys
(individual-level characteristics, socioeconomic status, employment, and
acculturation), epidemiological research would benefit from the data generated
from ethnography and more nuanced behavioral studies. A focus on the lived
experiences of new Americans and the explicit examination of institutional
support, peer support, and interactions between children and caretakers might
offer points of intervention for immigrant health which is a growing public
health concern.

PMID: 18253832 [PubMed - in process]

20. BMC Health Serv Res. 2008 Feb 4;8:33.

Factors contributing to attrition behavior in diabetes self-management programs:
a mixed method approach.

Gucciardi E, Demelo M, Offenheim A, Stewart DE.

Ryerson University, School of Nutrition, Toronto, Ontario, Canada.
egucciar@ryerson.ca

BACKGROUND: Diabetes self-management education is a critical component in
diabetes care. Despite worldwide efforts to develop efficacious DSME programs,
high attrition rates are often reported in clinical practice. The objective of
this study was to examine factors that may contribute to attrition behavior in
diabetes self-management programs. METHODS: We conducted telephone interviews
with individuals who had Type 2 diabetes (n = 267) and attended a diabetes
education centre. Multivariable logistic regression was performed to identify
factors associated with attrition behavior. Forty-four percent of participants (n
= 118) withdrew prematurely from the program and were asked an open-ended
question regarding their discontinuation of services. We used content analysis to
code and generate themes, which were then organized under the Behavioral Model of
Health Service Utilization. RESULTS: Working full and part-time, being over 65
years of age, having a regular primary care physician or fewer diabetes symptoms
were contributing factors to attrition behaviour in our multivariable logistic
regression. The most common reasons given by participants for attrition from the
program were conflict between their work schedules and the centre's hours of
operation, patients' confidence in their own knowledge and ability when managing
their diabetes, apathy towards diabetes education, distance to the centre,
forgetfulness, regular physician consultation, low perceived seriousness of
diabetes, and lack of familiarity with the centre and its services. There was
considerable overlap between our quantitative and qualitative results.
CONCLUSION: Reducing attrition behaviour requires a range of strategies targeted
towards delivering convenient and accessible services, familiarizing individuals
with these services, increasing communication between centres and their patients,
and creating better partnerships between centres and primary care physicians.

PMCID: PMC2277391
PMID: 18248673 [PubMed - indexed for MEDLINE]

21. Proc Nutr Soc. 2008 Feb;67(1):91-7.

Impact of food and nutrition interventions on poverty in an informal settlement
in the Vaal Region of South Africa.

Oldewage-Theron WH, Slabbert TJ.

Vaal University of Technology, Institute of Sustainable Livelihoods,
Vanderbijlpark 1900, South Africa. wilna@vut.ac.za

UNICEF has stated that urban poverty is primarily found in squatter settlements.
At present 13.5% of all South African households live in informal settlements.
The major research question is to what extent does poverty influence the food,
nutrition and health of informal-settlement dwellers. The purpose of the present
study was to determine the depth of poverty in this community and to measure the
possible effect that planned food and nutrition interventions may have on
eliminating poverty in this area. Pre-tested questionnaires were administered to
340 randomly-selected caregivers. A validated quantified FFQ was administered by
trained enumerators as the test measurement for dietary intake and food
consumption patterns and 24 h recall was used as the reference measurement, and
the data were analysed. A poverty model was used to measure the impact of extra
income on the poverty levels of 190 households. Of the respondents 89% lived in
Zn shacks and the average household size was 4.9 individuals. The unemployment
rate was 94.2% for respondents and 64.9% for their partners. The majority of
households (68.8%) had an income of 95th percentile, varied from 7% to 9% and did not differ
among the 3 groups but were higher than the 5% expected from national growth
charts. Rates of food insecurity were consistent with national data for minority
households with children. Families that did not receive WIC assistance because of
access problems had higher rates of food insecurity (28%) than did WIC
participants (23%), although differences were not significant after covariate
control. Caregivers who did not perceive a need for WIC services had more
economic and personal resources than did WIC participants and were less likely to
be food-insecure, but there were no differences in infants' weight-for-age,
perceived health, or overweight between families that did not perceive a need for
WIC services and those that received WIC assistance. CONCLUSIONS: Infants < or
=12 months of age benefit from WIC participation. Health care providers should
promote WIC utilization for eligible families and advocate that WIC receive
support to reduce waiting lists and eliminate barriers that interfere with
access.

PMID: 15231924 [PubMed - indexed for MEDLINE]

67. Obes Res. 2004 Jun;12(6):1019-30.

Longitudinal relationships among overweight, life satisfaction, and aspirations
in young women.

Ball K, Crawford D, Kenardy J.

School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood
Highway, Burwood, Melbourne, 3125 Victoria, Australia. kball@deakin.edu.au

OBJECTIVE: This study investigated associations of overweight status and changes
in overweight status over time with life satisfaction and future aspirations
among a community sample of young women. RESEARCH METHODS AND PROCEDURES: A total
of 7865 young women, initially 18 to 23 years of age, completed two surveys that
were 4 years apart. These women provided data on their future life aspirations in
the areas of further education, work/career, marital status, and children, as
well as their satisfaction with achievements to date in a number of life domains.
Women reported their height and weight and their sociodemographic
characteristics, including current socioeconomic status (occupation). RESULTS:
Young women's aspirations were cross-sectionally related to BMI category, such
that obese women were less likely to aspire to further education, although this
relationship seemed explained largely by current occupation. Even after adjusting
for current occupation, young women who were obese were more dissatisfied with
work/career/study, family relationships, partner relationships, and social
activities. Weight status was also longitudinally associated with aspirations and
life satisfaction. Women who were overweight or obese at both surveys were more
likely than other women to aspire to "other" types of employment (including
self-employed and unpaid work in the home) as opposed to full-time employment.
They were also less likely to be satisfied with study or partner relationships.
Women who resolved their overweight/obesity status were more likely to aspire to
being childless than other women. DISCUSSION: These results suggest that being
overweight/obese may have a lasting effect on young women's life satisfaction and
their future life aspirations.

PMID: 15229343 [PubMed - indexed for MEDLINE]

68. J Am Diet Assoc. 2004 Jul;104(7):1162-8.

Public beliefs about breastfeeding policies in various settings.

Li R, Hsia J, Fridinger F, Hussain A, Benton-Davis S, Grummer-Strawn L.

Division of Nutrition and Physical Activity, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, GA, USA. RIL6@cdc.gov

To understand the public beliefs about breastfeeding policies in various settings
and to examine the associations of these beliefs with sociodemographic
characteristics, we analyze the data from the 2001 Healthstyles survey, which is
an annual national mail survey to US adults. We found that establishing workplace
breastfeeding policies and lactation rooms in public places are the most
acceptable breastfeeding policies surveyed, especially among African Americans
and low-income populations. The overall population appears to approve of
breastfeeding in public, but less-educated or older people (aged >/=45 years) are
less likely to do so. In general, there is relatively less public support for
breastfeeding education in high schools. The results indicate that many
Americans, especially African Americans and those with low household income,
believe that women who breastfeed need extra support both at work and in public
places. A variety of policy strategies would be appropriate to create a favorable
environment for breastfeeding.

PMID: 15215778 [PubMed - indexed for MEDLINE]

69. Appetite. 2004 Jun;42(3):307-16.

Psycho-social influences on food choice in Southern France and Central England.

Pettinger C, Holdsworth M, Gerber M.

School of Biosciences, University of Nottingham, Sutton Bonington Campus,
Loughborough, Leics LE12 5RD, UK.

This study used attitudinal scales to investigate the nature of attitudes to diet
and health in a northern European country (Central England) and a southern
European country (Mediterranean France). Cross-sectional studies were conducted
using self-administered postal questionnaires that were distributed
simultaneously in April 2001 in Montpellier, France and Nottingham, England. A
stratified random sample of 1000 males and 1000 females aged 18-65 years was
generated from the electoral roll in each country. The final sample comprised
England: n = 826 (58% male and 42% female; mean age=44 years) and France: n = 766
(42% male and 58% female; mean age=42 years). This study has demonstrated that
the pleasurable and social aspects of eating, certain food quality issues, as
well as health as a value were regarded as priorities by French respondents. On
the other hand, English respondents reported that organic and ethical issues and
convenience were important factors influencing their food choices. In conclusion,
the two populations can be differentiated overall in their attitudes and beliefs
to food choice.

PMID: 15183922 [PubMed - indexed for MEDLINE]

70. Appetite. 2004 Jun;42(3):255-63.

Longitudinal dietary change from adolescence to adulthood: perceptions,
attributions and evidence.

Lake AA, Rugg-Gunn AJ, Hyland RM, Wood CE, Mathers JC, Adamson AJ.

Wellcome Research Laboratories, Human Nutrition Research Centre, University of
Newcastle upon Tyne, RVI, Queen Victoria Road, Newcastle NE1 4LP, UK.
amelia.lake@ncl.ac.uk

Dietary patterns and change in eating habits are influenced by multiple factors
from an individual's internal and external environment. A longitudinal dietary
survey study provided quantitative evidence of dietary change and investigated
factors influencing dietary change from adolescence to adulthood, using
sociodemographic data and participants' own perceptions of, and attributions for,
their dietary change. Longitudinal dietary data were obtained in 1980 and 2000
(average age 11.6 and 32.5 years, respectively). Two questionnaires (2000) and 2
x 3-day food diaries (1980 and 2000) were collected from 198 participants. Foods
consumed were assigned to one of the five food groups from The Balance of Good
Health (a UK food guide). Questionnaire responses were used to examine how
subjects perceived their own dietary change and the factors to which they
attributed such change. Six key factors were identified from the questionnaire:
parents, partners, children, nutritional awareness, employment and lack of time.
Demographic and key factors were associated with degree of change in intake. The
complex process of change in food consumption can be linked with an individual's
attributions for change.

PMID: 15183916 [PubMed - indexed for MEDLINE]

71. Nutrition. 2004 Jun;20(6):502-8.

Associations between sociodemographic and lifestyle factors and dietary quality
among adolescents in Palma de Mallorca.

Tur JA, Puig MS, Benito E, Pons A.

Laboratory of Physical Activity Sciences, Universitat de les Illes Balears, Palma
de Mallorca, Spain. pep.tur@uib.es

OBJECTIVE: We assessed associations between sociodemographic and lifestyle
factors and dietary quality among adolescents. METHODS: Subjects were 445
adolescents (171 boys, 274 girls; 14 to 18 y old) selected from the Palma de
Mallorca (Balearic Islands, Spain) school census (96% participation) using
two-stage probability sampling. The study protocol included dietary intake by
means of a validated semiquantitative food-frequency questionnaire;
sociodemographic factors of sex, maternal level of education, parental
occupational status, and maternal region of origin; physical activity; and body
weight and height measurements. Body mass index was calculated and energy intake
expressed as multiples of basal metabolic rate. RESULTS: Mean daily energy
intakes were 12.9 MJ for boys and 12.0 MJ for girls. Boys showed a higher
percentage of energy from carbohydrates but a lower percentage from proteins and
fat than did girls (44.9 versus 41.6, 18.8 versus 19.8, and 36.3 versus 38.5,
respectively). Dietary fiber intake was within the recommended levels. Mineral
and vitamin intakes generally met their estimated needs, except for vitamins A
and D, which covered less than two-thirds of the recommended intake. Maternal
educational level was positively correlated with dietary mineral and vitamin
intakes. A positive relation between physical activity and dietary intakes of
carbohydrate and of mineral and vitamin was found. CONCLUSIONS: Maternal level of
education and physical activity are associated to the quality of diet among
adolescents in Palma de Mallorca.

PMID: 15165611 [PubMed - indexed for MEDLINE]

72. Qual Life Res. 2004 May;13(4):819-32.

Development of a preliminary diabetes dietary satisfaction and outcomes measure
for patients with type 2 diabetes.

Ahlgren SS, Shultz JA, Massey LK, Hicks BC, Wysham C.

Community Health Association of Spokane, Spokane, Washington, USA.

Adopting dietary lifestyle changes for diabetes management is often difficult for
patients; yet the health-related quality of life (HRQOL) outcomes of dietary
management for the patient are not extensively developed in the HRQOL assessments
now widely used in diabetes research. This study developed a preliminary
instrument, the diabetes dietary satisfaction and outcomes measure, to assess
outcomes of individuals' experiences in following a meal plan for the treatment
of type 2 diabetes. A theoretical framework and preliminary focus group data
guided the design of a 47-item questionnaire, administered to 239 patients with
type 2 diabetes. Medical file data was obtained on 180 of these patients.
Fifty-four percent of respondents were women, with mean age of 64 +/- 12 years
and diabetes duration of 10 +/- 8 years. Scores for the satisfaction and other
outcome measures discriminated between patient groups by age, gender, medication
use, depression diagnosis, meal plan status, and employment status. Significant
correlations also occurred with diet adherence, number of co-morbidities, and
glycemic control as measured by glycolated hemoglobin (HbA1c). Future research
with additional patient samples is needed to refine the measure for use in
diabetes education programs.

PMID: 15129892 [PubMed - indexed for MEDLINE]

73. Int J Epidemiol. 2004 Apr;33(2):328-36.

The metabolic syndrome and associated lifestyle factors among South Korean
adults.

Park HS, Oh SW, Cho SI, Choi WH, Kim YS.

Department of Family Medicine, University of Ulsan College of Medicine, Seoul,
Korea. hyesoon@amc.seoul.kr

INTRODUCTION: The importance of managing the metabolic syndrome has been
emphasized in the prevention of cardiovascular disease. Although South Koreans
have a low prevalence of obesity, little information is available about the
prevalence of the metabolic syndrome and its associated risk factors. METHODS:
Data was obtained from individuals aged 20-79 years from the Korean National
Health and Nutrition Examination Survey 1998, a cross-sectional health survey of
a nationally representative sample of non-institutionalized civilian South
Koreans. The prevalence of the metabolic syndrome, as defined by the Third Report
of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP
III), was determined, and lifestyle factors associated with predisposition to the
metabolic syndrome were analysed. RESULTS: Among South Korean adults, the
age-adjusted prevalence of the metabolic syndrome was 14.2% for men and 17.7% for
women, whereas the age-adjusted prevalence of obesity (body mass index (BMI)
>or=30 kg/m(2)) was 1.7% and 3.0% for men and women, respectively. Age,
unemployment, higher BMI, and current smoking were associated factors for the
metabolic syndrome regardless of gender. Moderate exercise (2-3 sessions/week) in
men and light alcohol drinking (<15 g/day) in women decreased the odds of the
metabolic syndrome. CONCLUSIONS: Metabolic syndrome is present in more than 15%
of South Koreans despite a low prevalence of obesity. Higher BMI and current
smoking were identified as independent modifiable risk factors of the metabolic
syndrome. Weight control and smoking cessation may therefore decrease the
prevalence of the metabolic syndrome in South Korean adults.

PMID: 15082635 [PubMed - indexed for MEDLINE]

74. Salud Publica Mex. 2003;45 Suppl 4:S477-89.

Breast-feeding practices in Mexico: results from the Second National Nutrition
Survey 1999.

González-Cossío T, Moreno-Macías H, Rivera JA, Villalpando S, Shamah-Levy T,
Monterrubio EA, Hernández-Garduño A.

Instituto Nacional de Salud Pública, Centro de Investigaciones en Nutrición y
Salud, Cuernavaca, Morelos, México. tgonzale@insp.mx

OBJECTIVE: To assess breast-feeding (BF) practices and determinants of exclusive
BF (EBF) < 4 and < 6 months (mo) among women and infants < 23 mo in the NNS-1999.
MATERIAL AND METHODS: BF practices from the day and night before the interview
were ascertained, and median duration estimated. Determinants of EBF < 4 and < 6
mo were analysed by logistic regression models for complex surveys. RESULTS:
Prevalence of EBF < 4 mo was 25.7%, and of < 6 mo 20.3%. The overall rate of
continued BF (second year) was 30.9%, median duration of BF 9 mo, and the
national proportion of children ever breast-fed 92.3%. The probability (p) of EBF
< 4 mo was determined by infant age and sex, by maternal socio-economic level
(SEL) and ethnicity, and by the interaction between infant sex and SEL. The pEBF
< 6 mo was determined by infant age and length, by maternal ethnicity, and
employment. CONCLUSIONS: EBF rates and duration are low in Mexico and have
improved only slightly in the last 20 y. Infant and maternal characteristics
determine the pEBF. If improvements in infant health are a national priority,
aggressive interventions to promote and protect BF are urgently needed in Mexico,
as well as formal evaluation of current initiatives. The English version of this
paper is available too at: http://www.insp.mx/salud/index.html.

PMID: 14746042 [PubMed - indexed for MEDLINE]

75. Aust N Z J Public Health. 2003 Dec;27(6):645-8.

Comparison of health estimates between Victorian Population Health Surveys and
National Health Surveys.

Serraglio A, Carson N, Ansari Z.

Rural and Regional Health and Aged Care Services, Department of Human Services,
Melbourne, Victoria. adrian.serraglio@dhs.vic.gov.au

OBJECTIVE: The computer-assisted telephone interviewing (CATI) method has grown
rapidly in recent years as an epidemiological tool for obtaining data on health
issues. However, it is still argued that coverage, methods and lower response
rates from CATI surveys compared with face-to-face interviewing may have an
impact on the validity of the health estimates obtained. This paper compares
demographic and health estimates from the Victorian Population Health Survey
(VPHS) 2001, using CATI, with the National Health Survey (NHS) 2001 that is based
on face-to-face interviews. METHODS: The profiles of the VPHS (2001) and NHS
(2001) respondents were compared, specifically demographic characteristics (age,
gender, marital status, country of birth, and employment status) and
health-related estimates such as self-reported health status, prevalence of
diabetes and asthma, smoking status, daily intake of fruit, categories of
psychological distress and private health insurance status. RESULTS: In both
surveys, the demographic characteristics and health-related estimates of the
adult population were remarkably similar as shown by the similarity of weighted
estimates and overlapping confidence intervals. CONCLUSIONS: The degree to which
derived estimates correspond in the two independent surveys lends support to the
reliability of the CATI method used for collection of routine population health
related data.

PMID: 14723415 [PubMed - indexed for MEDLINE]

76. Cancer Causes Control. 2003 Oct;14(8):749-60.

Cancer prevention for working class, multiethnic populations through small
businesses: the healthy directions study.

Hunt MK, Stoddard AM, Barbeau E, Goldman R, Wallace L, Gutheil C, Sorensen G.

Dana-Farber Cancer Institute, Center for Community-Based Research, 44 Binney
Street, Boston MA 02115, USA. mkhunt@cox.net

OBJECTIVE: We report demographic and social contextual characteristics of
multiethnic, blue-collar workers from the baseline survey of a study conducted in
24 small businesses. We discuss ways in which we incorporated these
characteristics into the design of the intervention. METHODS: We used a
randomized controled design, with 12 small businesses assigned to a social
contextual intervention and 12 to a minimum intervention control condition. The
response rates to the survey were 84% at baseline (n = 1717). Primary outcomes
included reduction in red meat consumption and increase in physical activity and
daily multivitamin intake. Secondary outcomes targeted reduction in smoking and
occupational exposures. RESULTS: The majority of the respondents were male
(67.6%). This was an ethnically diverse sample with 24.7% representing
racial/ethnic groups other than white and 43.6% of participants or their parents
born outside of the US. To meet study recommendations, workers needed improvement
in all behaviors measured. Participants reported a smoking rate of 25.8, 86.2%
ate fewer than 5 servings of fruits and vegetables a day 69.5% ate more than
three servings of red meat a week, 46.8% engaged in less than 2.5 h a week and
72.4% reported that they did not consume a daily multivitamin. CONCLUSIONS:
Interventions that address the contextual environment in which health behaviors
occur, may provide a method that researchers and practitioners can use to reduce
health disparities.

PMID: 14674739 [PubMed - indexed for MEDLINE]

77. Nutrition. 2003 Nov-Dec;19(11-12):1006-12.

Determinants of non-home-prepared food consumption in two low-income areas in
Nairobi.

van 't Riet H, den Hartog AP, Hooftman DA, Foeken DW, van Staveren WA.

Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen,
The Netherlands.

OBJECTIVE: Street foods are an important source of nutrients for poor urban
residents. This study aimed to identify determinants of the proportion of daily
energy provided by non-home-prepared foods. METHODS: A survey was conducted in a
slum and a low- to middle-income area of Nairobi. The survey included 241 men and
254 women. Through a structured questionnaire, data on demographic and
socioeconomic factors were collected and food intake was assessed with three
standardized 24-hour recalls. A measure of socioeconomic status was constructed
with principal component analysis. RESULTS: For women in the slum area, the
presence of school-age children and distance to work were determinants of
non-home-prepared food consumption, whereas employment status and distance to
work were determinants for men in the slum area (P < 0.05). Having their own
income and, for those employed, employment status were determinants for women in
the low- to middle-income area, whereas socioeconomic status was the determinant
for the men (P < 0.05). In the slum area, most non-home-prepared foods were
derived from street foods, whereas in the low- to middle-income area, both kiosks
and street foods were important sources of non-home-prepared foods. CONCLUSIONS:
In the determinants of non-home-prepared energy consumption, we discerned a
pattern from rather basic determinants to determinants of a more complicated
nature with increasing socioeconomic level of the groups. Furthermore, a shift
from street foods to kiosks as the main source of non-home-prepared foods
consumed appeared with increasing socioeconomic levels.

PMID: 14624955 [PubMed - indexed for MEDLINE]

78. J Hum Nutr Diet. 2003 Oct;16(5):349-64.

Disparities in food habits in Europe: systematic review of educational and
occupational differences in the intake of fat.

López-Azpiazu I, Sánchez-Villegas A, Johansson L, Petkeviciene J, Prättälä R,
Martínez-González MA; FAIR-97-3096 Project.

Department of Epidemiology and Public Health, University of Navarra, Pamplona,
Spain.

BACKGROUND: A higher socio-economic level is associated with healthier dietary
habits. Nevertheless, socio-economic differences in the intake of fat have not
consistently been reported in Europe. The objective of our study was to
systematically assess differences in total fat (TF) intake and saturated fat (SF)
intake across social groups. METHODS: Representative samples from nine European
countries were used to perform a meta-analysis of surveys between 1985-1999,
including both published and nonpublished results. RESULTS: Because important
heterogeneity was found and the estimates for TF from Spain and Estonia were
different from all others, we calculated the differences in intake excluding
these two countries. We found a lower TF intake in the highest (versus the
lowest) occupational level both for men (difference: -1.1% of total energy
intake; 95% CI: -1.3 to -0.8%) and women (difference: -0.9%; 95% CI: -1.2 to
-0.6%) when Estonia and Spain were excluded. CONCLUSION: European surveys
indicate that people in the lowest category of occupation consume more fat and SF
than people in the highest category.

PMID: 14516382 [PubMed - indexed for MEDLINE]

79. Community Dent Health. 2003 Jun;20(2):117-22.

Demographic and geographic variations of oral health among African Americans
based on NHANES III.

Green BL, Person S, Crowther M, Frison S, Shipp M, Lee P, Martin M.

Texas A&M University, College of Education and Human Development, Department of
Health and Kinesiology, College Station, Texas 77843, USA. lgreen@hlkn.tamu.edu

As efforts continue to improve the health of all US citizens, oral health must
not be overlooked. Oral health is an integral part of overall health status and
oral diseases are among the most prevalent of all health problems. OBJECTIVES: To
describe the oral health status and oral health behaviors of African Americans.
METHODS: The National Health and Nutrition Examination Survey (NHANES III) data
set was used to examine a range of oral health indicators of African Americans
with specific attention to demographic and geographic factors. The original data
set consisted of 20,050 subjects, gathered through the use of complex,
multi-stage, stratified and clustered sampling techniques. Only African Americans
were included in this study which resulted in a sample of 5,616. Statistical
analysis was conducted to allow the proper modeling of the complex, stratified,
multistage survey design and sample weights of NHANES III. RESULTS: Sixty-two
percent of respondents indicated that they only visit the dentist when needed and
had no regular visitation schedule. Dental health was worse for those individuals
who were poor, unemployed, and uninsured. Regional differences in dental care
appeared with individuals living in the south reporting poorer dental health.
CONCLUSIONS: The findings from this study are useful for identifying
sociodemographic and geographic factors related to oral health status. The
insights gained from this study illustrate the need for tailoring oral health
promotion programmes and services to specific groups within the African American
community because service utilisation and response patterns and perceptions may
be different.

PMID: 12828273 [PubMed - indexed for MEDLINE]

80. Am J Gastroenterol. 2003 May;98(5):1175-80.

Insurance, employment, and psychosocial consequences of a diagnosis of hereditary
hemochromatosis in subjects without end organ damage.

Shaheen NJ, Lawrence LB, Bacon BR, Barton JC, Barton NH, Galanko J, Martin CF,
Burnett CK, Sandler RS.

Center for Gastrointestinal Biology and Disease, and the Division of Digestive
Diseases and Nutrition, University of North Carolina, Chapel Hill, North Carolina
27599, USA.

OBJECTIVES: Asymptomatic individuals with hereditary hemochromatosis (HH) may
experience difficulties in obtaining employment or insurance, despite their good
health. The extent to which these difficulties occur is unclear. The aim of this
study was to assess the insurance, employment, and psychosocial consequences of a
diagnosis of HH in subjects with no end organ damage. METHODS: In three
outpatient clinics specializing in the treatment of HH, we performed a survey of
individuals diagnosed with HH who were without end organ damage secondary to iron
overload, along with their unaffected siblings. A review of the medical records
of subjects with HH was performed. Main outcomes were attaining and keeping
employment; health, disability and life insurance; and scores on the SF-36, a
quality of life measure, and the SCL-90-R, a measure of psychological well-being.
RESULTS: Of 130 eligible subjects with HH, 126 (97%) responded. Of the 55
eligible controls, 46 (84%) responded. Of the 126 subjects with HH, 25 (20%)
described 28 incidents of insurance denial or increased premium rates, which they
attributed to their diagnosis HH. Of the 28 incidents, 16 (57%) involved life
insurance, eight (29%) involved health insurance, and four (14%) involved
disability insurance. One subject reported an employment refusal. Five of the 25
subjects (20%) reporting insurance denial or increased premiums had significant
comorbid conditions. One of 46 sibling controls (2%) reported an increased rate
for life insurance (p = 0.003). No differences were noted in either the SF-36 or
the SCL-90-R scores between subjects with HH and unaffected siblings. Overall
rates of active health, disability, and life insurance were similar between the
groups. CONCLUSIONS: Insurance denial and increased premium rates are reported
commonly among individuals with HH without end organ damage. However, the overall
proportion of those with active insurance, the quality of life, and the
psychological well-being of these subjects were similar to those of unaffected
siblings.

PMID: 12809845 [PubMed - indexed for MEDLINE]

81. Soc Sci Med. 2003 Aug;57(3):477-86.

Socio-demographic predictors of self-rated health in the Republic of Ireland:
findings from the National Survey on Lifestyle, Attitudes and Nutrition, SLAN.

Kelleher CC, Friel S, Nic Gabhainn S, Tay JB.

Health Research Board Unit on Health Status and Health Gain, Department of Health
Promotion, Clinical Sciences Institute, National University of Ireland, Costello
Road, Shantalla, Galway City, Ireland. cecily.kelleher@nuigalway.ie

Though Ireland continues to have a poor health profile compared with other
European Union countries, previous research on social variations has been
limited. For the first time in the Republic of Ireland, the influence on
self-rated health of various socio-demographic indicators was assessed in a
multi-variate logistic regression model, separately for men and women. Data were
from the first National Survey of Lifestyles, Attitudes and Nutrition, SLAN,
conducted by post in a multi-stage, cluster random sample across 26 counties.
There were 6539 respondents (45.4% males). Mean self-rated health differed
significantly according to age, marital status, tenure, educational status,
social class, household size and eligibility for general medical services (GMS),
but not according to gender or rurality. There were also differences if residing
in a district with low level of affluence, or according to social cluster
groupings. There were numerous significant correlations between the nine
socio-demographic measures, but the most consistent pattern was between GMS
eligibility and the various indicators, for both men and women. In the case of
men, whether social class was included in the multi-variate model or not,
education status remained predictive in the final model, (OR 2.36 CI 1.35-4.12)
as did smoking status (OR 2.11 CI 1.47-3.02). Odds ratio for GMS eligibility was
3.33 (CI 2.61-4.26) attenuated to 1.70 (CI 1.12-2.56) in the final model. For
women the pattern was somewhat different. Only GMS status (OR 2.64 CI 1.74-3.99)
and level of education (2.25 CI 1.19-4.24) were predictive in the final model. A
multi-level analysis showed that area level of affluence was not significantly
predictive of self-rated health when individual level factors were taken into
account.

PMID: 12791490 [PubMed - indexed for MEDLINE]

82. J Am Diet Assoc. 2003 Jun;103(6):699-706; discussion 706.

Baseline fat-related dietary behaviors of white, Hispanic, and black participants
in a cholesterol screening and education project in New England.

Gans KM, Burkholder GJ, Risica PM, Lasater TM.

Institute for Community Health Promotion, Brown University, I Hoppin Street,
Providence, RI 02903, USA. Kim_Gans@brown.edu

OBJECTIVE: To examine baseline fat-related dietary behaviors of white, Hispanic,
and black participants in Minimal Contact Education for Cholesterol Change, a
National Institutes for Health-funded cholesterol screening and education project
conducted in New England. SUBJECTS: A sample of 9,803 participants who joined the
study at baseline (n=7,817 white; n=1,425 Hispanic; and n=561 black). METHODS:
Participants completed baseline questionnaires that included demographic and
psychosocial items as well as the Food Habits Questionnaire, a dietary assessment
tool measuring fat-related dietary behaviors. They also had their blood
cholesterol level and height and weight measured. STATISTICAL ANALYSES: Analysis
of variance (ANOVA) was used to compare racial/ethnic groups on continuous
demographic variables, and the chi(2) test of association was used to compare
groups on demographic categorical variables. Multivariate analysis of variance
(MANOVA) was used to compare mean differences between racial/ethnic groups on six
behavioral subscales (Fat Factors) differentiating domains of behavior related to
fat intake and to compare 27 individual fat-related dietary behaviors. RESULTS:
After adjusting for sex, age, marital status, education, employment status, and
percent time lived in the United States, white participants had the lowest Food
Habits Questionnaire summary score (2.44) (indicating a lower fat diet), followed
by Hispanic (2.61) and black (2.68) participants. The three ethnic groups also
differed on the prevalence of Fat Factors and specific fat-related dietary
behaviors. White participants were more likely to use lower-fat alternatives, to
avoid frying, to replace meat, and to modify meat to make it lower in fat.
However, they were least likely to eat fruits and vegetables for snacks and
desserts. Hispanic participants were more likely to engage in fat-avoidance
behaviors and to eat fruits and vegetables for snacks and desserts. Black
participants were less likely to eat meatless meals and modify meats to make them
lower in fat. Black and Hispanic participants were more likely than white
participants to fry foods. Hispanics were less likely to read food labels for
nutrition information. The most and least prevalent fat-related behaviors also
differed by each ethnic group, showing that different behaviors were more and
less easily implemented by each ethnic group. CONCLUSIONS/APPLICATIONS: The
results of this study suggest that there is a need for improvement in dietary
behaviors related to fat intake, especially for blacks and Hispanics, and that
the specific dietary behavior issues differ widely by ethnicity. These results
can be used by nutrition educators and researchers to help them decide what
messages to emphasize in dietary counseling, nutrition education programs, and
materials. The results can also be used to help design better dietary assessment
tools and more effective interventions for culturally diverse populations.

PMID: 12778040 [PubMed - indexed for MEDLINE]

83. Pharmacoeconomics. 2003;21(8):565-72.

Labour force participation among individuals with hepatitis C in the US.

Jacobs P, Ng YC, Stafinski T, Dodd R, Larke B, Wong W.

Department of Public Health Sciences, University of Alberta and Institute of
Health Economics, #1200-10405 Jasper Avenue, Edmonton, Alberta T5J 3N4, Canada.
philip.jacobs@ualberta.ca

BACKGROUND: In 1996, the number of persons newly infected with hepatitis C virus
(HCV) in the US was estimated to be 36 000. As a chronic disease that primarily
affects younger persons, hepatitis C has the potential to influence employment
considerably. OBJECTIVE: To estimate employment effects associated with hepatitis
C morbidity. DESIGN: An economic model of labour supply, which used the outcome
measure workforce participation (yes/no), was applied. STUDY PARTICIPANTS: The
study samples (by gender) were comprised of persons 18-65 years of age, with and
without serological evidence of HCV infection, and with normal or elevated levels
of alanine aminotransferase (ALT) who participated in the National Health and
Nutrition Examination Survey III from 1988-1994. RESULTS: After controlling for
the potential confounding effects of demographic, social, and economic factors,
positive HCV status/normal ALT level in males was associated with a 10.7%
reduction in labour force participation (when compared with negative HCV status).
Positive HCV status and elevated ALT levels was associated with a 17.5% reduction
in employment. The results for females were not statistically significant.
CONCLUSIONS: Nationally, the employment response for HCV-positive status and
elevated ALT levels translates into an excess non-employment of 48 000 males
annually.

PMID: 12751914 [PubMed - indexed for MEDLINE]

84. J Health Econ. 2003 May;22(3):477-504.

Maternal employment and overweight children.

Anderson PM, Butcher KF, Levine PB.

Department of Economics, Dartmouth College, Hanover, NH 03755-3514, USA.
patricia.m.anderson@dartmouth.edu

This paper seeks to determine whether a causal relationship exists between
maternal employment and childhood weight problems. We use matched mother-child
data from the National Longitudinal Survey of Youth (NLSY) and employ econometric
techniques to control for observable and unobservable differences across
individuals and families that may influence both children's weight and their
mothers' work patterns. Our results indicate that a child is more likely to be
overweight if his/her mother worked more hours per week over the child's life.
Analyses by subgroups show that it is higher socioeconomic status mothers whose
work intensity is particularly deleterious for their children's overweight
status.

PMID: 12683963 [PubMed - indexed for MEDLINE]

85. Public Health Nutr. 2003 Apr;6(2):159-68.

Low-income consumers' attitudes and behaviour towards access, availability and
motivation to eat fruit and vegetables.

Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ.

Institute of Food Research, Norwich Research Park, Colney, NR4 7UA.
Louise.Dibsdall@bbsrc.ac.uk

OBJECTIVE: To determine low-income consumers' attitudes and behaviour towards
fruit and vegetables, in particular issues of access to, affordability of and
motivation to eat fruit and vegetables. DESIGN AND SETTING: Questionnaire survey
mailed to homes owned by a large UK housing association. PARTICIPANTS:
Participants were 680 low-income men and women, aged 17-100 years. RESULTS: Age,
employment, gender, smoking and marital status all affected attitudes towards
access, affordability and motivation to eat fruit and vegetables. Few (7%)
participants experienced difficulty in visiting a supermarket at least once a
week, despite nearly half having no access to a car for shopping. Fruit and
vegetables were affordable to this low-income group in the amounts they
habitually bought; purchasing additional fruits and vegetables was seen as
prohibitively expensive. Less than 5% felt they had a problem with eating
healthily and yet only 18% claimed to eat the recommended 5 or more portions of
fruit and vegetables every day. CONCLUSIONS: Supported by research, current UK
Government policy is driven by the belief that low-income groups have
difficulties in access to and affordability of fruit and vegetables. Findings
from this particular group suggest that, of the three potential barriers, access
and affordability were only a small part of the 'problem' surrounding low fruit
and vegetable consumption. Thus, other possible determinants of greater
consequence need to be identified. We suggest focusing attention on motivation to
eat fruit and vegetables, since no dietary improvement can be achieved if people
do not recognise there is a problem.

PMID: 12675958 [PubMed - indexed for MEDLINE]

86. Int J Obes Relat Metab Disord. 2003 Mar;27(3):394-403.

Social factors and obesity: an investigation of the role of health behaviours.

Ball K, Mishra GD, Crawford D.

School of Health Sciences, Deakin University, Australia. kball@deakin.edu.au

OBJECTIVES: This study evaluated a behavioural model of the relation between
social factors and obesity, in which differences in body mass index (BMI) across
sociodemographic groups were hypothesized to be attributable to social group
differences in health behaviours affecting energy expenditure (physical activity,
diet and alcohol consumption and weight control). METHODS: A total of 8667 adults
who participated in the 1995 Australian National Health and Nutrition Surveys
provided data on a range of health factors including objectively measured height
and weight, health behaviours, and social factors including family status,
employment status, housing situation and migration status. RESULTS: Social
factors remained significant predictors of BMI after controlling for all health
behaviours. Neither social factors alone, nor health behaviours alone, adequately
explained the variance in BMI. Gender-specific interactions were found between
social factors and individual health behaviours. CONCLUSIONS: These results
suggest that social factors moderate the relation between BMI and weight-related
behaviours, and that the mechanisms underlying sociodemographic group differences
in obesity may vary among men and women. Additional factors are likely to act in
conjunction with current health behaviours to explain variation in obesity
prevalence across sociodemographic groups.

PMID: 12629569 [PubMed - indexed for MEDLINE]

87. J Am Diet Assoc. 2003 Mar;103(3):317-22.

Family meal patterns: associations with sociodemographic characteristics and
improved dietary intake among adolescents.

Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C.

Division of Epidemiology, School of Public Health, University of Minnesota,
Minneapolis, MN 55454, USA. Neumark@epi.umn.edu

Comment in:
J Am Diet Assoc. 2007 Sep;107(9):1498-501.

OBJECTIVE: To examine family meal patterns and associations with sociodemographic
characteristics and dietary intake in adolescents. DESIGN: A population-based
cross-sectional study design was employed. Adolescents completed the Project EAT
(Eating Among Teens) survey and the Youth and Adolescent Food Frequency
Questionnaire within their schools. Subjects/setting The study population
included 4,746 middle and high school students from Minneapolis/St. Paul public
schools with diverse racial and socioeconomic backgrounds. Statistical analyses
Associations were examined using cross tabulations, log-linear modeling, and
linear regressions. RESULTS: There was a wide distribution in the frequency of
family meals during the previous week: never (14.0%), 1 or 2 times (19.1%), 3 to
6 times (40.1%), and 7 or more times (24.8%). Sociodemographic characteristics
associated with more frequent family meals included gender (boys), school level
(middle school), race (Asian American), mother's employment status (not
employed), and socioeconomic status (high). Frequency of family meals was
positively associated with intake of fruits, vegetables, grains, and calcium-rich
foods and negatively associated with soft drink consumption. Positive
associations were also seen between frequency of family meals and energy; protein
(percentage of total calories); calcium; iron; folate; fiber; and vitamins A, C,
E, and B-6. CONCLUSIONS: Family meals appear to play an important role in
promoting positive dietary intake among adolescents. Feasible ways to increase
the frequency of family meals should be explored with adolescents and their
families.

PMID: 12616252 [PubMed - indexed for MEDLINE]

88. Soc Sci Med. 2003 Apr;56(7):1397-410.

Socioeconomic differences in dietary patterns among middle-aged men and women.

Martikainen P, Brunner E, Marmot M.

Department of Epidemiology, International Centre for Health and Society,
University College London Medical School, 1-19 Torrington Place, WC1E 6BT,
London, UK. pekka@public-health.ucl.ac.uk

The aim of the study is to (i) identify common dietary patterns, (ii) study
socioeconomic differences in these dietary patterns, and (iii) assess whether
they contribute to socioeconomic differences in biological risk factors. The data
come from the Whitehall II study of London civil servants, who participated in
the third phase (1991-1993) and were 39-63-years old (N=8004). Food frequency
questionnaire and socioeconomic background information was from a questionnaire,
and biological risk factors from a medical screening. Six dietary patterns were
identified. In reference to high employment grade men, the odds ratios of low
grade men consuming the 'unhealthy' or the 'very unhealthy' diet were 1.26 and
3.34, respectively, while the odds for the 'French' diet was 0.13. Among women
the corresponding odds were 2.98, 6.19 and 0.25. Adjusting for spouse's
socioeconomic status and to a lesser extent smoking and exercise as well as job
control attenuate these grade differences somewhat. Among men and women adjusting
for dietary patterns accounted for about 25-50 per cent of grade differences in
HDL and serum triglyceride levels.

PMID: 12614692 [PubMed - indexed for MEDLINE]

89. Am J Public Health. 2003 Mar;93(3):477-81.

Why do WIC participants fail to pick up their checks? An urban study in the wake
of welfare reform.

Rosenberg TJ, Alperen JK, Chiasson MA.

Medical and Health Research Association of New York City Inc., NY 10013-2988,
USA. trosenberg@mhra.org

OBJECTIVES: This study explored whether work or immigration concerns affect
women's participation in the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC). METHODS: The sample included women who had withdrawn
from the WIC program and current WIC clients from 1 center in New York City.
Logistic regression analyses were used to predict noncollection of checks;
demographic characteristics, program participation, and problems with the WIC
program were independent variables. RESULTS: Strong predictors of noncollection
of checks were job conflicts, transportation or illness problems, and WIC receipt
by the woman herself (rather than by her children). CONCLUSIONS: Employment
conflicts were related to failure to pick up WIC checks; immigration concerns
were not. As a means of enhancing WIC participation, flexibility is recommended
in terms of center hours, locations, and staffing and program check distribution
policies.

PMCID: PMC1447767
PMID: 12604499 [PubMed - indexed for MEDLINE]

90. Am J Kidney Dis. 2002 Dec;40(6):1132-7.

The effect of renal insufficiency on workforce participation in the United
States: an analysis using National Health and Nutrition Examination Survey III
data.

Klarenbach S, Stafinski T, Longobardi T, Jacobs P.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
swk@ualberta.ca

BACKGROUND: End-stage renal disease is associated with workforce
nonparticipation, but no previous study has assessed the impact of renal
insufficiency on employment status from a population standpoint. METHODS: To
determine whether renal insufficiency is independently associated with labor
force participation, an analysis was performed using observational data from the
Third National Health and Nutrition Examination Survey, which represents a
cross-sectional sample of the US population. Five thousand five hundred
fifty-eight subjects of the civilian noninstitutionalized US population aged 18
to 64 years provided complete information regarding key variables. A logistic
regression equation with workforce participation as the dependent variable was
created. Explanatory variables included age, sex, race, marital status, census
region, and education, as well as the health-state indicators of general health
status, presence or absence of diabetes, hypertension, stroke, congestive heart
failure, myocardial infarction, and an indicator of renal function. Renal
dysfunction was defined by serum creatinine values greater than 1.7 mg/dL (150
micromol/L) for women and greater than 2.0 mg/dL (180 micromol/L) for men.
RESULTS: Renal dysfunction was independently associated with labor force
nonparticipation, with an odds ratio of 7.94 (95% confidence interval, 1.60 to
39.43). This relationship remained statistically significant after subjects with
markedly elevated serum creatinine levels were excluded. CONCLUSION: A previously
unrecognized independent association between renal function and labor force
participation was identified. This group of patients warrants further attention
regarding identification of specific factors leading to nonemployment, potential
for workforce rehabilitation, and assessment of the impact of renal insufficiency
in other functional spheres. Copyright 2002 by the National Kidney Foundation,
Inc.

PMID: 12460030 [PubMed - indexed for MEDLINE]

91. Int Arch Occup Environ Health. 2002 Oct;75 Suppl:S21-6. Epub 2002 Jul 6.

Possibilities to control the health risk of petrochemical workers.

Georgieva T, Michailova A, Panev T, Popov T.

Department of Toxicology, National Center of Hygiene, Medical Ecology and
Nutrition, 15D Nestorov Boulevard, 1431 Sofia, Bulgaria. tzvege@dir.bg

OBJECTIVES: It is well known that the adverse health effects of a number of
chemical substances are related to the formation of free radicals. The aim of
this study was to assess the degree of oxidative stress and the possibility of
strengthening the antioxidative potential of the organism by antioxidant
treatment. METHODS: The levels of benzene, toluene, xylene, hexane, ethylbenzene
and total hydrocarbons were measured in workplace air by personal dosimetry. A
questionnaire was used to collect data on length of service, past and current
occupational exposure to chemicals, lifestyle, diet, past and current diseases,
drug use. The antioxidative status was measured by indices: malondialdehyde (MDA)
and reduced glutathione (GSH); glutathione peroxidase (GPx) and superoxide
dismutase (SOD) activity; total antioxidant status (TAS), levels of
alpha-tocopherol and vitamin A; selenium, before and after the treatment. The
workers were given tablets containing vitamins, micro-elements, and
bioflavonoids, in appropriate doses. All subjects had signed an informed consent.
RESULTS: Before treatment the workers had significantly higher MDA levels (
P<0.001) and lower GSH concentrations ( P<0.001) and GPx activities ( P<0.001)
than did the controls. Other indices were without significant changes. The
results after 40 days of supplementation demonstrated that the number of subjects
with high values of MDA decreased significantly; the activity of GPx was within
the referent values; the level of GSH had also recovered and conformed to
physiological norms. CONCLUSIONS: The decrease of GPx and GSH and the increase of
the MDA levels give evidence of misbalance in the antioxidant status. The
decreased values of MDA and the increased GPx activity and GSH concentrations at
the second examination proved the positive effect of the treatment. The
strengthened antioxidant potential of workers exposed to a mixture of
hydrocarbons confirmed the possibilities that the exposure-related health risk
can be controlled and the adverse effects prevented.

PMID: 12397407 [PubMed - indexed for MEDLINE]

92. Nutr Clin Care. 2002 Jul-Aug;5(4):168-81.

Talking to patients about food insecurity.

Messer E, Ross EM.

Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA,
USA.

Comment in:
Nutr Clin Care. 2002 Jul-Aug;5(4):149-51.

Food insecurity is highly prevalent in the United States. Even in the best of
times, some 10% of the U.S. population self-reports food insecurity in the U.S.
annual census instrument, and some 23.3 million Americans use the community-based
emergency food system. Unemployed or underemployed individuals, the elderly,
single parents, substance abusers, and uninsured or underinsured individuals with
medical illnesses are at increased risk for food insecurity. This article
discusses clinical approaches to food-insecure individuals. Measurement tools
developed to define and document the extent of hunger and food insecurity in the
U.S. population are presented as templates for discussion between doctor or
dietitian and patient. Information is provided to help clinicians guide patients
with food insecurity to appropriate resources.

PMID: 12380244 [PubMed - indexed for MEDLINE]

93. Public Health Nutr. 2002 Oct;5(5):625-30.

Free school meals and children's social and nutritional status in Trinidad and
Tobago.

Gulliford MC, Mahabir D, Rocke B, Chinn S, Rona RJ.

Department of Public Health Sciences, King's College London, Capital House, 42
Weston Street, UK. martin.gulliford@kcl.ac.uk

OBJECTIVE: To evaluate the provision of free school meals in Trinidad and Tobago
in relation to children's social and nutritional status. DESIGN AND METHODS:
Cross-sectional survey of a nationally representative sample of 66 government
schools, including children in the admissions classes (aged 4 to 7 years) and
classes for 'rising nines' (aged 7-10 years). Data included questionnaire details
of free school meals and children's social background, and measurements of
children's heights, weights and skinfold thicknesses. RESULTS: Of 6731 eligible
children, data were analysed for 5688 (85%). There were 2386 (42%) children
receiving free meals provided at school. At different schools the proportion of
all children receiving free meals ranged from 20% to 100%, Receipt of free meals
was associated with larger family size (one child, 32% received free meals; > or
=6 children, 63%), lower paternal educational attainment (primary, 52% free;
university, 30%), father's employment (employed, 39% free meals; unemployed >12
months, 59%) as well as maternal education and employment and household
amenities. After adjusting for age, sex and ethnic group, children who received
free meals were shorter (mean difference in height standard deviation score (SDS)
-0.12, 95% confidence interval (CI) -0.17 to -0.06), lighter (body mass index SDS
-0.21, -0.28 to -0.14) and thinner (subscapular skinfold SDS -0.13, -0.18 to
-0.09). CONCLUSIONS: Free school meals were widely available, with some targeting
of provision to children with less favourable social and nutritional status.
Greater universality would reduce inequity, but more stringent targeting and
reduction of school-level variation would increase efficiency.

PMID: 12372155 [PubMed - indexed for MEDLINE]

94. Am J Epidemiol. 2002 Oct 15;156(8):738-46.

Association between chronic obstructive pulmonary disease and employment by
industry and occupation in the US population: a study of data from the Third
National Health and Nutrition Examination Survey.

Hnizdo E, Sullivan PA, Bang KM, Wagner G.

Division of Respiratory Disease Studies, National Institute for Occupational
Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
26505, USA. Exh6@cdc.gov

Data from the US population-based Third National Health and Nutrition Examination
Survey, conducted from 1988 to 1994, were used to estimate the population
prevalence, prevalence odds ratios, and attributable fractions for the
association of chronic obstructive pulmonary disease (COPD) with employment by
industry and occupation. The aim was to identify industries and occupations at
increased risk of COPD. COPD was defined as forced expiratory volume in 1 second
(FEV(1))/forced vital capacity <70% and FEV(1 )<80% predicted. The authors used
SUDAAN software (Research Triangle Institute, Research Triangle Park, North
Carolina) to estimate the weighted population prevalence and odds ratios using
9,823 subjects aged 30-75 years who underwent lung function tests. Odds ratios
for COPD, adjusted for age, smoking status, pack-years of smoking, body mass
index, education, and socioeconomic status, were increased for the following
industries: rubber, plastics, and leather manufacturing; utilities; office
building services; textile mill products manufacturing; the armed forces; food
products manufacturing; repair services and gas stations; agriculture; sales;
construction; transportation and trucking; personal services; and health care.
Occupations associated with increased odds ratios for COPD were freight, stock,
and material handlers; records processing and distribution clerks; sales;
transportation-related occupations; machine operators; construction trades; and
waitresses. The fraction of COPD attributable to work was estimated as 19.2%
overall and 31.1% among never smokers.

PMID: 12370162 [PubMed - indexed for MEDLINE]

95. J Health Popul Dev Ctries. 1997 Fall;1(1):68-84.

Integrated use of qualitative and quantitative methods to elicit women's
differential knowledge of breastfeeding and lactational amenorrhea in periurban
Bolivia.

Bender DE, Baker R, Dusch E, Mccann MF.

PIP: Exclusive and extended breast feeding is responsible for much of the
fertility limitation and child spacing throughout the world. In many developing
countries, where breast feeding is almost universal and of long duration,
postpartum amenorrhea protects women from closely spaced subsequent pregnancies.
However, at the same time, increased pressures toward modernization, rapid
rural-to-urban migration, frequent advertisements of powdered milk substitutes,
and the increased employment of women outside of the home are adversely affecting
traditional breast feeding practices. In Bolivia, almost all women breast feed
their newborn infants, for periods up to 2 years. This paper reports findings
which describe and compare patterns of women's differential knowledge of breast
feeding and lactational amenorrhea resulting from data collection using a survey
instrument and a focus group guide. The findings are part of a larger study on
infant feeding and child spacing conducted in periurban communities in Bolivia.
Current and historical trends with regard to paradigm and methodology in social
science research are reviewed and the survey/focus group research method is
described.

PMID: 12293262 [PubMed - indexed for MEDLINE]

96. Nurs Stand. 2001 May 23-29;15(36):33-6.

Barriers to healthy eating in the nursing profession: Part 1.

Faugier J, Lancaster J, Pickles D, Dobson K.

Manchester Metropolitan University.

AIM: The aim of this study commissioned by the NHS Executive North West was to
identify the main areas of the nurse's working environment that prevent healthy
eating, to ascertain if nurses have enough nutritional knowledge to make informed
choices, and to review sources, availability and quality of food provided for
nursing staff. METHOD: A purposive sample size of 126 nurses from across eight
healthcare sites in the North West region completed questionnaires. RESULTS:
Shift patterns and failure to take breaks were identified as the two main
barriers to healthy eating by respondents. However, satisfaction with food on
offer and a supportive environment were also identified as important influences.
CONCLUSION: Several recommendations were made as a result of the study. Ideally,
nurses should take regular breaks. Food should carry nutritional labelling and
nutritional information should be displayed at healthcare sites in a more
imaginative and innovative way. More refrigerated vending machines with a
selection of healthier options should be supplied. Packed lunches or plated
salads obtainable from restaurants by evening and night-shift nurses should be
offered, in addition to a better selection of sandwiches and other food choices
outside the hours of 9 am to 5 pm, Monday to Friday. Nurses should be encouraged
to drink the recommended amount of eight glasses of water per day (Health and
Fitness Tips 2000) by providing adequate water dispensers. The possibility of
having separate catering facilities for staff who wish to avoid patients and
visitors during breaks should be explored.

PMID: 12205837 [PubMed - indexed for MEDLINE]

97. Nurs Stand. 2001 May 30-Jun 5;15(37):33-5.

Barriers to healthy eating in the nursing profession: Part 2.

Faugier J, Lancaster J, Pickles D, Dobson K.

Manchester Metropolitan University.

AIM: This is the second of two articles that report on work commissioned by the
NHS Executive North West, to explore the perceived barriers to healthy eating
within the nursing profession. METHOD: Observations were made of catering
facilities within eight healthcare sites (six acute hospitals, an NHS walk-in
centre and an NHS Direct site) across the North West region. Twenty four
unstructured interviews were conducted with nurses and three were sampled from
each healthcare site. RESULTS: Four main themes emerged as barriers to healthy
eating: availability; variety; distance from catering facilities; and
breaks/staffing levels/workload issues CONCLUSION: Respondents in this study do
not consider their working environments to be conducive to healthy eating
practices.

PMID: 12205763 [PubMed - indexed for MEDLINE]

98. Public Health Nutr. 2002 Aug;5(4):515-22.

Non-home prepared foods: contribution to energy and nutrient intake of consumers
living in two low-income areas in Nairobi.

van't Riet H, den Hartog AP, van Staveren WA.

Division of Human Nutrition and Epidemiology, Wageningen University, PO Box 8129,
The Netherlands. hilda.vantriet@staff.nutepi.wau.nl

OBJECTIVE:: To determine the nutritional importance of non-home prepared foods
for men, women and schoolchildren living in two low-income residential areas of
Nairobi, and the sources of these non-home prepared foods. DESIGN, SETTING AND
SUBJECTS:: A survey was conducted in Korogocho, a slum area, and Dandora, a
low-middle-income residential area. Some 241 men, 254 women and 146 children aged
9 to 14 years were included in the study. Food intake was measured using three
24-hour recalls per individual, with special attention on the sources of all
foods consumed. RESULTS:: The median proportion of daily energy intake of
consumers provided by non-home prepared foods ranged from 13% for schoolchildren
in Korogocho to 36% for men in Dandora. The median contribution to fat intake was
higher than to energy, but the contributions to iron and vitamin A intakes were
lower than to energy intake. Men consumed more non-home prepared foods on
weekdays than at the weekend. Intakes of energy and most nutrients were below
Kenyan Recommended Daily Intakes in all groups, but similar for consumers and
non-consumers. In Korogocho, street foods were the main source of non-home
prepared foods. In Dandora, both kiosks and street foods were major sources.
CONCLUSIONS:: Non-home prepared foods are an important source of energy and
nutrients for men, women and schoolchildren in Nairobi. In Korogocho, street
foods, and in Dandora, both kiosks and street foods are the main sources of
non-home prepared foods. The adequacy of energy and nutrient intakes does not
differ between consumers and non-consumers of non-home prepared foods.

PMID: 12186659 [PubMed - indexed for MEDLINE]

99. J Occup Environ Med. 2002 Jun;44(6):503-9.

Exposure to secondhand smoke in the workplace: serum cotinine by occupation.

Wortley PM, Caraballo RS, Pederson LL, Pechacek TF.

Office on Smoking and Health, Centers for Disease Control and Prevention, 4770
Buford Highway, N.E. MS-K50, Atlanta, GA 30341-3717, USA. pmw1@cdc.gov

To examine workplace exposure to secondhand smoke by occupation, we analyzed data
from The Third National Health and Nutrition Examination Survey (NHANES III)
(1988 to 1994), a nationally representative sample of the noninstitutionalized
population. The analysis was restricted to 4952 employed nonsmoking adults who
reported no home exposure to cigarette smoke. Occupations were assigned to 40
groups and 7 categories. Among the categories, geometric mean serum cotinine
(ng/mL) ranged from 0.09 for farming/forestry/fishing occupations to 0.22 for
operators/fabricators/laborers (median, 0.16). The lowest values were observed
among farmers and nursery workers (0.06) and the highest among waiters (0.47).
Between 1988 to 1991 and 1991 to 1994, the overall geometric mean cotinine and
the proportion reporting that they could smell smoke at work decreased
significantly. In conclusion, workplace exposure to secondhand smoke varied by
occupation, and decreases in exposure occurred between 1988 to 1991 and 1991 to
1994.

PMID: 12085475 [PubMed - indexed for MEDLINE]

100. Int J Obes Relat Metab Disord. 2002 Apr;26(4):559-65.

Which aspects of socioeconomic status are related to obesity among men and women?

Ball K, Mishra G, Crawford D.

School of Health Sciences, Deakin University, Burwood, Victoria, Australia.
kball@deakin.edu.au

OBJECTIVE: This study aimed to investigate the relationships between body weight
and fat distribution, and four empirically derived domains of socioeconomic
status: employment, housing, migration status and family unit. DESIGN: A
population-based study was used. PARTICIPANTS: A total of 8667 randomly-selected
adults (4167 men; 4500 women) who participated in the 1995 Australian National
Health and Nutrition Surveys provided data on a range of health factors including
objective height, weight and body fat distribution, and a range of
sociodemographic indicators. RESULTS: Results demonstrated associations for
women, after controlling for age, between the employment domain, and body mass
index and waist-to-hip ratio. Low status employed women were 1.4 times as likely
to be overweight as high status employed women. There were less consistent
relationships observed among these factors for men. Relationships between family
unit and indicators of body weight and body fat distribution were observed for
both men and women, with those who were married, particularly men (OR = 1.6, 95%
CI 1.4-2.0), at higher risk of overweight. The migration and housing
socioeconomic status domains were not consistently associated with body mass
index or waist-to-hip ratio. CONCLUSIONS: These findings indicate that different
components of socioeconomic status may be important in predicting obesity, and
thus should be examined separately. Future research would benefit from
investigating the underlying mechanisms governing the relationships between
socioeconomic status domains further, particularly those related to employment
and family unit and obesity.

PMID: 12075584 [PubMed - indexed for MEDLINE]

101. Bull World Health Organ. 2002;80(2):106-13.

Health, nutrition and prosperity: a microeconomic perspective.

Thomas D, Frankenberg E.

Department of Economics, UCLA, Los Angeles, CA 90095-1477, USA. dt@ucla.edu

A positive correlation between health and economic prosperity has been widely
documented, but the extent to which this reflects a causal effect of health on
economic outcomes is very controversial. Two classes of evidence are examined.
First, carefully designed random assignment studies in the laboratory and field
provide compelling evidence that nutritional deficiency - particularly iron
deficiency - reduces work capacity and, in some cases, work output. Confidence in
these results is bolstered by a good understanding of the underlying biological
mechanisms. Some random assignment studies indicate an improved yield from health
services in the labour market. Second, observational studies suggest that general
markers of nutritional status, such as height and body mass index (BMI), are
significant predictors of economic success although their interpretation is
confounded by the fact that they reflect influences from early childhood and
family background. Energy intake and possibly the quality of the diet have also
been found to be predictive of economic success in observational studies.
However, the identification of causal pathways in these studies is difficult and
involves statistical assumptions about unobserved heterogeneity that are
difficult to test. Illustrations using survey data demonstrate the practical
importance of this concern. Furthermore, failure to take into account the dynamic
interplay between changes in health and economic status has led to limited
progress being reported in the literature. A broadening of random assignment
studies to measure the effects of an intervention on economic prosperity,
investment in population-based longitudinal socioeconomic surveys, and
application of emerging technologies for a better measure of health in these
surveys will yield very high returns in improving our understanding of how health
influences economic prosperity.

PMCID: PMC2567722
PMID: 11953788 [PubMed - indexed for MEDLINE]

102. Prev Med. 2002 Mar;34(3):313-23.

Effects of a tailored health promotion program for female blue-collar workers:
health works for women.

Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K, Belton L, Sanhueza A.

Department of Nutrition, Campus Box 7400, University of North Carolina, Chapel
Hill, North Carolina 27599, USA. marci_campbell@unc.edu

BACKGROUND: This study assessed the effects of the Health Works for Women (HWW)
intervention on improving multiple behaviors including nutrition and physical
activity among rural female blue-collar employees in North Carolina. METHODS:
Nine small to mid-size workplaces were randomly assigned to either intervention
or delayed intervention conditions. After a baseline survey, an intervention
consisting of two computer-tailored magazines and a natural helpers program was
conducted over 18 months. Delayed worksites received one tailored magazine.
Approximately 77 and 76% of baseline respondents completed follow-up surveys at 6
and 18 months, respectively, and 538 women (63%) completed all three surveys.
RESULTS: At the 18-month follow-up, the intervention group had increased fruit
and vegetable consumption by 0.7 daily servings compared to no change in the
delayed group (P < 0.05). Significant differences in fat intake were observed at
6 months (P < 0.05) but not at 18 months. The intervention group also
demonstrated improvements in strengthening and flexibility exercise compared to
the delayed group. The rates of smoking cessation and cancer screening did not
differ between study groups. CONCLUSIONS: The HWW project was a successful model
for achieving certain health behavior changes among blue-collar women. (C)2002
American Health Foundation and Elsevier Science (USA).

PMID: 11902848 [PubMed - indexed for MEDLINE]

103. Ann N Y Acad Sci. 2001 Dec;952:153-60.

Diet and breast cancer surveillance behaviors among Harlem women.

Gorin SS, Jacobson J.

Department of Sociomedical Sciences, Mailman School of Public Health of Columbia
University, New York, New York 10032, USA.

The consumption of green, yellow, and other vegetables, fruits and fruit juices
may be protective against breast cancer, and, alongside regular breast cancer
screening, may contribute to ethnic and racial differences in breast cancer
rates. The purpose of this study is to assess the dietary and sociodemographic
predictors of surveillance among Harlem women, using a population-based household
survey. One half of the Harlem women in this sample consumed no or one fruit or
vegetable per day. Logistic regression analyses revealed that women who consumed
more fruits and vegetables had received more recent mammography, and that women
who were unemployed were less likely to receive recent breast cancer screening
than were those who worked full- or part-time. The high response rate and the
representativeness of the sample are study strengths. Owing to the small sample
size for women between 40-65, the ages for which screening mammography and
clinical breast exam are recommended, subgroup analyses were limited. Therefore,
additional study of age-adjusted dietary patterns and screening among African
American women is suggested.

PMID: 11795435 [PubMed - indexed for MEDLINE]

104. Int J Obes Relat Metab Disord. 2001 Dec;25(12):1823-33.

Fast food restaurant use among adolescents: associations with nutrient intake,
food choices and behavioral and psychosocial variables.

French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P.

Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota, USA.
french@epi.umn.edu

OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency
of fast food restaurant use in a community-based sample of 4746 adolescent
students. DESIGN: A survey was administered to students in classrooms at 31
secondary schools in a large metropolitan area in Minnesota, United States.
Height and body weight were measured. SUBJECTS: Students in grades 7-12 who were
enrolled in participating schools, had parental consent and were in attendance on
the day of data collection. MEASUREMENTS: Frequency of fast food restaurant use
(FFFRU), dietary intake, and demographic and behavioral measures were
self-reported. Dietary intake was assessed using a semi-quantitative food
frequency questionnaire. Height and body weight were directly measured. RESULTS:
FFFRU was positively associated with intake of total energy, percent energy from
fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and
was inversely associated with daily servings of fruit, vegetables and milk. FFFRU
was positively associated with student employment, television viewing, home
availability of unhealthy foods, and perceived barriers to healthy eating, and
was inversely associated with students' own and perceived maternal and peer
concerns about healthy eating. FFFRU was not associated with overweight status.
CONCLUSIONS: FFFRU is associated with higher energy and fat intake among
adolescents. Interventions to reduce reliance on fast food restaurants may need
to address perceived importance of healthy eating as well as time and convenience
barriers.

PMID: 11781764 [PubMed - indexed for MEDLINE]

105. Asia Pac J Clin Nutr. 2001;10 Suppl:S19-28.

Intrahousehold food distribution: a case study of eight provinces in China.

Luo W, Zhai F, Jin S, Ge K.

Institute of Nutrition and Hygiene, Chinese Academy of Preventive Medicine,
Beijing.

A longitudinal survey of health and nutrition in China was undertaken in eight
provinces (Liaoning, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, Guizhou).
Data were collected in 1989, 1991, 1993 and 1997. The 1991 and 1993 data were
used to investigate factors affecting intrahousehold food distribution. The
discrepancy score and the ratio of food share to energy share were used to
describe food distribution within households. Findings indicated that, in most
cases, males had a higher proportion of nutrient intake than females,
particularly in the young adult group where men presented with a higher
discrepancy score than women for energy and all nutrients observed. The food and
nutrient distribution tends to be more favourable to the middle-aged group,
although the youngest group, while accepting relatively smaller amounts of
cereals, ate much bigger amounts of meat, dairy products and fruits. Household
members with higher incomes are more favoured in terms of food consumption and
nutrient intake. Household leaders accepted a higher share of energy and
nutrients in comparison with other members of the household across all age and
sex groups. Administrators and people working in service or trade industries in
rural areas are favoured in terms of food distribution relative to farmers and
manual workers. Well-educated people accepted a better food allocation than
others and those in employment received more nutrients than the unemployed. The
'contribution rule' (individuals who make a greater contribution to the family
receive a larger share of the family's food) is discussed and deemed to be
applicable in explaining the discrepancy in food distribution and nutrient intake
among household members.

PMID: 11708578 [PubMed - indexed for MEDLINE]

106. Br J Nutr. 2001 Sep;86(3):405-14.

Dietary assessment in Whitehall II: comparison of 7 d diet diary and
food-frequency questionnaire and validity against biomarkers.

Brunner E, Stallone D, Juneja M, Bingham S, Marmot M.

International Centre for Health and Society, Department of Epidemiology and
Public Health, University College London Medical School, 1-19 Torrington Place,
London WC1E 6BT, UK. e.brunner@ucl.ac.uk

The aim of the present cross-sectional study was to examine the agreement and
disagreement between a 7 d diet diary (7DD) and a self-administered
machine-readable food-frequency questionnaire (FFQ) asking about diet in the
previous year, and to validate both methods with biomarkers of nutrient intake.
The subjects were an age- and employment-grade-stratified random subsample of
London-based civil servants (457 men and 403 women), aged 39-61 years, who
completed both a 7DD and a FFQ at phase 3 follow-up (1991-1993) of the Whitehall
II study. Mean daily intakes of dietary energy, total fat, saturated,
monounsaturated and polyunsaturated fatty acids, linoleic acid, total
carbohydrate excluding fibre, sugars, starch, dietary fibre, protein, vitamin C,
vitamin E (as alpha-tocopherol equivalents), folate, carotenes (as total
beta-carotene activity), Fe, Ca, Mg, K and alcohol were measured. Serum
cholesteryl ester fatty acids (CEFA), plasma alpha-tocopherol and beta-carotene
were also measured as biomarkers. Estimates of mean energy intake from the two
methods were similar in men, and some 10 % higher according to the FFQ in women.
Compared with the 7DD, the FFQ tended to overestimate plant-derived micronutrient
intakes (carotenes from FFQ v. 7DD men 2713 (SD 1455) v. 2180 (SD 1188) microg/d,
women 3100 (SD 1656) v. 2221 (SD 1180) microg/d, both differences P<0.0001) and
to underestimate fat intake. Against plasma beta-carotene/cholesterol, carotene
intake was as well estimated by the FFQ as the 7DD (Spearman rank correlations,
men 0.32 v. 0.30, women 0.27 v. 0.22, all P< or =0.0001, energy-adjusted data).
Ranking of participants by other nutrient intakes tended to be of the same order
according to the two dietary methods, e.g. rank correlations for CEFA linoleic
acid against FFQ and 7DD estimates respectively, men 0.38 v. 0.41, women 0.53 v.
0.62, all P< or =0.0001, energy-adjusted % fat). For alpha-tocopherol there were
no correlations between plasma level and estimated intakes by either dietary
method. Quartile agreement for energy-adjusted nutrient intakes between the two
self-report methods was in the range 37-50 % for men and 32-44 % for women, and
for alcohol, 57 % in both sexes. Disagreement (misclassification into extreme
quartiles of intake) was in the range 0-6 % for both sexes. The dietary methods
yielded similar prevalences (about 34 %) of low energy reporters. The two methods
show satisfactory agreement, together with an expected level of systematic
differences, in their estimates of nutrient intake. Against the available
biomarkers, the machine-readable FFQ performed well in comparison with the
manually coded 7DD in this study population. For both methods, regression-based
adjustment of nutrient intake to mean dietary energy intake by gender appears on
balance to be the optimal approach to data presentation and analysis, in view of
the complex problem of low energy reporting.

PMID: 11570993 [PubMed - indexed for MEDLINE]

107. Singapore Med J. 2001 May;42(5):208-13.

Social and health profiles of rural elderly Malays.

Shahar S, Earland J, Abd Rahman S.

Department of Nutrition and Dietetics, Faculty of Allied Health Sciences,
Universiti Kebangsaan, Malaysia, Kuala Lumpur.

AIM: To evaluate the social and health functions of rural elderly Malays. METHOD:
A survey was carried out on 350 elderly Malays aged 60 and above using a set of
socio and health questionnaires. RESULTS: The majority of elderly people in the
study were married (64%), unemployed with no pension (76%), relied on children
for their main economic resources (62%) and perceived that they have sufficient
money to buy the food they require (61%). Most of the subjects felt healthy,
contented and satisfied with their everyday life, were able to do most of the
Activities of Daily Living (ADL) tasks and were actively involved in community
activities. However, most of the subjects (60%) had either one or two diagnosed
chronic diseases. Thus, only 15% of the subjects had not taken any type of
medicines during the previous 12 months. CONCLUSION: Although the majority of the
elderly in this study were able to perform all the ADL tasks and perceived their
health as good, physical impairments (eg. sight, hearing and chewing
difficulties) are prevalent and the use of medicines is widespread. It is
expected that in future a greater proportion of rural elderly Malays will live
alone and will face economic and health problems because of the lack of
sufficient and satisfactory programmes for this age group.

PMID: 11513058 [PubMed - indexed for MEDLINE]

108. Obes Res. 2001 Jan;9(1):21-31.

Self-reported body mass index and health-related quality of life: findings from
the Behavioral Risk Factor Surveillance System.

Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP.

Division of Nutrition and Physical Activity, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, Georgia 30341, USA. esf2@cdc.gov

OBJECTIVE: To examine the relationship between self-reported body mass index
(BMI) and health-related quality of life in the general adult population in the
United STATES: RESEARCH METHODS AND PROCEDURES: Using data from 109,076
respondents in the 1996 Behavioral Risk Factor Surveillance System, we examined
how self-reported BMI is associated with five health-related quality of life
measures developed by the Centers for Disease Control and Prevention for
population health surveillance. RESULTS: After adjusting for age, gender, race or
ethnicity, educational attainment, employment status, smoking status, and
physical activity status, participants with a self-reported BMI of <18.5 kg/m(2)
and participants with a self-reported BMI of > or =30 kg/m(2) reported impaired
quality of life. Compared with persons with a self-reported BMI of 18.5 to <25
kg/m(2), odds ratios (ORs) of poor or fair self-rated health increased among
persons with self-reported BMIs of <18.5 (1.57, 95% confidence interval [CI]:
1.31 to 1.89), 25 to <30 kg/m(2) (1.12, 95% CI: 1.04 to 1.20), 30 to <35 kg/m(2)
(1.65, 95% CI: 1.50 to 1.81), 35 to <40 kg/m(2) (2.58, 95% CI: 2.21 to 3.00), and
> or =40 kg/m(2) (3.23, 95% CI: 2.63 to 3.95); ORs for reporting > or =14 days of
poor physical health during the previous 30 days were 1.44 (95% CI: 1.21 to
1.72), 1.04 (95% CI: 0.96 to 1.14), 1.32 (95% CI: 1.19 to 1.47), 1.80 (95% CI:
1.52 to 2.13), and 2.37 (95% CI: 1.90 to 2.94), respectively; ORs for having > or
=14 days of poor mental health during the previous 30 days were 1.18 (95% CI:
0.97 to 1.42), 1.02 (95% CI: 0.95 to 1.11), 1.22 (95% CI: 1.10 to 1.36), 1.68
(95% CI: 1.42 to 1.98), and 1.66 (95% CI: 1.32 to 2.09), respectively.
DISCUSSION: In the largest study to date, low and increased self-reported BMI
significantly impaired health-related quality of life. Particularly, deviations
from normal BMI affected physical functioning more strongly than mental
functioning.

PMID: 11346664 [PubMed - indexed for MEDLINE]

109. Public Health Nutr. 2001 Feb;4(1A):141-6.

Eat to live or live to eat? Do parents and children agree?

Le Bigot Macaux A.

aabc@compuserve.com.

The lifestyles and diets of children in developed countries is changing rapidly
in response to the social and cultural climate, as well as the availability of an
increasing range of foods. The aim of this on-going study is to assess the trends
in food-related behaviours of children and their attitudes towards food and
nutrition. The study also monitors markers for physical activity, which have been
presented elsewhere (Bellisle et al, 2000). Three successive surveys (1993, 1995,
and 1997) were carried out on samples of 1000 French children aged 9--11 years
and their mothers. RESULTS: Attitudes towards food varied markedly between
children and their mothers. Children viewed food primarily as a necessity of
life, whereas mothers viewed food primarily as a pleasure for their child, with
necessity and nutrition given a lower importance. Contrary to popular belief
children's enjoyment of 'unhealthy' and 'healthy' foods was similar. French-fries
were the favourite food for 92% of children, closely followed by pasta (89%).
Fruit and candy received similar scores (82% and 81% respectively), suggesting
that external factors such as convenience are the prime barrier to fruit
consumption rather than the enjoyment factor. Over the three surveys a strong
persistence of the traditional French meal pattern has been demonstrated, with
breakfast, lunch and evening meals eaten by 97%, 96% and 99% of children
respectively. One increasing occurrence is the viewing of television during meal
times with 25% of breakfasts, 46% of afternoon snacks and 41% of evening meals
consumed in front of the television. Children's attitudes towards food
demonstrated an overwhelming trust of their mother and her ability to provide
them with nourishing foods. Mothers often found it difficult to reconcile the
demands of family life, employment, healthy eating and the maintenance of a
pleasurable atmosphere at mealtimes. CONCLUSIONS: Overall, children and mothers
appeared to have divergent attitudes towards food. An understanding of children's
enjoyment of foods considered more 'healthy' or less 'healthy' enables effective
nutrition messages to be developed for children. However, further work is needed
to explore the long-term impact of mothers' attitudes towards food and mealtimes
on a child's relationship to food and eating habits during adolescence through to
adulthood.

PMID: 11255504 [PubMed - indexed for MEDLINE]

110. Birth. 2000 Jun;27(2):91-6.

Breastfeeding duration in a multiethnic population in Hawaii.

Novotny R, Hla MM, Kieffer EC, Park CB, Mor J, Thiele M.

Department of Food Science and Human Nutrition, College of Tropical Agriculture
and Human Resources, University of Hawaii at Manoa, Honolulu 96822, USA.

BACKGROUND: The increasing ethnic diversity in the United States necessitates a
study of variations in infant feeding patterns among ethnic groups. This study
was conducted as part of Hawaii's surveillance system to identify infant feeding
patterns in Hawaii; specifically, to identify factors influencing duration of
breastfeeding among ethnically diverse mothers. METHODS: All women who delivered
an infant in Hawaii between January 1 and March 31, 1989, were mailed surveys 14
to 19 months after delivery. Fifty-one percent (n = 2011) of women responded, of
whom 1574 (78%) did some breastfeeding and are included in the analysis of
prediction of weaning (cessation of breastfeeding). Cox regression (survival)
analysis was used to predict weaning. RESULTS: The median duration of
breastfeeding was 150 days; 45 percent of infants were still breastfeeding at age
6 months and 16 percent at age 1 year. Factors associated with early weaning were
Japanese ethnicity; mother born in a country other than the United States, Japan,
or the Philippines; first language other than English, or two languages at home;
employed full-time outside the home; introduced formula or fruit before age 6
months; received formula from the WIC program; and stopped breastfeeding for
convenience, breast problems, problems getting breastfeeding started,
insufficient milk, baby refusing the breast, and a sick baby. Factors associated
with late weaning were older maternal age; college education; living on a rural
island; previous breastfeeding experience; helpful breastfeeding advice from
family or friends; receiving WIC for breastfeeding mothers; introducing the cup
before age 6 months; and not giving fruit to the baby. CONCLUSION: In Hawaii,
programs that address how and when to introduce foods, use of formula, and
management of outside employment and breastfeeding should be made available to
those groups of women at risk for early weaning to lengthen their duration of
breastfeeding.

PMID: 11251485 [PubMed - indexed for MEDLINE]

111. Arthritis Care Res. 2000 Feb;13(1):11-22.

Loss of physical independence in rheumatoid arthritis: interview data from a
representative sample of patients in rheumatologic care.

Westhoff G, Listing J, Zink A.

Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.

OBJECTIVE: The goal of the study was to obtain an estimate of the proportion of
patients with rheumatoid arthritis (RA) in rheumatologic care who are unable to
live independently. It investigates the association of age, disease duration,
disease activity, joint involvement, and comorbidity with dependence on help and
care. In addition, we attempt to derive an estimate of the level of physical
disability at which dependence on external help is to be expected in more than
50% of the cases. METHODS: A sample of 273 patients with RA and considerable
physical disabilities (less than 67% of full functional capacity) was drawn from
the Berlin rheumatologic database. Standardized questionnaires and interview data
were used to ascertain dependence on help and care. Patients were classified as
in need of help when they depended on external help to manage household chores
and as in need of care if beyond this they depended on assistance to manage
personal hygiene and nutrition. RESULTS: More than 50% of the patients who had
less than 58% of full functional capacity (Health Assessment Questionnaire [HAQ]
> 1.54) required help, and for patients with less than 30% (HAQ > 2.3) the need
for help was almost certain (more than 95%). Generalizing these results to all RA
patients treated by rheumatologists in Berlin, 33% were expected to be dependent
on external help and 7% to be dependent on care. Even in patients with disease
duration < or = 5 years, a rather high expected proportion of help-dependence was
found (26%). When single joints were compared, the highest amount of disability
resulted from impaired wrists. Our data suggest that the contribution of
comorbidity to functional impairment was low, especially in patients in need of
help, while patients independent of help reported more frequently that their
comorbid condition had an impact on their physical function. CONCLUSION: The
results support the importance of identifying high-risk patients and of the
employment of a strategy of early therapeutic intervention, since a high degree
of dependence on help was observed in patients with short disease duration. As
help-dependence is highly influenced by the condition of the wrists, more
attention should be paid to the treatment and stabilization of these joints.

PMID: 11094922 [PubMed - indexed for MEDLINE]

112. AIDS Patient Care STDS. 1999 Jul;13(7):427-33.

Perception of quality of life of persons with HIV/AIDS and maintenance of
nutritional parameters while on protease inhibitors.

Echeverria PS, Jonnalagadda SS, Hopkins BL, Rosenbloom CA.

Department of Nutrition, Georgia State University, Atlanta, USA.

This descriptive study investigated quality of life issues, biochemical indices,
and nutritional parameters of individuals with HIV/AIDS before the initiation of
protease inhibitors (PI) and after PI therapy. Telephone interviews were
conducted with 45 men and women who were diagnosed with HIV/AIDS. A 26-item
subjective questionnaire was used to determine intake of liquid nutritional
supplements, use of micronutrient and herb supplements, adherence to modified
diets, gastrointestinal symptoms, employment status, sociability, and ability to
conduct activities of daily living. A medical chart review was conducted to
collect data on biochemical indices, weight, medication regimens, and incidence
of opportunistic infections. The results of the study suggest that HIV/AIDS
individuals gain weight, improve CD4 counts, and decrease HIV RNA viral load
while on PI-based drug combination therapy. Opportunistic infections decreased,
quality of life was improved, and blood albumin was elevated. Hyperlipidemia,
that is, elevations in total cholesterol and triglycerides, was observed in study
participants (44% and 40% of patients, respectively) after PI therapy. These
findings support the need for future investigations to examine the long-term
influence of PI-based combination drug therapies on nutrient intake, body
composition, and quality of life of persons with HIV/AIDS.

PMID: 10870596 [PubMed - indexed for MEDLINE]

113. Am J Prev Med. 2000 Jan;18(1):46-53.

Race/ethnicity, social class and their relation to physical inactivity during
leisure time: results from the Third National Health and Nutrition Examination
Survey, 1988-1994.

Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE.

Department of Health and Fitness, American University, Washington, DC 20016-8037,
USA. crespoc@america.edu

BACKGROUND: Physical inactivity is more prevalent among racial and ethnic
minorities than among Caucasians. It is not known if differences in participation
in leisure time physical activity are due to differences in social class. Thus,
this paper provides estimates of the prevalence of physical inactivity during
leisure time and its relationship to race/ethnicity and social class. METHODS:
This was a national representative cross-sectional survey with an in-person
interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20
or older responded to the household adult and family questionnaires as part of
the Third National Health and Nutrition Examination Survey . Mexican-Americans
and African-Americans were over-sampled to produce reliable estimates for these
groups. Multiple assessment of social class included education, family income,
occupation, poverty status, employment status, and marital status. RESULTS: The
age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is
lower among Caucasians (18%) than among African-Americans (35%) and
Mexican-Americans (40%). African-American and Mexican-American men and women
reported higher prevalence of leisure time inactivity than their Caucasian
counterparts across almost every variable, including education, family income,
occupation, employment, poverty and marital status. CONCLUSIONS: Current
indicators of social class do not seem to explain the higher prevalence of
physical inactivity during leisure time among African-American and
Mexican-American. More research is needed to examine the effect of other
constructs of social class such as acculturation, safety, social support and
environmental barriers in promoting successful interventions to increase physical
activity in these populations.

PMID: 10808982 [PubMed - indexed for MEDLINE]

114. Prev Med. 2000 Apr;30(4):295-301.

Eating habits, health status, and concern about health: a study among 1641
employees in the German metal industry.

Reime B, Novak P, Born J, Hagel E, Wanek V.

Department of Medical Sociology, University of Ulm, Ulm, D-89081, Germany.

BACKGROUND: Nutrition has been found to be associated with sociodemographic
characteristics and concern about health. There is limited knowledge, however, of
associations between blue-collar worker's diet, morbidity, and health care
utilization. METHODS: We conducted a survey on eating habits, physical symptoms,
health care utilization, health status, and concern about health in two German
metal companies. A self-administered questionnaire was mailed to employees of
whom 1641 participated in the study (response rate 54. 7%). RESULTS: Most
employees were characterized by a combination of healthy and unhealthy eating
elements. Using linear regression analyses adjusted for age, gender, and
occupational status, healthy eating was negatively associated with stomach aches
and headaches, but not with cardiovascular disease. Restricted activity days and
days in hospital were associated with healthy eating, but self-assessed health
status and physician consultations were not. Using stepwise multiple regression
analysis, age, gender, and concern about health were strongly and morbidity was
weakly related to diet. Occupational status, marital status, and number of
children were not associated with nutrition. CONCLUSIONS: Health promotion
programs should motivate younger and male employees to participate in and aim
toward increasing concern about health. Copyright 2000 American Health Foundation
and Academic Press.

PMID: 10731458 [PubMed - indexed for MEDLINE]

115. Prev Med. 2000 Feb;30(2):83-92.

Social relationships and cardiovascular disease risk factors: findings from the
third national health and nutrition examination survey.

Ford ES, Ahluwalia IB, Galuska DA.

Division of Nutrition and Physical Activity, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, GA 30341, USA. esf2@cdc.gov

Objective. Our aim was to study the associations between social relationships and
several health behaviors in a national sample of the U.S. population. Methods.
Using data from National Health and Nutrition Examination Survey III, which was
conducted from 1988 to 1994, we examined the associations between the frequencies
of organizational and individual relationships (derived from factor analysis) and
cigarette smoking, not having had a blood pressure check during the preceding 12
months, not having had a cholesterol check, not engaging in physical activity,
and eating fruits and vegetables fewer than five times per day among men and
women aged 18 years and older. Results. After adjusting for age, sex, race,
educational attainment, marital status, and employment status, increases in
organizational relationships were associated with decreases in all five
behaviors: significant inverse linear trends were noted only for smoking and
physical activity. For individual relationships, significant inverse linear
trends were noted for not having a blood pressure check within the previous 12
months, not having had a cholesterol check, and inadequate fruit and vegetable
consumption. For physical inactivity, the shape of the relationship approximated
a threshold response. For smoking, a significant positive linear trend was
present. Conclusions. These results support findings from previous studies and
indicate that social relationships have a beneficial effect on several behaviors
that directly or indirectly affect the risk of cardiovascular disease. Copyright
2000 American Health Foundation and Academic Press.

PMID: 10656835 [PubMed - indexed for MEDLINE]

116. Med Sci Sports Exerc. 1999 Dec;31(12):1821-7.

Prevalence of physical inactivity and its relation to social class in U.S.
adults: results from the Third National Health and Nutrition Examination Survey,
1988-1994.

Crespo CJ, Ainsworth BE, Keteyian SJ, Heath GW, Smit E.

American University, Department of Health and Fitness, Washington, DC 20016-8037,
USA. crespoc@american.edu

PURPOSE: This study examines the prevalence of physical inactivity during leisure
time in a national representative sample of U.S. adults. METHODS: Data were
obtained from the Third National Health and Nutrition Examination Survey,
conducted between 1988 and 1994. A total of 18,825 adults aged 20 yr and older
participated in a home interview where information about physical activity,
education, income, occupation, employment, and labor force participation was
obtained. RESULTS: The prevalence of physical inactivity among U.S. adults was
23%, with more women (28%) than men (17%) reporting being inactive during their
leisure time. Additionally, inactivity is more common among in social class such
as persons who are less educated, living below the poverty line, living in
households with income below 20,000 dollars, and who are retired. In every
category of social class, women experienced a higher prevalence of physical
inactivity than men. CONCLUSIONS: We conclude that social class is associated
with physical inactivity and that more research is needed to better understand
the effect that other social and environmental factors have on sedentary
behaviors in our society.

PMID: 10613434 [PubMed - indexed for MEDLINE]

117. J Am Diet Assoc. 1999 Dec;99(12):1514-21.

Longitudinal study of nutrient and food intakes of white preschool children aged
24 to 60 months.

Skinner JD, Carruth BR, Houck KS, Bounds W, Morris M, Cox DR, Moran J 3rd,
Coletta F.

Department of Nutrition, College of Human Ecology, University of Tennessee,
Knoxville 37996-1900, USA.

OBJECTIVE: To determine nutrient and food intakes of 72 white preschool children
primarily from families of middle and upper socioeconomic status and to compare
children's nutrient intakes with current recommendations. DESIGN: Six in-home
interviews were conducted with mothers when children were 24 to 60 months old; at
each time mothers provided 3 days of dietary information on the child. Children
and mothers independently provided information on the child's favorite and least
favorite foods at 42 and 54 months. SUBJECTS: Preschool children (24 to 60 months
old) participating in a longitudinal study. STATISTICAL ANALYSES: Mean nutrient
intakes were compared with the most recent Recommended Dietary
Allowances/Adequate Intakes. Differences over time were tested with
repeated-measures analysis of variance; gender differences were determined with t
tests. Food frequencies (i.e., percentage of children consuming specific foods)
were determined from dietary recalls and food records. Dietary variety was
assessed with the Variety Index for Toddlers or the Variety Index for Children.
RESULTS: Means were consistently less than the RDA/AI for energy, zinc, folate,
and vitamins D and E. Energy, carbohydrate, and fat intakes were highest (P < or
= .01) at 60 months. Boys consumed more (P < or = .05) protein (10 g), calcium
(197 mg), magnesium (35 mg), and pantothenic acid (0.8 mg) at 60 months than did
girls. Foods most commonly eaten were fruit drink, carbonated beverages, 2% milk,
and french fries. The vegetable group consistently had the lowest variety scores;
vegetables also dominated least favorite foods lists. APPLICATIONS: Parents need
to be encouraged to include more sources of zinc, folate, vitamin E, and vitamin
D in children's diets. Parents should also encourage their children to eat more
vegetables, zinc- and folate-fortified cereals, lean red meats, seafood,
vegetable oils, and low-fat milk.

PMID: 10608944 [PubMed - indexed for MEDLINE]

118. Am J Health Promot. 1999 Jul-Aug;13(6):315-8, ii.

Lifestyle and cancer: the relative effects of a workplace health promotion
program across gender and social class.

Hope A, Kelleher C, O'Connor M.

Department of Health Promotion, National University of Ireland, Galway, Ireland.

A self-administered cross-sectional survey was used to assess the relative impact
of a health promotion program on blue- and white-collar workers of both sexes.
The program operated in five different types of organizations and consisted of
exercise, nutrition, smoking, stress, breast and testicular self-examination.
Significant positive improvements occurred on at least five health behaviors for
female workers reporting and four behaviors for male workers, with the greatest
gains among blue-collar women. Several study limitations are noted suggesting a
cautious interpretation of the results.

PMID: 10557503 [PubMed - indexed for MEDLINE]

119. J Am Diet Assoc. 1999 Oct;99(10):1267-9.

Vitamin and mineral diet adequacy and supplement use by full-time employed women
with preschool children.

Brech DM.

Biomedical Sciences Department of Southwest Missouri State University,
Springfield 65804, USA.

PMID: 10524393 [PubMed - indexed for MEDLINE]

120. Am J Clin Nutr. 1999 Oct;70(4):456-65.

Genetic and environmental influences on eating patterns of twins aged >/=50 y.

van den Bree MB, Eaves LJ, Dwyer JT.

Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth
University, Richmond, USA. mvandenb@intra.nida.nih.gov

BACKGROUND: Clinicians and researchers could benefit from a greater understanding
of the role of genetic and environmental factors in human eating behavior.
OBJECTIVE: Our aim was to estimate the relative influence of genetic and
environmental factors on habitual eating patterns in middle-aged and elderly men
and women. DESIGN: Male and female twins (n = 4640) aged >/=50 y completed a
mailed version of the National Cancer Institute food-frequency questionnaire.
Factor analysis was performed to identify eating patterns among respondents.
Estimates of genetic, common environmental (shared by family members), and
specific environmental (unique to an individual) influences were obtained for
food use, serving size, and consumption frequency by comparing monozygotic and
dizygotic twin-pair groups with structural equation analysis. RESULTS: Two
independent eating patterns were identified: the first consisted of items high in
fat, salt, and sugar, and the second reflected healthful eating habits. Although
the influence of environmental factors was larger, between 15% and 38% of the
total variation in pattern 1 and between 33% and 40% in pattern 2 were explained
by genetic influences. Models accounting for sex differences in genetic and
environmental estimates fit the data significantly better for food use and
serving size of foods in eating pattern 1 and for food use in eating pattern 2.
CONCLUSION: Although 60-85% of the variability in eating patterns was associated
with environmental factors, genetic influences were also apparent and there was
some evidence of sex specificity. These findings may be important in crafting
dietary interventions and predicting adherence to these interventions.

PMID: 10500013 [PubMed - indexed for MEDLINE]

121. J Natl Cancer Inst. 1999 Sep 1;91(17):1491-500.

Randomized trial testing the effect of peer education at increasing fruit and
vegetable intake.

Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, Larkey L,
Alatorre C, Wentzel TM.

D.B. Buller, AMC Cancer Research Center, Denver, CO, USA. bullerd@amc.org

BACKGROUND: The National Cancer Institute recommends that Americans eat at least
five daily servings of fruits and vegetables. National strategies to increase
consumption may not reach minority and lower socioeconomic populations. In a
randomized trial, peer education was tested for effectiveness at increasing fruit
and vegetable intake among lower socioeconomic, multicultural labor and trades
employees. METHODS: Employees (n = 2091) completed a baseline survey and received
an 18-month intervention program through standard communication channels (e.g.,
workplace mail, cafeteria promotions, and speakers). Ninety-three social networks
(cliques) of employees were identified, which were pair matched on intake. At an
interim survey (during months 8 and 9), 11 cliques no longer existed and 41
matched pairs of cliques containing 905 employees remained, with one clique per
pair being randomly assigned to the peer education intervention. Employees who
were central in the communication flow of the peer intervention cliques served as
peer educators during the last 9 months of the intervention program. Fruit and
vegetable intake was measured with 24-hour intake recall and with food-frequency
questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up
surveys. All P values are two-sided. RESULTS: By use of multiple regression,
statistically significant overall effects of the peer education program were seen
in the intake recall (increase of 0.77 total daily servings; P<.0001) and the
food-frequency (increase of 0.46 total daily servings; P =.002) questions at the
outcome survey. The effect on the total number of servings persisted at the
6-month follow-up survey when measured by the intake recall (increase of 0.41
total daily servings; P =.034) but not the food-frequency (decrease of 0.04 total
daily servings; P =.743) questions. CONCLUSIONS: Peer education appears to be an
effective means of achieving an increase in fruit and vegetable intake among
lower socioeconomic, multicultural adult employees.

PMID: 10469751 [PubMed - indexed for MEDLINE]

122. Women Health. 1999;29(3):13-29.

The association between extent of employment and hypertension among women
participants of the Second National Health and Nutrition Survey.

Rose KM, Newman B, Bennett T, Tyroler HA.

School of Public Health at the University of North Carolina at Chapel Hill 27514,
USA. kathy.rose@sph.unc.edu

The association between extent of employment and hypertension was examined among
3,824 women participants of the Second National Health and Nutrition Examination
Survey. Women in three employment groups (full-time, part-time, and short-term)
were compared to homemakers. In covariate-adjusted, logistic regression models,
women employed full-time had a somewhat lower, but not significantly different,
prevalence of hypertension (OR = 0.8, 95% CI = 0.7, 1.1), whereas both part-time
(OR = 0.6, 95% CI = 0.4, 0.7) and short-term (OR = 0.5, 95% CI = 0.4, 0.7)
workers had significantly lower prevalences. Associations did not tend to vary by
age, ethnicity, or occupation. Employment does not appear to increase the risk of
hypertension in women; in fact, moderate levels were associated with lower risk.

PMID: 10466508 [PubMed - indexed for MEDLINE]

123. Occup Med (Lond). 1999 Feb;49(2):65-70.

Status of health promotion programme implementation in small-scale enterprises in
Japan.

Muto T, Hsieh SD, Sakurai Y.

Juntendo University School of Medicine, Japan. mutot@med.juntendo.ac.jp

This study was conducted to determine the status of the implementation of health
promotion programmes (HPPs) in Japanese small-scale enterprises (SSEs). A survey
was conducted in 1996 using a questionnaire mailed to all the member construction
companies (n = 772) of a health insurance society, and a response rate of 84% was
obtained. Health examination was most frequently conducted (90%), followed by
exercise/fitness programmes (17%), smoking measures (12%), health guidance (11%)
and nutrition education (6%). Mental health programmes and the
government-advocated Total Health Promotion Plan (THP) were implemented at less
than 2% of SSEs. The implementation rates for these programmes, except for
smoking measures and the THP, were higher at large enterprises than at SSEs. The
employment rate for occupational physicians (OPs) was 9% and 49% at SSEs and
large enterprises, respectively. The activity most frequently conducted by OPs
was health examination, followed by curative services and health education.
Advising employees to undergo re-examination or more valid examination after the
annual health examination was most frequently conducted by non-health
professionals.

PMID: 10436557 [PubMed - indexed for MEDLINE]

124. Health Educ Behav. 1999 Aug;26(4):478-94.

Impact of the Working Well Trial on the worksite smoking and nutrition
environment.

Biener L, Glanz K, McLerran D, Sorensen G, Thompson B, Basen-Engquist K, Linnan
L, Varnes J.

Center for Survey Research, University of Massachusetts, Boston 02125, USA.
lois.biener@umb.edu

This article reports the effect of a worksite cancer control intervention on
aspects of the physical and social environment related to dietary and smoking
behaviors of employees. Data are from 111 intervention and control worksites that
participated in the Working Well Trial. Employee surveys and interviews with key
organizational informants assessed environmental and normative changes relevant
to nutrition and tobacco use. Results indicated significant effects of the
intervention on all nutrition outcomes: access to healthy food, nutritional
information at work, and social norms regarding dietary choice. Significant
benefits were not found for smoking norms or smoking policies. However, changes
occurred in both the control and intervention sites on these variables. This
first large analysis of environmental and normative effects of a worksite
intervention is consistent with the employee behavior change findings for the
trial and serves as a model for future analyses of multilevel worksite health
promotion programs.

PMID: 10435233 [PubMed - indexed for MEDLINE]

125. Am J Phys Anthropol. 1999 May;109(1):129-42.

Child growth and nutritional status in a high-poverty community in eastern
Kentucky.

Crooks DL.

Department of Anthropology, University of Kentucky, Lexington 40506-0024, USA.
dlcrooks@pop.uky.edu

The research reported in this paper examines the relationship between household
socioeconomic measures, child growth, and nutritional status in a community in
eastern Kentucky with a high rate of poverty. It is based on the premise that
child growth and nutritional status reflect the social circumstances in which
they occur. 21.6% of the children exhibited low height (<15th percentile of
National Center for Health Statistics [NCHS] reference values), with 13% of the
girls exhibiting stunting (<5th percentile). Thirty-three percent of the children
exhibited overweight, and 13% exhibited obesity (>85th percentile and >95th
percentile of National Health and Nutrition Examination Survey [NHANES] reference
values, respectively); 21.4% of boys were obese, compared to 8.7% of girls.
Analysis of variance indicated that child stature is best explained by the
father's education level interacting with employment status, and by the mother's
employment status interacting with household poverty level. Weight is best
explained by the mother's employment status. However, the relationships among
socioeconomic measures and growth outcomes differed by gender of the child. These
issues are discussed in light of the anthropology literature and the situation in
Bridges County, Kentucky where the research took place.

PMID: 10342469 [PubMed - indexed for MEDLINE]

126. Eur J Clin Nutr. 1999 Apr;53(4):298-308.

Development of a general nutrition knowledge questionnaire for adults.

Parmenter K, Wardle J.

ICRF Health Behaviour Unit, University College London.

OBJECTIVE: This paper describes the development of a reliable and valid
questionnaire to provide a comprehensive measure of the nutritional knowledge of
UK adults. The instrument will help to identify areas of weakness in people's
understanding of healthy eating and will also provide useful data for examining
the relationship between nutrition knowledge and dietary behaviour which, up
until now, has been far from clear. DESIGN: Items were generated paying
particular attention to content validity. The initial version of the
questionnaire was piloted and assessed on psychometric criteria. Items which did
not reach acceptable validity were excluded, and the final 50 item version was
administered to two groups differing in nutritional expertise on two occasions to
assess the construct validity and test-retest reliability. SETTING: The
questionnaire was developed in 1994 in the UK. SUBJECTS: Three hundred and
ninety-one members of the general public, recruited via their places of work,
completed the questionnaire at the piloting stage. The final version was
administered to 168 dietetics and computer science students following a
university lecture. RESULTS: The internal consistency of each section was high
(Cronbach's alpha = 0.70-0.97) and the test-retest reliability was also well
above the minimum requirement of 0.7. Nutrition experts scored significantly
better than computer experts [F(1167) = 200.5, P<0.001], suggesting good
construct validity. CONCLUSIONS: The findings demonstrate that the instrument
meets psychometric criteria for reliability and construct validity. It should
provide a useful scale with which to reassess the relationship between knowledge
and dietary behaviour.

PMID: 10334656 [PubMed - indexed for MEDLINE]

127. Appetite. 1999 Feb;32(1):86-92.

Evaluation of eating patterns with different methods: the Polish experience.

Kowrygo B, Górska-warsewicz H, Berger S.

Warsaw Agricultural University SGGW, Warszawa, ul. Nowoursynowska 166, Poland.

The implementation of a market economy at the beginning of the 1990s has changed
Polish consumers. This paper describes results of different methods which are
used to evaluate food consumption, including eating patterns, in this time of
transition. Except for the significant decrease of dairy products and increase of
vegetable oils the pattern of the menu in Poland remains very traditional. The
differences between the previous and present situation are based on changes in
the organization of shopping and the possibilities of preparing meals. Copyright
1999 Academic Press.

PMID: 9989918 [PubMed - indexed for MEDLINE]

128. Arch Phys Med Rehabil. 1998 Oct;79(10):1200-5.

Pre-AIDS physical disability: data from the AIDS Time-Oriented Health Outcome
Study.

O'Dell MW, Hubert HB, Lubeck DP, O'Driscoll P.

Department of Physical Medicine and Rehabilitation, Long Island Jewish Medical
Center, New Hyde Park, NY, USA.

Comment in:
Arch Phys Med Rehabil. 1999 Apr;80(4):473.

OBJECTIVE: To document the severity and correlates of perceived physical
disability in a group of persons with HIV infection before an AIDS-defining
illness, and to compare disability levels with a group of adults not infected
with HIV. DESIGN: Observational cross-sectional study. SETTING: Community-based
sample in California recruited through the AIDS Time-Oriented Health Outcome
Study. PARTICIPANTS: Five hundred thirty-one asymptomatic and 345 symptomatic
persons with HIV infection, primarily Caucasian, well-educated, homosexual and
bisexual men. The control group consisted of 2,567 persons evaluated in the
National Health and Nutrition Examination Survey and Epidemiologic Follow-up
Study, a national probability sample of civilian, noninstitutionalized persons
between ages 1 and 74 years living in the United States. MAIN OUTCOME MEASURE:
Perceived physical disability measured by the HIV Health Assessment
Questionnaire, a self-administered questionnaire that measures perceived
disability in eight areas of mobility and activities of daily living. RESULTS:
There were few significant differences between the asymptomatic and symptomatic
groups. Total disability scores demonstrated a moderately strong relationship to
number of symptoms, overall health status, employment, and Medical Outcomes
Study-HIV fatigue index (r = -.39 to .59; p < .001). With few exceptions, less
than 10% of the cohort perceived limitations to any degree and no more than 2%
reported being "unable to perform" in a given functional category. However, both
groups demonstrated somewhat higher levels of physical dysfunction than an age-,
race-, and education-matched comparison group of adults without HIV infection.
CONCLUSIONS: Persons with HIV infection before an AIDS-defining illness
demonstrate relatively low levels of physical dysfunction. When present, deficits
tend to occur among instrumental activities of daily living. Despite the
relatively low levels, perceived disability among the pre-AIDS sample is somewhat
higher than that of the general population. Implications for functional
assessment, disability screening, and future HIV disability research are
discussed.

PMID: 9779671 [PubMed - indexed for MEDLINE]

129. J Am Diet Assoc. 1998 Sep;98(9):995-1000.

Guess who's cooking? The role of men in meal planning, shopping, and preparation
in US families.

Harnack L, Story M, Martinson B, Neumark-Sztainer D, Stang J.

Division of Epidemiology, School of Public Health, University of Minnesota,
Minneapolis 55454-1015, USA.

OBJECTIVES: To determine the role of men in meal-related tasks in households with
both a male and female head, and to identify households in which the man is more
likely to be involved in these tasks. DESIGN: Data collected as part of the US
Department of Agriculture's 1994 Continuing Survey of Food Intakes of Individuals
were analyzed. SUBJECTS/SETTING: All analyses were restricted to sampled persons
who were identified as a male head of household residing in a household that also
had a female head (N = 1,204). STATISTICAL ANALYSES: Frequency distributions were
calculated and logistic regression analyses were conducted. RESULTS:
Approximately 23%, 36%, and 27% of men reportedly were involved in meal planning,
shopping, and preparation, respectively. Men in lower income and smaller
households were more likely to be involved in each of the meal activities.
Younger men and men in households in which the female head of household worked
full-time were more likely to be involved in meal planning and preparation.
IMPLICATIONS: Current education efforts to improve family nutrition tend to
target the female rather than the male head of household. Our findings confirm
that this focus is appropriate for most dual-headed households.

PMID: 9739799 [PubMed - indexed for MEDLINE]

130. Soc Sci Med. 1998 Jun;46(12):1519-29.

Gender, socioeconomic status and family status as determinants of food behaviour.

Roos E, Lahelma E, Virtanen M, Prättälä R, Pietinen P.

Department of Nutrition, National Public Health Institute, Helsinki, Finland.

This study examines social structural and family status factors as determinants
of food behaviour. The data were derived from the FINMONICA Risk Factor Survey,
collected in Finland in spring 1992. A multidimensional framework of the
determinants of food behaviour was used, including social structural position,
family status and gender. The associations between the determinants of food
behaviour were estimated by multivariate logistic regression models, adjusted for
age and regional differences. Food behaviour was measured by an index including
six food items which were chosen based on Finnish dietary guidelines. In general,
women's food behaviour was more in accordance with the dietary guidelines than
that of men. The pattern of association between educational level and food
behaviour was similar for both genders, but slightly stronger for men than women.
Employment status was associated only with women's food behaviour, but the
tendency was the same for men. Marital status was associated with men's as well
as women's food behaviour. The food behaviour of married men and women was more
in line with the dietary guidelines than the food behaviour of those who had been
previously married. Parental status, however, was only associated with women's
food behaviour, that is, the food behaviour of women with young children was more
closely in line with the dietary guidelines than that of the rest of the women.

PMID: 9672392 [PubMed - indexed for MEDLINE]

131. Am J Public Health. 1998 Jul;88(7):1042-6.

The effect of work status on initiation and duration of breast-feeding.

Fein SB, Roe B.

Center for Food Safety and Applied Nutrition, US Food and Drug Administration,
Washington, DC 20204, USA. sbf@cfsan.fda.gov

OBJECTIVES: In this study, longitudinal data are used to examine the effect of
work status on breast-feeding initiation and duration. METHODS: Mothers from a
mail panel completed questionnaires during late pregnancy and 10 times in the
infant's first year. Mother's work status was categorized for initiation by hours
she expected, before delivery, to work and for duration by hours she worked at
month 3. Covariates were demographics; parity; medical, delivery, and hospital
experiences; social support; embarrassment; and health promotion. RESULTS:
Expecting to work part-time neither decreased nor increased the probability of
breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and
.89, P > .50), but expecting to work full-time decreased the probability of
breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum
decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative
to not working, but part-time work of 4 or fewer hours per day did not affect
duration, and part-time work of more than 4 hours per day decreased duration less
than full-time work. CONCLUSION: Part-time work is an effective strategy to help
mothers combine breast-feeding and employment.

PMCID: PMC1508266
PMID: 9663151 [PubMed - indexed for MEDLINE]

132. Stud Fam Plann. 1998 Mar;29(1):69-78.

The impact of type of employment on women's use of prenatal-care services and
family planning in urban Cebu, the Philippines.

Miles-Doan R, Brewster KL.

Center for the Study of Population, Florida State University, Tallahassee
32306-2240, USA.

This study re-evaluates the relationship of urban women's employment to their
health-service and contraceptive use, drawing on data from the Cebu Longitudinal
Health and Nutrition Survey. Multivariate analyses reveal significant differences
across types of work for the likelihood of both obtaining timely prenatal care
and practicing contraception at one year postpartum. Wage workers in white-collar
jobs are significantly more likely than those not employed for pay to have
obtained prenatal care and are substantially more likely to have adopted a
contraceptive method in the year following childbirth. Women who are
self-employed also are significantly more likely than those not employed for pay
to be using contraceptives. Blue-collar wage work and piecework employment have
no relationship to either dependent variable. These findings suggest that
work-related autonomy encourages women to exercise control in other areas of
their lives.

PIP: This article examined the relationship between women's employment and use of
prenatal care services and family planning in Cebu, the Philippines. Data were
obtained from the Cebu Longitudinal Health and Nutrition Baseline and Follow-up
Survey among a 12-month birth cohort of 2695 Filipino infants and their mothers,
residing in a sample of 33 urban and rural barangays in 1983 and 1984. The
largest percentage of women who had early prenatal care were white collar workers
(WCWs) and professionals (57%), followed by blue collar, service, and
self-employed workers (22%), and non-wage workers (23%). The smallest percentage
of women obtaining prenatal care were pieceworkers (15%). Modern contraceptive
use at 1 year postpartum was greatest among WCWs (34%), followed by self-employed
workers (32%) and non-wage workers (26%). The lowest proportion were pieceworkers
among modern method users, and blue collar workers and service workers among
traditional method users. Logistic models indicate that WCWs were 2.5 times more
likely than non-wage workers to obtain care within the first 5 months of
pregnancy. Among women who received free care, WCWs still had the best prenatal
care patterns. The likelihood of prenatal care was the same for blue collar
workers, self-employed workers, and pieceworkers. Women aged 25-34 years were
more likely than older women to obtain early prenatal care. Husband's education,
a resident grandmother, and household assets contributed to a higher likelihood
of seeking early prenatal care. The degree of autonomy on the job was more
closely related to contraceptive and health service use.

PMID: 9561670 [PubMed - indexed for MEDLINE]

133. Am J Public Health. 1998 Mar;88(3):419-26.

Food insufficiency exists in the United States: results from the third National
Health and Nutrition Examination Survey (NHANES III).

Alaimo K, Briefel RR, Frongillo EA Jr, Olson CM.

National Center for Health Statistics, Center for Disease Control and Prevention,
Hyattsville, Md., USA. ka22@cornell.edu

OBJECTIVES: The purpose of this study was to estimate the prevalence of food
insufficiency in the United States and to examine sociodemographic
characteristics related to food insufficiency. METHODS: Data were analyzed from
the third National Health and Nutrition Examination Survey, a cross-sectional
representative sample of the civilian noninstitutionalized population living in
households. Individuals were classified as "food insufficient" if a family
respondent reported that the family sometimes or often did not get enough food to
eat. RESULTS: From 1988 through 1994, the overall prevalence of food
insufficiency was 4.1% and was primarily related to poverty status. In the
low-income population, food insufficiency was positively associated with being
Mexican American, being under the age of 60, having a family head who had not
completed high school, participating in the Food Stamp Program, and not having
health insurance. It was not related to family type or employment status of the
family head. Over half of food-insufficient individuals lived in employed
families. CONCLUSIONS: Food insufficiency is not limited to very low-income
persons, specific racial/ethnic groups, family types, or the unemployed.
Understanding food insufficiency is critical to formulating nutrition programs
and policies.

PMCID: PMC1508323
PMID: 9518974 [PubMed - indexed for MEDLINE]

134. Vital Health Stat 3. 1997 Dec;(31):1-91.

Women: work and health.

Wagener DK, Walstedt J, Jenkins L, Burnett C, Lalich N, Fingerhut M.

National Center for Health Statistics, National Institute for Occupational Safety
and Health, USA.

OBJECTIVES: This report describes the sociodemographics, household
characteristics, and health of women according to workforce status and job
conditions. The report also presents data on men for comparison. METHODS: This
report combines data from numerous data systems, including: The National Health
Interview Survey, National Health and Nutrition Examination Survey, National
Maternal and Infant Health Survey, National Hospital Ambulatory Medical Care
Survey, National Traumatic Occupational Fatalities Surveillance System, and the
National Occupational Mortality Surveillance System, which are conducted by the
U.S. Department of Health and Human Services; the Census of Fatal Occupational
Injuries and Annual Survey of Occupational injuries and illnesses conducted by
the U.S. Department of Labor; and the Current Population Survey conducted by the
U.S. Department of Commerce. The report also presents selected tables from
publications of the Women's Bureau and the Bureau of Labor Statistics, U.S.
Department of Labor. RESULTS: The report presents summary data on physical
conditions and exposures, health conditions attributed to work, other health
conditions that impact on work, health promotion in the workplace, and
health-related benefits provided by employers. Most estimates are shown according
to sex, age, race, ethnicity, educational attainment, and major occupational
group.

PMID: 9470482 [PubMed - indexed for MEDLINE]

135. Eur J Clin Nutr. 1997 Dec;51(12):815-25.

Dietary assessment in Whitehall II: the influence of reporting bias on apparent
socioeconomic variation in nutrient intakes.

Stallone DD, Brunner EJ, Bingham SA, Marmot MG.

Department of Epidemiology and Public Health, University College London Medical
School.

OBJECTIVE: To assess socio-economic differences in nutrient intake, giving
particular consideration to the influence of reporting bias. DESIGN:
Cross-sectional study. Three methods of data analysis (inclusion of all subjects,
exclusion of low energy reporters, and regression-based energy adjustment) were
evaluated against biomarkers of fatty acid and antioxidant intakes. SETTING:
London-based Civil Servants. SUBJECTS: Age and employment grade stratified random
sub-sample of 459 men and 406 women aged 39-61 y who completed 7 d diet diaries
at Phase 3 follow-up (1991-93) of the Whitehall II Study. DIETARY MEASURES: Mean
daily intakes by employment grade (6 levels) of dietary energy, total fat,
saturated fatty acids, polyunsaturated fatty acids (PUFA), linoleic acid,
carbohydrate excluding fibre, dietary fibre, protein, alcohol, vitamin C, vitamin
E, carotenes, potassium and calcium. Biomarkers: serum cholesterol ester fatty
acids (CEFA), total cholesterol, plasma alpha-tocopherol and beta-carotene.
RESULTS: Low energy reporting (LER), defined as a reported energy intake below
1.2 times calculated basal metabolic rate, was strongly associated with
employment grade (top grade: men 17.3%, women 19.3%, bottom grade: men 45.7%,
women 49.2% trend P < 0.0001 both sexes). This association is only to a small
extent accounted for by the relative weight distribution across grades. The
direct associations with grade--high status, high intakes--of total fat,
saturated and polyunsaturated fatty acids seen in the results overall were
greatly reduced or abolished when LER were excluded or when energy adjustment was
used. Direct associations between grade and intakes of vitamin C and potassium in
both sexes were evident regardless of data presentation method. Spearman
correlations between biomarkers and reported intakes, for example CEFA and
dietary linoleate (men 0.46, women 0.61), plasma beta-carotene/cholesterol ratio
and dietary carotenes (men 0.16, women 0.21) together with theoretical
considerations indicate that energy adjustment may be the preferred method for
reducing the influence of reporting bias. CONCLUSIONS: Low energy reporting is a
major source of bias in dietary surveys and its prevalence shows a marked inverse
association with socio-economic status. The energy adjustment method provides an
approach which reduces this bias without exclusion of low energy reporters.
Intakes of micronutrients including vitamin C, rather than fatty acids, showed
associations with socio-economic status consistent with a dietary explanation for
social inequalities in cardiovascular disease.

PMID: 9426356 [PubMed - indexed for MEDLINE]

136. J Natl Med Assoc. 1997 Sep;89(9):594-600.

Sociodemographic factors and obesity in preadolescent black and white girls:
NHLBI's Growth and Health Study.

Patterson ML, Stern S, Crawford PB, McMahon RP, Similo SL, Schreiber GB, Morrison
JA, Waclawiw MA.

Kaiser Permanente Medical Center, Riverside, USA.

The association of sociodemographic and family composition data with obesity was
studied in 1213 black and 1166 white girls, ages 9 and 10, enrolled in the
National Heart, Lung, and Blood Institute's Growth and Health Study. Obesity was
defined as body mass index at or greater than age- and sex-specific 85th
percentile as outlined in the Second National Health and Nutrition Examination
Survey. The prevalence of obesity was higher for pubertal girls than for
prepubertal girls and for girls with older mothers/female guardians. As odds
ratio of 1.14 was observed for each 5-year increase in maternal age. Obesity was
less common for girls with more siblings; the odds for obesity decreased by 14%
for each additional sibling in the household. In blacks, the prevalence of
obesity was not related to parental employment or to parental education. In
whites, the odds of obesity were higher for girls with no employed
parent/guardian in the household and for girls with parents or guardians with
lower levels of educational attainment. Examining the associations between
sociodemographic factors and risk of childhood obesity provides important clues
for understanding racial differences in obesity, a major risk factor for coronary
heart disease.

PMCID: PMC2608268
PMID: 9302856 [PubMed - indexed for MEDLINE]

137. Eur J Clin Nutr. 1997 Jun;51 Suppl 2:S8-15.

Influences on food choice perceived to be important by nationally-representative
samples of adults in the European Union.

Lennernäs M, Fjellström C, Becker W, Giachetti I, Schmitt A, Remaut de Winter A,
Kearney M.

National Institute of Public Health, Stockholm, Sweden.

OBJECTIVE: The purpose of this baseline survey was to obtain comparable data on
perceived influences on food choice from EU member countries as the starting
point for EU healthy eating promotion campaigns and programmes. DESIGN: A
cross-sectional study in which quota-controlled, nationally-representative
samples of approximately 1000 adults from each country completed a face-to-face
interview-assisted questionnaire. SETTING: The survey was conducted between
October 1995 and February 1996 in the 15 member states of the European Union.
SUBJECTS: 14331 subjects (aged 15 y upwards) completed the questionnaire. Data
were weighted by population size for each country and by sex, age and regional
distribution within each member state. RESULTS: The five most important factors
influencing consumers food choice were 'quality or freshness' (74%), 'price'
(43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'family preferences'
(29%). Subjects in different categories (age, sex, education and employment
status) selected different factors as having major influence on their food
choice. Demographic factors seemed to have greater effects on perceived
influences than culture (country): 'quality/freshness', 'price', 'trying to eat
healthy', 'family preferences' seemed to be most important in women, 'taste' and
'habit' in males. Females and older and more educated subjects were more likely
than other subjects to select 'trying to eat healthy' as having a major
influence. 'Price' seemed most important in unemployed and retired subjects.

PMID: 9222718 [PubMed - indexed for MEDLINE]

138. Aust N Z J Public Health. 1997 Apr;21(2):121-6.

A health profile of adults in a Northern Territory aboriginal community, with an
emphasis on preventable morbidities.

Hoy WE, Norman RJ, Hayhurst BG, Pugsley DJ.

Menzies School of Health Research, Darwin, NT.

Comment in:
Aust N Z J Public Health. 1997 Jun;21(3):343-4.

We conducted a brief health survey of adults in an isolated Northern Territory
Aboriginal community, whose standardised mortality rates are the second highest
in Australia. The screen revealed high rates of smoking and excessive drinking,
of preventable infections and their sequelae, and of hypertension, insulin
resistance, diabetes and renal disease. The infectious morbidities were more
pronounced and the life-style morbidities almost entirely new since a health
screen in 1957. Most morbidities were strongly associated with identifiable risk
factors, such as overweight, smoking, excessive drinking, skin sores and scabies,
all of which which are amenable to modification. Problems with food supply and
pricing, poor food choices and diversion of money to cigarettes, beer and
gambling all contributed to poor nutrition. Low birthweight probably compounds
the risk for serious adult disease associated with these environmental
influences. This profile highlights the failure of current systems to deal with
health needs. Improvements in infrastructure, education and employment, and
reinvigoration of preventive and primary health care programs, assumption of
responsibility for health by the community and by individuals themselves, and
better management of existing morbidities are essential to rectifying this
shameful situation.

PMID: 9161065 [PubMed - indexed for MEDLINE]

139. Obes Res. 1997 Mar;5(2):131-41.

Parity-associated body weight: modification by sociodemographic and behavioral
factors.

Wolfe WS, Sobal J, Olson CM, Frongillo EA Jr.

Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA.

This research examines the association between parity and body weight and how
this relationship is modified by sociodemographic and behavioral factors. Using
multiple linear regression analysis, the study assessed the relationship between
parity and relative body weight (as Body Mass Index, BMI) and how this
relationship interacts with seven sociodemographic and seven behavioral factors
in a national sample of 5,707 women from the Second National Health and
Nutritional Examination (NHANES II) survey. After adjusting for sociodemographic
factors, the amount of weight associated with parity averaged about 0.5 kg per
child. However, parity-associated weight differed by sociodemographic and
behavioral factors, and was much larger in some subgroups. Among 18-45 year olds,
the amount of weight associated with parity was greater in blacks than in whites,
less in employed than unemployed white women but greater in employed than
unemployed black women, less in smokers than nonsmokers, less in those with a
high level of recreational exercise, and differed with the level of
nonrecreational physical activity depending on race. Among 46-74 year olds, the
amount of weight associated with parity was greater in married than unmarried
women, and less in those who were active outside of recreation versus those who
were less active. These results suggest that sociodemographic and behavioral
variables modify the relationship between parity and body weight, and provide
insight for identifying women who are at risk for having greater BMI with higher
parity. This information may be applicable to the targeting and design of
interventions to prevent postpartum weight retention.

PMID: 9112248 [PubMed - indexed for MEDLINE]

140. Prev Med. 1997 Mar-Apr;26(2):227-35.

Worksite cancer screening and nutrition intervention for high-risk auto workers:
design and baseline findings of the Next Step Trial.

Tilley BC, Vernon SW, Glanz K, Myers R, Sanders K, Lu M, Hirst K, Kristal AR,
Smereka C, Sowers MF.

Division of Biostatistics and Research Epidemiology, Henry Ford Health Sciences
Center, Detroit, Michigan 48202, USA. bct@biostat.hfh.edu

BACKGROUND: This article describes the design and baseline findings of The Next
Step Trial, a health promotion intervention targeting automobile industry
employees at increased colorectal cancer risk. The intervention encouraged
colorectal cancer screening participation and adoption of low-fat, high-fiber
diets. METHODS: Twenty-eight worksites (n = 5,042) were randomized to control (a
company-sponsored screening program) or intervention (an enhanced screening
program including a personalized educational booklet and motivational telephone
call and diet-change program including nutrition classes, self-help materials,
and computer-generated personalized feedback). Outcomes included screening
compliance and fat and fiber intake. RESULTS: Pretrial data indicated targeted
employees were predominantly older, well educated, married, Caucasian men.
Sixty-one percent (SE = 2) participated in the screening program in the preceding
2 years, and 24% (SE = 1) reported a history of colorectal polyps or cancer.
Fifty-eight percent of the cohort responded to the baseline questionnaire;
respondents were older and more educated; more were married, retired, and
Caucasian than nonrespondents. Mean dietary intakes were 36.9% energy from fat
(SE = 0.21), 8.8 g fiber/1000 kcal (SE = 0.07), and 3.4 servings of fruits and
vegetables per day (SE = 0.04). CONCLUSIONS: Baseline data show moderate
screening participation and dietary intakes that did not meet guidelines; hence
intervention efforts were warranted. Data from this trial will support a rigorous
test of whether this high-risk employee population is responsive to targeted
health promotion, early cancer detection, and prevention interventions.

PMID: 9085392 [PubMed - indexed for MEDLINE]

141. Ann Epidemiol. 1997 Feb;7(2):107-14.

Employment status and high blood pressure in women: variations by time and by
sociodemographic characteristics.

Rose KM, Newman B, Bennett T, Tyroler HA.

Department of Epidemiology, University of North Carolina at Chapel Hill School of
Public Health, USA.

PURPOSE: The association between employment status and high blood pressure in
women was examined at two time periods to determine if associations between
employment status and high blood pressure varied by time period or by age, race,
education, marital status, or parental status. METHODS: Women participants from
the National Health Examination Survey (1960) and the Second National Health and
Nutrition Survey (1976-1980) between the ages of 25 and 64 and currently employed
or keeping house were included. Logistic regression analysis was used to examine
the cross-sectional association between employment status and high blood pressure
in each survey, taking into account potential effect modifiers and covariates.
RESULTS: In 1960 employment was associated with a slight, but not statistically
significant, elevation in odds of high blood pressure. In 1976-1980, it was
associated with a modest but significant reduction in odds of high blood
pressure. Variations in associations occurred by marital status (protective
associations were limited to unmarried women) and race (associations were of
stronger magnitude among African-American women). CONCLUSIONS: The employment
status-high blood pressure relationship shifted across surveys. Changes in the
composition of the employed and nonemployed groups account for at least part of
the varying relationships.

PMID: 9099398 [PubMed - indexed for MEDLINE]

142. Public Health. 1996 Nov;110(6):361-7.

Prescribed medication and nutrition of social care patients in Crete, Greece.

Tzimis L, Katsantonis N, Leledaki A, Vasilomanolakis K, Kafatos A.

Department of Pharmacy Services, Chania General Hospital, St George, Crete,
Greece.

OBJECTIVE: The aim of this study was to make a systematic registration of a group
of 354 social care indigent patients in relation to: their pharmaceutical needs:
the conditions for which it was prescribed, its cost, and details of
prescriptions. In addition patients' eating patterns relating to and knowledge of
how to use their medication was assessed. They were compared to a control group
of 153 Social Security patients. SUBJECTS: The Social Care indigent patients were
of low income, consisting of groups as unmarried mothers with their children and
Greeks emigrants coming back home from other countries (Albania, Russia, Georgia,
Ukraine, Romania etc.). The socio-demographic profiles of this group reveal an
unemployment rate of 74% and an illiteracy rate of 18%. As regards marital
status, 20% are bachelors and 12% divorcees. RESULTS: The results of the study
indicated no significant difference between the two groups in the mean cost of
prescription (40 ECU for Social Care patients vs 32 ECU for Social Security
patients), in the mean number of medication per prescription (2.6 vs 2.6
respectively), in the percentages of the Daily Defined Doses and the cost of the
various categories of drugs. For both groups, the most common drugs were those of
the Cardiovascular system (30% vs 26%), Gastrointestinal system (17% vs 27%) and
Nervous system (16% vs 18%). The most common diagnosis was Hypertension (10% vs
8%) and the most common drugs were Ranitidine (3% vs 2%), Diclofenac (3% vs 3%),
Salbutamol (3% vs 3%) and Paracetamol (2% vs 2%). Significant differences between
Social Care patients to Social Security patients respectively were found
regarding: knowing how to take their medication correctly (47% vs 77%), knowing
for how long treatment needed to be taken (21% vs 43%), requesting information
from the pharmacist (39% vs 68%) knowledge of dietary instructions regarding
medication (17% vs 41%) and in smoking more than 20 cigarettes per day (15% vs
3%). CONCLUSIONS: The results indicated that the Social Care patients, in
comparison with the patients of the Social Security, need more education and more
help in the area of the proper use of drugs and in the personal contact that this
procedure involves.

PMID: 8979753 [PubMed - indexed for MEDLINE]

143. Eur J Clin Nutr. 1996 Aug;50(8):560-4.

Socio-economic influences on gender inequalities in child health in rural
Bangladesh.

Rousham EK.

Department of Anatomy and Human Biology, University of Western Australia,
Nedlands, Perth, Western Australia.

OBJECTIVE: To investigate gender inequalities in child growth and nutritional
status in relation to socio-economic status in Bangladesh. DESIGN: A 16-month
longitudinal study of child growth measuring anthropometric and socio-economic
status. SETTING: A rural area of Jamalpur district, northern Bangladesh.
SUBJECTS: 1366 children from 2 to 6 years of age. METHODS: Child height and
weight were measured monthly. Morbidity, food intake and health-seeking
behaviours were assessed fortnightly. Multivariable analyses were performed on
the growth and nutritional status of male and female children in relation to
socio-economic factors including father's occupation, parental education, birth
order and family size. RESULTS: There was no evidence of gender bias in farming
and trading/employee households but landless female children had significantly
poorer height-for-age (P < 0.001) and weight-for-age (P < 0.001) than their male
counterparts. During a period of natural disaster, a statistically significant
interaction was observed between father's occupation and sex (P < 0.05) such that
the combination of being female and being landless was more detrimental to
nutritional status than either variable alone. Over the following 16-months,
catch-up-growth was apparent in landless female children who grew significantly
more in height-for-age (P < 0.001) and weight-for-age (P < 0.001) than their male
counterparts. CONCLUSIONS: Gender inequalities in health in Bangladesh varied
significantly according to occupational status, such that the effect of sex was
dependent upon occupation. These effects were statistically significant during
the period of natural disaster but became insignificant as local conditions
improved. This demonstrates both temporal and socio-economic variation in gender
inequalities in health.

PIP: During February 1989-June 1990 in Bangladesh, local field assistants
collected data on 1366 children 2-6 years old, attending maternal and child
health clinics operated by a nongovernmental organization, and living in 13
villages in Jamalpur District situated on the banks of the Jamuna River. The
field assistants made home visits to record child morbidity every 2 weeks and to
measure child height and weight once a month. During January-April 1989, this
area suffered from extensive food shortages due to a prolonged drought and one of
the worst floods recorded in Bangladesh. Gender bias was not apparent in farming
and trading/employee households. In landless households (i.e., fathers'
occupation was laborer), girls were significantly shorter and less heavy than
boys (p 0.001), however. During a natural disaster, fathers' occupation
significantly interacted with sex (p 0.05). Specifically, children who were both
female and living in a landless household were more likely to have poor
nutritional status than children who were female and living in a farming or
trading/employee household and children who were male and living in a landless
household. This interaction was not apparent as local conditions improved. Over
the 16 months following the natural disaster, landless girls grew significantly
more in height-for-age and weight-for-age than landless boys (p 0.001). In other
words, these girls experienced more catch-up growth than the boys. At the end of
the study, nutritional status varied only according to socioeconomic status but
not according to gender. These findings suggest that gender bias within this
population depends on changes in food availability and the rural economy. Thus,
child nutrition programs should target landless girls, who are at highest risk of
gender discrimination and malnutrition during economic adversity.

PMID: 8863018 [PubMed - indexed for MEDLINE]

144. Health Serv Res. 1996 Aug;31(3):347-63.

Use of care and subsequent mortality: the importance of gender.

Franks P, Gold MR, Clancy CM.

Primary Care Institute, Highland Hospital, Rochester, NY, USA.

OBJECTIVE. In light of recent discussions on access that have emphasized the need
to relate access measures to outcomes, we examined the relationship between three
self-reported utilization and access to care measures and the risk of subsequent
mortality. DATA SOURCES AND DESIGN. A nationally representative sample from the
first National Health and Nutrition Examination Survey that included adults 25-64
years of age without publicly funded health insurance was followed prospectively
from initial interview in 1971 through 1975. DATA COLLECTION. Complete baseline
and follow-up information was obtained on 4,491 persons (90 percent). Baseline
access and use was assessed with answers to three questions: having a usual
source of care, obtaining a general checkup, and not obtaining needed care (or
forgone care). The relationships between the access and use measures and
mortality by 1987 in men and women were examined using survival analyses. The
analyses adjusted for race, and for baseline age, education, income, residence,
insurance status, employment status, the presence of morbidity on examination,
self-rated health, smoking status, leisure exercise, alcohol consumption, and
obesity. PRINCIPAL FINDINGS. After adjusting for all other baseline variables,
not obtaining a general checkup was associated with higher mortality in women
(hazard ratio = 1.64 [95% confidence interval = 1.16, 2.32]), but not in men
(hazard ratio = 1.07 [95% confidence interval = 0.80, 1.42]). Reporting a usual
source of care and forgone care were not related to subsequent mortality in
either women or men. CONCLUSIONS. Reporting a general checkup is an
outcome-related utilization measure in women only. Further development of access
and use indicators should address gender differences in health care use.

PMCID: PMC1070123
PMID: 8698589 [PubMed - indexed for MEDLINE]

145. JAMA. 1996 Apr 24;275(16):1233-40.

Exposure of the US population to environmental tobacco smoke: the Third National
Health and Nutrition Examination Survey, 1988 to 1991.

Pirkle JL, Flegal KM, Bernert JT, Brody DJ, Etzel RA, Maurer KR.

National Center for Environmental Health, Centers for Disease Control and
Prevention, Atlanta, GA 30341-3725, USA.

Comment in:
JAMA. 1996 Aug 28;276(8):603; author reply 604.
JAMA. 1996 Aug 28;276(8):603-4.
JAMA. 1996 Aug 28;276(8):603; author reply 604.

OBJECTIVE: To estimate the extent of exposure of the US population to
environmental tobacco smoke and the contribution of the home and workplace
environment to environmental tobacco smoke exposure. DESIGN: Nationally
representative cross-sectional survey including questionnaire information from
persons aged 2 months and older (n=16818) and measurements of serum cotinine (a
metabolite of nicotine) from persons aged 4 years and older (n=10642).
SETTING/PARTICIPANTS: Participants in the Third National Health and Nutrition
Examination Survey, October 25, 1988, to October 21, 1991. RESULTS: Of US
children aged 2 months to 11 years, 43% lived in a home with at least 1 smoker,
and 37% of adult non-tobacco users lived in a home with at least 1 smoker or
reported environmental tobacco smoke exposure at work. Serum cotinine levels
indicated more widespread exposure to nictoine. Of non-tobacco users, 87.9% had
detectable levels of serum cotinine. Both the number of smokers in the household
and the hours exposed at work were significantly and independently associated
(P<.001, multiple regression t test) with increased serum cotinine levels. Serum
cotinine levels of children, non-Hispanic blacks, and males indicated that these
groups had higher exposure to environmental tobacco smoke. Dietary variables
showed no consistent association with serum cotinine levels, and dietary
contribution to serum cotinine level, if any, appeared to be extremely small.
CONCLUSIONS: The high proportion of the population with detectable serum cotinine
levels indicates widespread exposure to environmental tobacco smoke in the US
population. Both the home and workplace environments significantly contribute to
environmental tobacco smoke exposure in the United States.

PMID: 8601954 [PubMed - indexed for MEDLINE]

146. Am J Public Health. 1996 Apr;86(4):533-7.

The health insurance status of US Latino women: A profile from the 1982-1984
HHANES.

de la Torre A, Friis R, Hunter HR, Garcia L.

Health Care Administration Program, College of Health and Human Services,
California State University, Long Beach, CA 90840, USA.

OBJECTIVES: This research studied the correlates of health insurance status among
three major subpopulations (Mexican, Puerto Rican, and Cuban) of adult (ages of
20 to 64) Latino women. METHODS: Data from the Hispanic Health and Nutrition
Examination Survey (HHANES), 1982-1984, were examined to determine the
percentages of health insurance coverage among the sample populations and to
assess the relationship between access to coverage and selected sociodemographic
employment/income, ancestry, and acculturation variables. RESULTS: Variations in
health insurance coverage existed by Latina subpopulation. While Puerto Rican
women had the highest percentage of any health insurance coverage, Mexican-origin
women (particularly those 50 to 64 years old) had the lowest. For all three
Latina groups, health insurance coverage was greater among those who reported a
family income above the poverty level than among those whose income fell below
the poverty level; employment location, acculturation variables, and ancestry
were also related to coverage. CONCLUSIONS: Eligibility requirements,
particularly for Mexican-and Cuban-origin women, need to be streamlined, and
innovative health insurance programs need to be developed to increase access of
Latinas to health insurance.

PMCID: PMC1380555
PMID: 8604785 [PubMed - indexed for MEDLINE]

147. Prev Med. 1996 Mar-Apr;25(2):212-7.

Determinants of fat and fiber consumption in American rural energy workers.

Kuppens R, Eriksen MP, Adriaanse HP, Nijhuis FJ, Aaron JC.

Department of Health Promotion and Health Education, Netherlands Heart
Foundation, The Hague, The Netherlands.

BACKGROUND. The objective of this study was to gain insight into the determinants
of dietary fat and fiber consumption in American rural energy workers. Main
determinants in this study were knowledge, efficacy expectations, and outcome
expectations. The determinants will be ordered in a model, assuming that efficacy
and outcome expectations predict intention. METHODS. The study consisted of a
cross-sectional survey. The questionnaires on food behavior and the determinants
of fat and fiber consumption were administered to the subjects at the same time.
Models of determinants of fat and fiber consumption were derived from the
correlation and regression analyses. RESULTS. There were 211 questionnaires
analyzed. The scales were shown to be valid and reliable. In the models of
determinants of fat and fiber consumption the following determinants were
generated: gender, education, knowledge, interest, efficacy expectations, outcome
expectations, and intention. In this study efficacy expectations were important
to determine fat and fiber consumption. CONCLUSIONS. Efficacy expectations can be
considered an important variable of an intervention program aiming at the
decrease of fat consumption and at the increase of fiber consumption in rural
energy workers.

PMID: 8860287 [PubMed - indexed for MEDLINE]

148. Indian J Matern Child Health. 1996 Jan-Mar;7(1):20-3.

The impact of family milieu on the prevalence of protein-energy malnutrition in
infants.

Nanda S.

PIP: In India's Varanasi district, a nutrition survey was conducted of 360
infants living in an urban unit of Sunderapur and two rural units of
Kashividhyapeeth and Baragaon blocks to examine protein-energy malnutrition (PEM)
in these infants and the effect of family type on the prevalence of this type of
malnutrition. 57% of children from extended families had PEM compared to 25% of
those from nuclear families (p 0.001). PEM became more prevalent as family size
increased (21.6% for family size of 5, 37.88% for family size of 5-10, and 74.76%
for family size of 10; p 0.001). PEM was inversely related to maternal
educational status. PEM was most prevalent in infants whose father belonged to
the labor class and least prevalent in those whose father belonged to the service
class (90.91% vs. 15.28%). Severe PEM was especially prevalent in infants whose
father belonged to the labor class (36.37% vs. 9.89% for service and 6.89% for
business classes). It was also more prevalent in infants from the poorest
families (less than Rs. 100 per capita) than in the wealthiest families (more
than Rs. 200) (51.35% vs. 43.17%). Severe PEM made up most of this difference.

PMID: 12320379 [PubMed - indexed for MEDLINE]

149. Soz Praventivmed. 1996;41(6):348-58.

[The distribution of selected cardiac risk factors in employed and studying
youths in the rural region of Steiermark (Austria)]

[Article in German]

Rásky E, Stronegger WJ, Freidl W.

Institut für Sozialmedizin, Universität Graz.

Demographic data, components of lifestyles such as risk behavior, health
complaints, illnesses and utilization of preventive and curative services were
surveyed through a health survey conducted in 79 selected rural communities of
Styria between 1989 and 1933. Our research focussed on the stratification of
cardiovascular risk factors such as smoking, high blood pressure, unhealthy
nutrition, low physical activity and obesity in adolescents employed or attending
school. The sample comprises 1239 adolescents divided into two groups: 651 were
employed and 588 were in school. We could show that even at such a young age
significant differences occur in the distribution of cardiovascular risk factors
between these two groups. The employed adolescents were far more stressed than
those of their age group attending school. Generally, the females are less
strained than the males. Our results suggest that efficient programs to prevent
cardiovascular disease need to specifically focus on the various life contexts of
young people. Such programs should start at an early date.

PMID: 9027139 [PubMed - indexed for MEDLINE]

150. Bull N Y Acad Med. 1996 Winter;73(2):370-97.

Occupations, cigarette smoking, and lung cancer in the epidemiological follow-up
to the NHANES I and the California Occupational Mortality Study.

Leigh JP.

Department of Economics, San Jose State University, CA 95192-0114, USA.

What jobs are associated with the highest and lowest levels of cigarette use and
of lung cancer? Are there gender differences in these jobs? Two data sets-the
Epidemiological Follow-up to the National Health and Nutrition Examination Survey
(NHEFS) and the California Occupational Mortality Study (COMS) were analyzed to
answer these questions. For females, the broad occupations ranking from highest
to lowest cigarette use in the NHEFS was: transportation operators, managers,
craft workers, service workers, operatives, laborers, technicians, administrative
workers, farm owners and workers, sales workers, no occupation, and
professionals. The corresponding ranking for males was: transportation operators,
no occupation, laborers, craft workers, service workers, technicians, and
professionals. The highest-ranking jobs in the COMS were waitresses, telephone
operators, and cosmetologists for women, and water-transportation workers,
roofers, foresters and loggers for men. Teachers were especially low on all four
lists. This study could not determine whether employment within any occupation
encouraged smoking or if smokers selected certain occupations.

PMCID: PMC2359318
PMID: 8982527 [PubMed - indexed for MEDLINE]

151. Public Health Rep. 1996;111 Suppl 2:15-7.

Hypertension among Mexican Americans in Starr County, Texas.

Hanis CL.

Human Genetics Center, School of Public Health, University of Texas Health
Science Center at Houston, 77225, USA.

THE MEXICAN-AMERICAN POPULATION in the United States has generally elevated
frequencies of several chronic conditions, including non-insulin-dependent
diabetes mellitus (NIDDM), gallbladder disease, and obesity. Prevalence of
cardiovascular disease and hypertension is less clear. To document prevalence and
risk factors of hypertension in this population, we measured blood pressure in
1004 randomly selected Mexican Americans in Starr County, Texas, ages 15 to 74.
We defined hypertension as systolic blood pressure greater than or equal to 140
mmHg or diastolic pressure greater than or equal to 90 mmHg or current (within
the last 48 hours) use of antihypertensive medications. Prevalences by age and
gender are elevated in this population group compared with those in the general
population. In addition to age and gender, body mass and diabetes status were
also predictors of hypertension. Comparison of the Starr County results with
those reported from the Third National Health and Nutrition Examination Survey
(NHANES III) sampling of Mexican Americans indicates a slight increase in
frequency of hypertension in Starr County, while comparison with results from San
Antonio Mexican Americans indicates a marked increase in frequency in Starr
County. These differences are not simple functions of measurement protocols, but
are likely to be caused by differences in population structure, employment and
socioeconomic status, education, and other such factors.

PMCID: PMC1381654
PMID: 8898763 [PubMed - indexed for MEDLINE]

152. J Am Diet Assoc. 1996 Jan;96(1):39-45.

Transformational leadership of clinical nutrition managers.

Arensberg MB, Schiller MR, Vivian VM, Johnson WA, Strasser S.

Nutrition Services, Ross Products Division, Abbott Laboratories, Columbus, Ohio
43215, USA.

OBJECTIVE: To identify leadership qualities of clinical nutrition managers and
associate these leadership qualities with selected demographic variables (eg,
training/degree, length of time in management, number of people supervised,
income, and participation in advanced practice activities). DESIGN: The theory of
transformational leadership, that is, leadership that incorporates specific
interpersonal behaviors of the leader and his or her actions within the
organization, provided the framework for the study. Specific transformational
leadership qualities--leader behavior, leader personal characteristics, and the
effect of the leader on organizational functioning and culture--were measured
using the Leadership Behavior Questionnaire (LBQ). The reliability and validity
of the LBQ have been reported previously. Other data were obtained using two
demographic surveys. SAMPLE: Demographic surveys were mailed to 1,599 members of
the Clinical Nutrition Management dietetic practice group. From the 951 (59.8%)
respondents, a study sample of 150 clinical nutrition managers and their
subordinates was selected to receive the LBQ; 116 (77.3%) instrument sets were
used for analysis. STATISTICAL ANALYSIS: Descriptive statistics were used to
analyze the demographic surveys. A specified mixed linear model repeated measures
Statistical Analysis System procedure was used to compare the clinical manager
and subordinate LBQ scores. Association of the selected demographic variables
with leadership qualities was measured by lambda, a predictive value measure,
using the BMDP 4F program. RESULTS: Clinical nutrition managers exhibited
transformational leadership qualities as rated by the LBQ, rating lowest on the
communication leadership score and highest on the respectful leadership score.
Most of the clinical nutrition manager self LBQ scores were significantly higher
than the clinical nutrition manager LBQ scores rated by subordinates. The
selected demographic variables appeared to have the strongest predictive effect
for the visionary culture building subscore of the LBQ. The visionary culture
building subscore is a measure of how well the leader interacts with and affects
the functioning of an organization. APPLICATIONS/CONCLUSIONS: More research is
needed to define leadership in dietetics: this study can serve as a possible
model. One way clinical nutrition managers may be able to enhance their
leadership behaviors is to strengthen their skills in communicating their vision.
Programs are needed to help clinical nutrition managers shape their organizations
to foster leadership development in their subordinates.

PMID: 8537568 [PubMed - indexed for MEDLINE]

153. Med J Malaysia. 1995 Dec;50(4):382-90.

Nutrient intake and socio-economic status among children attending a health
exhibition in Malaysian rural villages.

Norhayati M, Noor Hayati MI, Oothuman P, Fatmah MS, Zainudin B, Fatimah A.

Department of Parasitology and Medical Entomology, Faculty of Medicine,
Universiti Kebangsaan Malaysia, Kuala, Lumpur.

A dietary survey was carried out in 216 children (109 males, 107 females) aged
1-7 years, living in rural villages in Selangor, Malaysia to assess their
nutrient intake and to determine the association between nutrient consumption and
socio-economic background. All the children studied had inadequate intakes of
energy, iron and niacin according to Recommended Daily Intake (RDI). Children
aged of 4-9 years showed inadequate intake of calcium, thiamine and riboflavin.
However, the intake of protein, vitamin A and ascorbic acid were above the
recommended value. The mean percentage requirements of protein, iron and niacin
were significantly higher in children from small families compared with children
from large families. However the employment status of mothers had a significantly
effect on the mean percentage requirements of niacin. The results indicate that
education level of the mothers, is strongly associated with the mean percentage
nutrient requirements of children and we strongly feel that this is a strategy to
be adopted for improvement in nutrition of children.

PIP: During January-June 1993, in the rural villages of Mukim Labu and Dengkil,
Malaysia, a dietary survey was conducted of 216 children 1-7 years old attending
a health and worm infestation exhibit. It aimed to determine the dietary intake
of these children and to examine the association between dietary intake with age,
household income, family size, employment status of mothers, and level of
mothers' education. All the children had lower intakes of energy, iron, and
niacin than the recommended daily intake (RDI). Their intake of protein, vitamin
A, and ascorbic acid tended to be more than the RDI, however. Children 4-9 years
old consumed insufficient amounts of calcium, thiamin, and riboflavin. The
researchers controlled for age in the remaining analyses, since it is a
confounding factor. Children from low-income households had significantly lower
intakes of protein, iron, and niacin than those from higher income households (p
0.05). Children from small size families (1-5) consumed more riboflavin than
those from larger size families (=or 6) (104.6 vs. 67.4-74.3 mg; p 0.05).
Children of working mothers consumed more niacin than those whose mothers were
housewives (66.3 vs. 44.1 mg; p 0.05). Mother's education had a positive
association with intake of protein, iron, vitamin A, and niacin (p 0.05). These
findings suggest that household income, mother's education, and small family size
had a positive association with nutrient intake.

PMID: 8668061 [PubMed - indexed for MEDLINE]

154. Prev Med. 1995 Nov;24(6):546-52.

Barriers to providing nutrition counseling by physicians: a survey of primary
care practitioners.

Kushner RF.

Clinical Nutrition Research Unit, University of Chicago, IL 60637, USA.
rkushner@midway.uchicago.edu.

Comment on:
Prev Med. 1995 Nov;24(6):543-5.

BACKGROUND: Previous surveys have shown that there is a disparity between
physicians' beliefs about the importance of diet and nutrition in health
maintenance and disease prevention and the actual delivery of nutrition
counseling. The primary objective of this study was to assess the current
attitudes, practice behavior, and barriers to the delivery of nutrition
counseling by primary care physicians. METHODS: A random-sample-mailed
questionnaire was sent to 2,250 primary care physicians selected from the AMA
masterfile from general practice, internal medicine, and pediatrics, representing
self-employed, group, hospital, and HMO practices. Participants were stratified
by age, gender, geographical region, and present employment. The main outcome
measures were to determine time spent by physicians providing and percentage of
patients receiving dietary counseling and to identify barriers to the delivery of
nutrition counseling. RESULTS: A 49% response rate (n = 1,103) was obtained.
Results are presented for the 1,030 physicians (70% private practice) with
complete data. Over two-thirds of physicians provide dietary counseling to 40% or
less of patients and spend 5 or fewer min discussing dietary changes. Despite
this pattern, nearly three-quarters of respondents feel that dietary counseling
is important and is the responsibility of the physician. Ranking of perceived
barriers to delivery of dietary counseling were lack of time, patient
noncompliance, inadequate teaching materials, lack of counseling, training, lack
of knowledge, inadequate reimbursement, and low physician confidence.
CONCLUSIONS: This survey suggests that multiple barriers exist that prevent the
primary care practitioner from providing dietary counseling. A multifaceted
approach will be needed to change physician counseling behavior.

PMID: 8610076 [PubMed - indexed for MEDLINE]

155. Environ Urban. 1995 Oct;7(2):51-65.

Fighting poverty: the economic adjustment of female migrants in Dhaka.

Huq-hussain S.

PIP: Data from a field survey of slum and squatter settlements in Dhaka,
Bangladesh, are used to examine the social adjustment of poor, female migrants to
work, occupational choice, work satisfaction, income, control over income, and
women's role in the family economy. A "poor household," defined in terms of
nutritional intake, included those families receiving under 2122 cal/person/day.
44% of the urban population in Bangladesh do not obtain the daily nutritional
requirement. Findings indicate that 61% of all female migrants expected to find
work on arrival in the city. 44% of female migrants were willing to take any kind
of work available at the time of arrival. Over 66% of all females found work in
less than 6 months. Almost 25% took 6 months to a year to find a job, and 15%
found work after a year's time. Recent migrants, who were older, found work
quicker. 16% of female migrants found their job with help from relatives and
friends (23% of recent migrants and 14% of long-term migrants). Among female
migrants who sought a job on their own, 14% found work within 6 months. 3% found
work between 6 months and a year. The rest were engaged in family and home-based
work or found a job much later. In Dhaka, most women migrants worked in the
service or informal sector. 40% of the sample worked as domestics, 38% worked in
the informal sector, 16% worked in other informal work, and 5% worked in
export-based garment industries. Most female migrants lived in the British Dhaka
zone and the post-British Dhaka zone. Those living in the Mughal Dhaka zone
tended to work in home-based informal activities. Garment industry workers tended
to have more education. Women in the informal sector did not receive cash income.
Just over 33% received income in kind, about 25% received a low income, and
another 25% received a moderate income. In 71% of cases, husbands or fathers
handled the money. 29% handled income on their own. Their own earnings went
mostly for survival needs. Over 70% changed jobs more than once. 44% were
satisfied with their work. Women were unhappy with low wages, tiring and hard
work, and long working hours.

PMID: 12291446 [PubMed - indexed for MEDLINE]

156. J Occup Environ Med. 1995 Jun;37(6):690-6.

Effects of a low-fat, worksite intervention on blood lipids and lipoproteins.

Hartman TJ, Himes JH, McCarthy PR, Kushi LH.

Division of Epidemiology, University of Minnesota School of Public Health,
Minneapolis 55454-1015, USA.

An 8-week educational intervention focusing on low-fat eating pattern messages
was conducted among employees of the city of Phoenix, Arizona. One hundred
nineteen employees with serum cholesterols of > or = 5.2 mmol/liter who
participated in at least one of eight weekly sessions were compared with 112
nonparticipants. Multiple regression analysis indicated significant intervention
effects. For participants, total blood cholesterols decreased an average of 0.22
mmol/liter, low-density lipoproteins (LDLs) decreased an average of 0.30
mmol/liter, and triglycerides decreased an average of 1.91 mmol/liter.
High-density lipoproteins (HDLs) increased an average of 0.68 mmol/liter.
Significant effects remained after considering initial lipid status, and
variation in age, sex, occupation, ethnicity, alcohol intake, fat intake, and
BMI. These results constitute a 3.8% decrease in serum cholesterol and a 7.8%
decrease in LDLs.

PMID: 7670915 [PubMed - indexed for MEDLINE]

157. J Hum Lact. 1995 Jun;11(2):93-6.

Mothers' attitudes towards donated breastmilk in Jos, Nigeria.

Ighogboja IS, Olarewaju RS, Odumodu CU, Okuonghae HO.

In many developing countries, the use of pooled human milk is not widely
accepted. Six hundred eighty breastfeeding mothers were interviewed to ascertain
their acceptance of donated breastmilk. Their attitudes toward stored breastmilk,
human milk banking, and breastfeeding in the event of human immunodeficiency
virus (HIV) positivity were solicited. About 71 percent would not accept donated
breastmilk for their baby while the rest would consent only if the donor were a
close family relative, owing to fear of transfer of diseases (28 percent), fear
of transfer of genetic traits (22 percent), and religious and cultural taboos (14
percent). However, 60 percent were willing to donate breastmilk. Only 38 percent
would accept milk from a breastmilk bank. None would breastfeed if she were HIV
positive.

PIP: In the Jos community of Plateau state, Nigeria, a survey was conducted among
mothers who were specifically questioned in relation to transmissible diseases
such as HIV. Their attitudes regarding pooled breast milk, breast milk banks, and
offering stored breast milk to their babies were also ascertained. 680
breast-feeding mothers attending the Jos University Teaching Hospital (JUTH) were
interviewed at the Pediatric Outpatient Department, Postnatal and Immunization
clinics using a structured pretested questionnaire. The ethnic distribution
reflected the major tribes in Nigeria (Ibo, Yoruba, and Hausa). Most of the women
had at least a primary school education, were Christians, were employed, and had
nursed babies previously. 70% were unwilling to accept donated breast milk. The
remaining mothers would accept it only if the donor was a close family relation.
Among the 92 health workers (90 nurses and 2 doctors) included in the study, only
11 (12%) would consent to using donated breast milk. Mothers who were employed
were less willing to accept donated breast milk when compared with unemployed
mothers (p .001). Similarly, mothers with secondary or postsecondary education as
a group were significantly less willing to accept donated breast milk in
comparison to those with primary or no formal education (p .02). The majority of
employed or well- educated mothers opted for manufactured baby milk feeds. Under
HIV-positive status, none would breast feed regardless of their educational or
employment status. 410 (60%) of the women were willing to donate breast milk, but
they preferred to do so for a relative's baby; 25% feared producing insufficient
breast milk to sustain their own infants if they had to donate milk. On the
whole, 63% believed that stored breast milk was unsafe after 6 hours in a home
refrigerator. Breast milk from a well- established human milk bank was acceptable
to 38% of the respondents. Negative responses were due to religious injunction
(27%), fear of transfer of genetic traits (17%), possible transfer of disease
(11%), cultural inhibition (4%), and personal dislike (2%).

PMID: 7619300 [PubMed - indexed for MEDLINE]

158. J Hum Lact. 1995 Mar;11(1):11-5.

Breastfeeding practices in Chengdu, Sichuan, China.

Guldan GS, Zhang M, Zeng G, Hong J, Yang Y.

Barriers to increased breastfeeding rates in Chengdu, Sichuan were investigated
in 1992 and 1993. Responses of focus groups showed that ignorance about
breastfeeding and belief that the mother's milk was inadequate, and lack of
support from their families, places of employment, and the health system acted as
barriers to the women's breastfeeding their infants up to the age of four to six
months. Subsequently, 363 mothers of 4- to 12-month-old Chengdu infants were
surveyed. Although most mothers in both studies said breastmilk was the best food
for their infant up to age of four to six months, only about half of the mothers
breastfed for longer than one month. Both studies showed that infants who roomed
with their mothers after birth were more likely to have been put to their
mother's breast earlier, fed colostrum, breastfed somewhat longer, and
exclusively breastfed for a somewhat longer period, although their mothers'
infant feeding knowledge did not differ. The researchers conclude that Chengdu
health workers should teach parents and parents-to-be more about breastfeeding,
and that rooming-in be expanded in Chengdu hospitals.

PIP: In China in 1992, a focus group was conducted of 4-9 mothers at eight
different places of employment in Chengdu, Sichuan (total mothers, 55), to learn
their attitudes, beliefs, concerns, knowledge, and preferred channels of
receiving infant feeding information. During April 1993, interviews were
conducted with 363 infant-caretaker pairs from each of Chengdu's five districts
to examine infant feeding practices. 88% of infants were ever breast fed. Even
though almost 73% of the caregivers thought that breast milk was the best food
for the first six months, only 32% of infants 4-6 months old were currently being
breast fed. The targeted breast feeding rate of the National Action Programme for
Child Development in China is 80%. Only one 7-month-old infant was currently
exclusively breast fed. The findings of the survey corroborated those of the
focus groups. Mothers tended to have little knowledge about breast feeding, to
believe their breast milk was inadequate, and to have no support from their
families, employers, and the health system. Knowledge on infant feeding of
mothers whose infants roomed with them after delivery and that of mothers whose
infants did not room with them after delivery was similar. Infants who roomed
with their mothers after delivery tended to have first been breast fed earlier (p
0.0001), to have been given breast milk as their first food (; 0.0001), to
continue to have been breast fed when the mothers thought that their breast milk
was inadequate (p = 0.0003), to have received colostrum (p = 0.003), to have been
breast fed longer (p = 0..0002), and to have been exclusively breast fed longer
(p 0.0001). These findings led to three recommendations to encourage breast
feeding in Chengdu: health workers should consider breast feeding important and
should educate parents about infant feeding and nutrition; more hospitals in

Chengdu need to practice rooming-in; and a study should be conducted to determine
whether health workers have adequate knowledge about breast feeding.

PMID: 7718100 [PubMed - indexed for MEDLINE]

159. J Am Diet Assoc. 1995 Feb;95(2):227-30.

Importance of food choice influences for working young adults.

Stewart B, Tinsley A.

Department of Nutritional Sciences, University of Arizona, Tucson 85721.

PMID: 7852692 [PubMed - indexed for MEDLINE]

160. Nutr Health. 1995;10(3):239-53.

Infant weaning practises of some Idoma women in Makurdi, Nigeria.

Igbedioh SO, Edache A, Kaka HJ.

University of Agriculture, Makurdi, Nigeria.

The weaning practices in infants aged 4-9 months of two hundred Idoma women
resident in Makurdi were examined. A pre-tested standard questionnaire was used
to collect data from mothers who regularly visited the post-natal health clinics
in Makurdi. The results showed that better educated mothers breast fed for a
shorter time or planned to cease breast feeding after a shorter period than
mothers who had little education or no formal training. Most mothers (97%) fed
milk formula which they claimed was used to supplement breast milk and was good
for their babies. The most influential factors were the hospital and the husband.
The majority of the mothers fed pap; 73% using corn in its preparation, with 91%
of them storing such paps in flask. More than half of the mothers used a bottle
in feeding the paper or gruel to their infants while a similar proportion (65.5%)
fed legumes to their infants in addition to fruits. The implications of these
practices in comparison with other ethnic groups is discussed.

PIP: During May-September 1993, in Benue State, Nigeria, interviews were
conducted with 200 healthy Idoma mothers aged 16-43 years attending the postnatal
health clinic in the Kwararafa area of Makurdi--largely a Tiv tribe
settlement--so researchers could learn about infant weaning practices of Idoma
women. 67% of the mothers had no more than primary education, while about 60% of
the husbands had at least secondary education. Most mothers breast fed on demand
6-8 times a day for 5-15 minutes. 90% planned to cease breast feeding at 12
months. The less educated mothers, who were either self-employed or unemployed,
planned to cease breast feeding later than the more educated mothers who were in
salaried employment. 97% gave their infant milk formula. Education was associated
with milk formula use (93% of mothers with no formal education, 97% of mothers
with primary education, and 100% of mothers with secondary or higher education).
The major reasons for using milk formula were supplementation of breast milk
(43%) and claiming it is good for infants (36.5%). The leading milk formula
brands were Nan (46.3%), Cerelac (30%), and SMA (10.5%). The factors that most
influenced introduction of milk formula included hospital advice (46.5%) and
husband's advice (33%). 52.5% introduced supplementary feeding at 3-4 months.
88.5% of all mothers gave supplementary food alongside breast milk. The most
important factors influencing type of supplementary food were suitability for
infant (35.5%), high quality (21.5%), and price (19.5%). The leading type of
weaning foods were pap (50.5%), Cerelac (26.5%), and pap mixed with other food
(11%). 82% of mothers fed gruel to their infant with a feeding bottle. 65.5% also
fed legumes, vegetables, and/or fruits to their infant. The decision to feed
these foods to their infant were based on hospital advice (36%), availability in
the family menu (24%), and easy availability (18.5%). Based on these findings,
health workers should use nutrition education, advice, and demonstration to teach
appropriate and timely introduction of supplementary foods, methods of food
preparation, and use of local fruits and vegetables.

PMID: 8684733 [PubMed - indexed for MEDLINE]

161. J Natl Cancer Inst Monogr. 1995;(18):41-7.

Comparing acculturation scales and their relationship to cancer screening among
older Mexican-American women.

Suarez L, Pulley L.

Associateship for Disease Control and Prevention, Texas Department of Health,
Austin 78756, USA.

BACKGROUND: Hispanic women in the United States are less likely to participate in
breast and cervical cancer screening than women of other racial and ethnic
groups. To plan appropriate interventions requires an understanding of the
barriers to participation, including those of acculturation and assimilation. Few
studies have examined the effects of acculturation and assimilation on the
cancer-screening behavior of Mexican-American women. PURPOSE: Because of the
extensive use of the Cuellar acculturation scale and the more recent use of the
Hazuda scale, we explore the utility of these two measures to predict Pap smear
and mammography screening. Using a population-based sample of Mexican-American
women aged 40 years and older, we compare the two scales with each other and
describe their relationship to sociodemographic factors and to participation in
cancer screening. METHODS: The data are from baseline surveys in El Paso and
Houston, Tex., conducted before the implementation of community interventions to
improve Pap smear and mammography screening in low-income Mexican-American women.
Study subjects were 923 randomly selected Mexican-American women aged 40 years
and older living in 16 El Paso census tracts and seven Houston census tracts.
Personal interviews solicited information on age, martial and employment status,
household annual income and size, education, health insurance coverage, Pap smear
and mammogram history, and a series of acculturation dimensions. Acculturation
was measured using the abbreviated version of the Cuellar scale developed for the
Hispanic Health and Nutrition Examination Survey, 1982-1984, and the Hazuda scale
developed for the San Antonio Heart Study. The eight-item Cuellar acculturation
scale assessed the extent to which Spanish and English were spoken, preferred,
read, and written; the ethnic identification of the respondent and her parents;
and generational status in the United States. The Hazuda scale assessed the
following dimensions of acculturation: adult proficiency in English, adult
pattern of English versus Spanish language usage, value placed on preserving
Mexican cultural origin, attitude toward traditional family structure and
sex-role organization, and adult interaction with members of mainstream society.
RESULTS: The Cuellar scale was highly correlated with Hazuda's two language
dimension. The Hazuda scale dimensions, Mexican cultural values and traditional
family attitudes, correlated the least with Cuellar's scale. All the
acculturation dimensions, Cuellar's and Hazuda's, were strongly associated with
education and health insurance coverage. With the use of multiple logistic
regression to adjust for education, health insurance, and other variables,
English proficiency was a predictor of both a recent Pap smear and a recent
mammogram. No other language-based acculturation dimension was associated with a
recent screening with adjustment for education, health insurance, and other
variables. However, in controlling for these factors, we found that a woman's
attitude toward traditional family structure was related inversely to mammogram
screening. That is, women who held the strongest traditional Mexican family
attitudes were more likely to participate in mammography screening. CONCLUSION:
This study shows the importance of separating the effects of acculturation on
cancer screening from those due to social and economic conditions. Results
suggest that the Hazuda scale provides a more multidimensional approach than the
Cuellar scale and is a superior measure of the acculturation process. Traditional
Mexican family attitudes positively influence mammogram-screening behavior, and
this finding has implications for cancer control interventions in this
population.

PMID: 8562221 [PubMed - indexed for MEDLINE]

162. Alcohol Alcohol. 1995 Jan;30(1):71-86.

Dangerous jobs and heavy alcohol use in two national probability samples.

Leigh JP.

Department of Economics, San Jose State University, CA 95192-0114, USA.

Samples of employed persons within the US were drawn from the National Health and
Nutrition Examination Survey II (n = 8477), and the Quality of Employment Survey
(n = 1393) to test the hypothesis that a positive association existed between
alcohol use and job hazards. Heavy total alcohol use, or beer or wine or liquor
use separately, were the dependent variables. The key independent variables
included subjects' evaluations of hazardous nature of the job and fatality rates
within occupations and industries. Models were estimated with logistic
regressions controlling for age, gender, race and other covariates. Only one
robust finding emerged: heavy beer use was found to be positively and strongly
correlated with the fatality rate within occupations. Additional correlations
between job hazards and heavy alcohol use were weak, generated large P values,
and some suggested an inverse association. The lack of robust findings for the
additional correlations may partially be explained by the associations between
job categories on the one hand and choice of beverage on the other. Blue-collar
jobs are more hazardous than white-collar jobs, on average. Persons in
blue-collar jobs were more likely to drink beer, while those in white-collar jobs
were more likely to drink wine or liquor (spirits). Separate analyses of beer,
wine and liquor appeared essential to explaining correlations between dangerous
jobs and heavy alcohol use in these data. Limitations of the study included (1)
age of the data (from the 1970s). (2) alcohol use and some job hazards were
measured by self-report, and (3) data were from only one country.

PMID: 7748279 [PubMed - indexed for MEDLINE]

163. J Epidemiol Community Health. 1994 Dec;48(6):549-54.

Antioxidant vitamins in the diet: relationships with other personal
characteristics in Finland.

Järvinen R, Knekt P, Seppänen R, Reunanen A, Heliövaara M, Maatela J, Aromaa A.

Department of Clinical Nutrition, University of Kuopio, Finland.

STUDY OBJECTIVE--The study aimed to reveal associations between dietary
antioxidant vitamins and other personal characteristics. DESIGN--Population
based, cross sectional survey. SETTING--Twenty seven rural, industrial, and
semiurban communities in six different regions of Finland. PARTICIPANTS--Subjects
included 5304 men and 4750 women aged 15 years or older, who were interviewed
about their dietary habits at the baseline study of the Finnish Mobile Clinic
Health Examination Survey, 1967-72. MAIN RESULTS--Intakes of carotenoids and
vitamins A, E, and C were estimated from dietary history interviews covering the
subjects' food consumption in the preceding year. In older age groups intakes of
all the vitamins studied were low. Occupation had a profound effect on dietary
antioxidant vitamins: intakes were highest in white collar workers and lowest in
farmers; those classified as service workers, industrial workers, or housewives
came in between. Current smoking was inversely associated with dietary
carotenoids and vitamin C, especially in men. The vitamin intakes of ex-smokers
were equal to or even slightly higher than those of never smokers. Married men
had higher intakes of carotenoids and vitamin C than men living alone. Body mass
index was not an important determinant of the intake of antioxidant vitamins.
CONCLUSIONS--The associations of dietary antioxidant vitamins with
sociodemographic characteristics and smoking were strong enough to exert a
confounding or modifying effect in studies on diet and diseases.

PMCID: PMC1060030
PMID: 7830008 [PubMed - indexed for MEDLINE]

164. Soc Sci Med. 1994 Sep;39(5):687-99.

Equity and the utilization of health services: report of an eight-province survey
in China.

Henderson G, Akin J, Zhiming L, Jin S, Ma H, Ge K.

University of North Carolina at Chapel Hill 27599.

This paper investigates equity with respect to one component of welfare in
China--the provision and use of health services. Based upon a large-scale survey
of almost 16,000 individuals in eight provinces in China, we examine a sub-sample
of working-age adults who have identified themselves as injured or ill during the
four weeks prior to being interviewed. We found that, beyond the level of
severity of the reported condition, very few individual-level factors are related
to the use of services when ill or injured. Only gender (female) and employment
in state-run enterprises are associated with higher patterns of use. These
results suggest that China has achieved a very wide distribution of clinics and
other services at the local level, and that they are widely used by those who
identify need for them. It is rare to be over half an hour away by bike from some
form of care and the majority of care appears to be reasonably inexpensive. This
broad availability of services contrasts with recent reports from China stressing
declining accessibility, and paints a picture of relatively equal access to
health care.

PMID: 7973867 [PubMed - indexed for MEDLINE]

165. Int J Obes Relat Metab Disord. 1994 Aug;18(8):561-9.

A prospective study of childbearing and 10-year weight gain in US white women 25
to 45 years of age.

Williamson DF, Madans J, Pamuk E, Flegal KM, Kendrick JS, Serdula MK.

Centers for Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion, Atlanta, Georgia 30333.

Although birth rates to US women aged 25 and older have increased markedly over
the last two decades, accurate estimates of the long-term weight gain associated
with childbearing are not available for older mothers in the general population.
We examined the effect of childbearing on weight change in 2547 white women aged
25-45 years who were initially weighed in the First National Health and Nutrition
Examination Survey (1971-75) and who were reweighed an average of 10 years later.
Linear and logistic regression estimates were adjusted for duration of follow-up,
age, body mass index, initial parity, education, smoking, drinking, employment
status, marital status, illness, physical activity, and dieting to lose weight.
Compared to parous women who did not give birth during the study period, the mean
excess weight gain was 1.6 kg (95% Confidence Limits, +/- 2.3 kg) for nulliparous
women, and was 1.7 kg (+/- 1.1 kg), 1.7 kg (+/- 2.0 kg), and 2.2 kg (+/- 4.3 kg),
for women having one, two and three live births, respectively. Among women who
were nulliparous at baseline, those that had their live births during the study
period gained similar amounts of weight to that of women who began childbearing
before the beginning of the study. The risk of gaining more than 13 kg was
increased by 40%-60%, and the risk of becoming overweight was increased by
60%-110% in women having live births during the study. We conclude that the
average weight gain associated with childbearing after the age of 25 is quite
modest in US white women. However, for some women who give birth after the age of
25 the risks of major weight gain and becoming overweight are increased in
association wtih childbearing.

PMID: 7951478 [PubMed - indexed for MEDLINE]

166. Soc Sci Med. 1994 Jul;39(1):115-22.

Consistency and variation in unhealthy behaviour among Finnish men, 1982-1990.

Prättälä R, Karisto A, Berg MA.

LEL Employment Pension Fund, Health Research Department, Helsinki, Finland.

The aim of the study was to describe four health related lifestyle
characteristics--smoking, exercise, alcohol and food consumption--among Finnish
men in 1982-1990. How do unhealthy patterns of behaviour vary according to
socio-demographic factors, and do they aggregate or accumulate? The data was
compiled in connection with a larger programme entitled 'Monitoring Health
Behaviour among the Finnish Adult Population' and conducted by the National
Public Health Institute. In the programme a postal questionnaire has been sent
annually to a random sample of Finns (N = 5000, resp. rate 70-85%). In this
paper, food consumption patterns are described by the use of butter, high-fat
milk, coffee sugar and vegetables. The other patterns of behaviour are each
measured by one variable. The degree of accumulation is analyzed by comparing the
observed and expected (assuming independent occurrence) proportions for
simultaneous occurrence of 3-4 unhealthy behaviour patterns. The proportion of
men displaying 3-4 unhealthy behaviour patterns has decreased, mostly because of
dietary changes. The majority of the men belonged to the intermediate group of
1-2 unhealthy behaviour patterns, and their proportion remained practically
unchanged throughout the study period. Unhealthy behaviour was more common in
lower educational groups, especially among middle-aged (30-49) and divorced men
with a low educational level. Despite the decreasing prevalence of unhealthy
behaviour, the degree of accumulation did not change. Accumulation of unhealthy
behaviour was much less pronounced among non-smokers than among smokers. This
implies that smokers are consistent in their unhealthy behaviour. Smoking might
be the gateway to an unhealthy lifestyle in general.

PMID: 8066482 [PubMed - indexed for MEDLINE]

167. Pop Sahel. 1994 May;(20):7.

[Statistical surveys in Mali: on indicators, markers for development]

[Article in French]

Sacko A, Wane HR.

PIP: In November 1993 in Bamako, Mali, the National Directorship of Statistics
and Information held a meeting for 60 cadres of different administrations and
national services to present the results of the National Surveys on
Budget-Expenses (EBC) and on the Informal Sector (ESI). EBC took place between
June 1988 and May 1989 and aimed to improve knowledge on food, nutrition, and
household expenses. Annual per capita household expenses varied from 84,000 FCFA
in Mopti to 214,000 FCFA in Bamako District. Per capita expenses in rural areas
were 66% of that in urban areas (166,500 vs. 181,000 FCFA). Expenses per unit of
food increased with the size of the unit of food. Expenses per person fell with
unit food size. Each person consumed, on average, 202 kg/year, providing 92% of
energy needs. Protein needs were more than satisfied (115%). 23.7% of children
aged 0-10 had stunted growth (25.3% in rural areas vs. 19.5% in urban areas).
Malnutrition occurred in 11.5% of urban children and 11.7% of rural children.
Malnutrition was present in 93% of less than one year olds and in 36.5% of
children aged 12-48 months. 19% of women and 14.5% of men were malnourished. ESI
was conducted between September 1989 and January 1990. The mean rate of activity
was 55.35%. Unemployed persons made up about 1% of this rate. 45,970 persons were
active in the informal sector, most in urban areas (60%). The informal sector
comprised 16% of the total active population. In Bamako District, the active
population in the informal sector was 155,000 persons. The rate of real activity
in Bamako was 40% for men and 31% for women. The unemployment rate was 8.4% for
men and 5.8% for women. 80% of unemployed persons in Bamako were less than 35
years old. 24% and 18% of the unemployed had secondary and postsecondary
education, respectively.

PMID: 12288138 [PubMed - indexed for MEDLINE]

168. Salud Publica Mex. 1994 Mar-Apr;36(2):161-7.

[Variables associated with breast-feeding patterns in Tijuana, Mexico]

[Article in Spanish]

Leyva-Pacheco R, Bacardi-Gascón M, Jiménez-Cruz A.

Universidad Autónoma de Baja California.

The aim of this study was to determine the prevalence of feeding patterns among
infants born in four community hospitals of the city of Tijuana, Mexico. From a
total of 1964 live births, a random sample of 236 was chosen from the clinical
files and distributed according to the total number of births in each hospital.
182 mothers from the original sample were contacted and accepted to participate
in the study: 61 in the three-month group, 60 in the six-month group, and 61 in
the twelve-month group. The most usual feeding patterns were: at three months of
age, breast milk plus formula; at six months, formula plus other foods; and, at
twelve months, fresh milk plus other foods. Three infants (1.65%) were never
breastfed; at three months of age, 43 per cent of the infants were not receiving
their mother's milk; and, at six months of age, 90 per cent were dependent on
formula and other food only. Furthermore, 20.4 per cent of the infants were
weaned before reaching their first month of age; 61.3 per cent between 30 and 119
days of age, 16.8 per cent between 120 and 209 days of age, and the rest after
209 days of age. It may be concluded that infants born in community hospitals in
Tijuana show tendencies in feeding patterns similar to those of Mexican-American
infants and those of urban regions in developing countries; that is, the
substitution of breastfeeding for formula, and early weaning.

PIP: A study of the prevalence of breast feeding and the variables associated
with early weaning was conducted among infants born in four community hospitals
in the city of Tijuana, Mexico. A random sample of 236 infants was selected from
the 1964 live births in the four hospitals in proportion to the number of births
at each hospital. 182 of the 236 mothers of selected infants were interviewed. 61
of the infants were three months old, 60 were six months old, and 61 were twelve
months old at the time of the interview. 78% of the mothers were aged 20-29 years
and 70% had 4 to 6 years of schooling. Three infants were never breast fed and
none of the 182 was exclusively breast fed at the time of the interview. 19.8% of
the total sample was exclusively breast fed for 1-30 days and 76.4% for 31-90
days. 20.4% were weaned at 1-30 days, 61.3% at 31-90 days, 16.8% at 91-180 days,
and 1.5% at 180 or more days. The most common diets were breast milk and formula
at three months, formula and other foods at six months, and fresh milk and other
foods at twelve months. 26 of the 61 mothers interviewed at three months had
weaned their infants, as had 54 of the 60 interviewed at six months and 60 of the
61 interviewed at one year. Only 35% of mothers who received nutritional advice
in the hospital weaned their babies before 120 days, while 68% who did not
receive advice weaned early. Significant differences were observed between
mothers weaning or not weaning their infants by three months in nine study
variables: maternal occupation, maternal smoking, employment during pregnancy,
domestic help in the household, timing of the first breast feeding, advice
outside the hospital, contraceptive method used, expenditures for powdered milk,
and family income.

PMID: 8073332 [PubMed - indexed for MEDLINE]

169. Soc Sci Med. 1994 Feb;38(4):575-83.

Correlations between education and arthritis in the 1971-1975 NHANES I.

Leigh JP, Fries JF.

Department of Economics, San Jose State University, CA 95192-0114.

Data from the National Health and Nutrition Examination Survey I, 1971-1975
(NHANES I) were used to analyze associations among highest education level and
arthritis. The dependent variables indicated whether the respondent had ever been
diagnosed with any form of arthritis by a physician (10,678 women and 7243 men)
or whether physician X-ray readings suggested arthritis of the knee (3491 women
and 3119 men). These variables did not distinguish between osteo- and rheumatoid
arthritis. It is likely that the great majority of the sample reporting or
diagnosed with arthritis had osteoarthritis. There were strong univariate
correlations between answers to the general arthritis question and the knee
question on the one hand and gender, age, body mass, schooling, income and
employment on the other. Respondents' education level was found to be strongly
and negatively associated with self-reported arthritis in the larger samples both
before and after controls were entered for employment, income and potential
biological risk factors. The association between self-reported arthritis or
arthritis of the knees and education was weaker for men, but not for women after
employment and income were accounted for. When body mass was accounted for, the
association between self-reported arthritis or arthritis of the knees and
education was weaker among women but not men. Long-run preventive strategies to
combat osteoarthritis ought to consider investments in education.

PMID: 8184320 [PubMed - indexed for MEDLINE]

170. Am J Clin Nutr. 1994 Jan;59(1):110-4.

Relationship between dietary vitamin C intake and pulmonary function in the First
National Health and Nutrition Examination Survey (NHANES I).

Schwartz J, Weiss ST.

Office of Policy Analysis, Environmental Protection Agency, Washington, DC.

We assessed the relationship between dietary vitamin C intake and the level of
pulmonary function (forced expiratory volume in 1 s, FEV1) in 2526 adults seen as
part of the first National Health and Nutrition Examination Survey (NHANES I)
between 1971 and 1974. Multiple-linear-regression analysis was performed with in
FEV1 as the dependent variable. After age, height, body mass index, race, sex,
cigarette smoking, and employment status were controlled for, dietary vitamin C
intake was positively and significantly associated with the level of FEV1 (beta =
0.00132, P = 0.01). Interaction terms for vitamin C intake and smoking and
vitamin C intake and respiratory disease were not significant. These data are
consistent with the hypothesis that vitamin C intake has a protective effect on
pulmonary function.

PMID: 8279390 [PubMed - indexed for MEDLINE]

171. IDRC Rep. 1993 Oct;21(3):2-5.

Urban food self-reliance: significance and prospects.

Mougeot LJ.

PIP: This news account provides coverage of the satisfaction of urban food needs
when retail costs are prohibitively high in developing countries. This account
reports that 50-80% of average income is spent on food in nearly 50% of
developing country's largest cities. Surveys conducted during the late 1980s
confirm a range of 60-80% of income for expenditures on food. Surveys reveal that
urban food costs are 10-30% higher than costs for rural dwellers. Urban household
food production is a practice that has been around since the times of the Aztecs,
the Incas, and Mayan cities. Reports survive of the Javanese and city dwellers
along the Tigris and Euphrates producing their own food. Asian policy makers
promote urban food production as critical to urban survival. Other factors
influence urban food production. These factors include rapid urbanization,
ineffective agricultural policies, inadequate food distribution systems,
withdrawal of subsidies, reduction of wages, inflation, unemployment, lax urban
regulations, civil strife, and drought. Government agencies are sometimes
obstacles in outlawing the practice. Recent support for urban agriculture
includes ten Asian, six African, and six Latin American countries. The number of
urban farm workers is reported as 200 million worldwide. 700 million receive the
benefits of urban agriculture. 25% of urban households in the US were engaged in
urban food production during the 1980s. Better information, such as in
comparative and longitudinal studies, is needed on urban poverty and the links
between nutrition, income, employment, waste, and environmental issues. If
cost-benefit analysis research finds a positive impact, then urban planners may
need to incorporate city farming into conventional land use. The value of city
farming needs to be assessed. Street food vending is an important source of
income, particularly for women. Urban farming requires efficiency of space and
knowledge of advances in technology and planning.

PMID: 12287223 [PubMed - indexed for MEDLINE]

172. JAMA. 1993 Aug 11;270(6):737-41.

Health insurance and mortality. Evidence from a national cohort.

Franks P, Clancy CM, Gold MR.

Department of Family Medicine, University of Rochester, NY.

OBJECTIVE--To examine the relationship between lacking health insurance and the
risk of subsequent mortality. DESIGN--Adults older than 25 years who reported
they were uninsured or privately insured in the first National Health and
Nutrition Examination Survey, a representative cohort of the US population, were
followed prospectively from initial interview in 1971 through 1975 until 1987.
PARTICIPANTS--Complete baseline and follow-up information was obtained on 4694
(91%) persons of the 5161 who reported not receiving publicly funded insurance at
baseline. MAIN OUTCOME MEASURE--The relationship between insurance status and
subsequent mortality was examined using Cox proportional hazards survival
analysis. The analysis adjusted for gender, race, and baseline age, education,
income, employment status, the presence of morbidity on examination, self-rated
health, smoking status, leisure exercise, alcohol consumption, and obesity. The
effects of interactions between insurance and all other baseline variables were
also examined. RESULTS--By the end of the follow-up period, 9.6% of the insured
and 18.4% of the uninsured had died. After adjustment for all other baseline
variables, the hazard ratio for lacking insurance was 1.25 (95% confidence
interval [CI], 1.00 to 1.55). The effect of insurance on mortality was comparable
to that of education, income, and self-rated health. There were no statistically
significant (P < .05) interactions. CONCLUSIONS--Lacking health insurance is
associated with an increased risk of subsequent mortality, an effect that is
evident in all sociodemographic health insurance and mortality groups examined.

PMID: 8336376 [PubMed - indexed for MEDLINE]

173. Soc Psychiatry Psychiatr Epidemiol. 1993 Aug;28(4):156-63.

Concordance between two measures of depression in the Hispanic Health and
Nutrition Examination Survey.

Cho MJ, Mościcki EK, Narrow WE, Rae DS, Locke BZ, Regier DA.

Division of Epidemiology and Services Research, National Institute of Mental
Health, National Institutes of Health, Rockville, MD 20857.

A concordance analysis between the Center for Epidemiologic Studies Depression
Scale (CES-D) and the National Institute of Mental Health (NIMH) Diagnostic
Interview Schedule (DIS) for current major depression was conducted using data
from Cuban Americans and Puerto Rican respondents to the Hispanic Health and
Nutrition Examination Survey (HHANES). Overall agreement between the two
depression measures was relatively high, which suggested that the CES-D might be
appropriate as a first-stage screening instrument for community-based surveys of
clinical depression. Female gender and indicators of social class (education,
income, poverty index, and employment) were related to low specificity and low
agreement. The estimated cutoff points of the CES-D that best predicted DIS
current major depression were different between the two ethnic groups; 17 for
Cuban Americans, and 20 for Puerto Ricans. A receiver operating characteristics
(ROC) curve analysis revealed that the traditional method of defining CES-D cases
by summing the scores for each item was superior to counting only the persistent
symptoms, that is, those present nearly everyday.

PMID: 8235801 [PubMed - indexed for MEDLINE]

174. Indian J Pediatr. 1993 May-Jun;60(3):429-33.

Mother surrogate and nutritional status of preschool children.

Jain S, Choudhry M.

Department of Foods and Nutrition, College of Home Sciences, Udaipur.

The study was conducted on 200 preschool children to find out the effect of
mother surrogate on the nutritional status. The nutritional status of children
was found to be affected by the time devoted by mother on child care activities,
working status of mother and type of family independently and jointly. The
children cared by mother had better nutritional status than those children who
were cared by servants and any other family member in the absence of mother. It
shows that no one can substitute the care provided by the mother.

PIP: A study of 200 preschool children in Udaipur, India, aimed to determine the
effect of people other than the mother caring for preschoolers has on child
nutritional status. On average, working mothers spent 5 hours/day on child care
while nonworking mothers spent 7 hours/day. Regardless of type of family or
working status, children of mothers who devoted more than 5 hours/day to child
care had a higher body weight as a percentage of time devoted to child care than
those who devoted less than 5 hours/day to child care (p 0.01). Mothers in
nuclear families spent less time in child care activities than did those in
extended families (p 0.01). Their children had a lower body weight as a
percentage of time devoted to child care than did those in extended families
(79.54% vs. 92.67%; p 0.01). It appears that extended family members shared
housework and child care activities. Children whose mothers did not work and
lived in an extended family had better nutritional status than did those whose
mothers worked and lived in a nuclear family (p 0.01). Children who were cared
for by a servant had poorer nutritional status than did those who were cared for
by a family member (e.g., weight/height; 91.49 vs. 94.64; p 0.01). Children cared
for by their mother had a better nutritional status than did those cared for by a
family member (100.58 vs. 94.64; p 0.001). The income of working mothers was not
significantly greater than that of nonworking mothers. The energy and protein
intake of children from a nuclear family was less than that of children from an
extended family (p 0.001). Children of working mothers in a nuclear family had
the lowest intake of calories and protein (967 vs. 1025-1195 Kcal and 30.7 vs.
32.8-41.1 g, respectively; p 0.05). These findings suggest that maternal
employment, time devoted by a mother to child care, and type of family
independently and jointly affect the nutritional status of preschool children.

PMID: 8253493 [PubMed - indexed for MEDLINE]

175. P N G Med J. 1993 Mar;36(1):10-5.

Community nutrition survey in an urban settlement in Papua New Guinea.

Earland J, Freeman P.

Save the Children Fund, Goroka, Papua New Guinea.

Results of a small nutrition survey carried out in an urban settlement in Port
Moresby are presented. Anthropometric, dietary and socioeconomic data were
collected on 90 children under five years old and 78 adults. 30% of the children
under five years old were below 80% weight for age. Of the 31% of adults found to
be undernourished, the majority were females aged less than 30 years. With
respect to dietary information, most families appear to eat a variety of foods
though no attempt was made to measure quantity of foods consumed. Rice is the
single most popular food, with 69% of adults having consumed it the previous day.
Despite the high reliance on purchased foods, income appears to be low with the
majority of people relying on money from relatives and the sale of home produce.
The recommendations made for appropriate health and nutrition education may be
applicable for other growing settlement populations in and around Port Moresby
and other urban centres of Papua New Guinea.

PIP: In May 1990 in Horsecamp settlement at Kilakila in Port Moresby, Papua New
Guinea, community medicine students, a technical staff member, and a trained
nutritionist went to 57 households of people who recently migrated from coastal
areas to Port Moresby (84 adults and 90 under 5 year old children) to conduct
interviews and take anthropometric measurements. The most frequently consumed
food by adults (69%) and children (58%) was rice. They ate fresh fish more
frequently than they did canned fish. They ate insufficient amounts of fruit. 30%
of the children were below 80% weight for age. 7% were stunted. 12% were wasted.
None of the children were both stunted and wasted. 30.7% of the adults were
malnourished, 79.2% of whom were women and 74% of whom were women less than 30
years old. 38% of adults who responded to the question on age of introduction of
foods other than breast milk introduced foods after the age of 5 months. 82% of
the mothers had attended school. Just 13% of adults had paid employment. Other
income sources were relatives and the sale of betel nut and garden produce. 68%
of the food consumed came from the store and market. 26% of households received
their food from the store and their own garden. 16 of the 27 families with their
own garden did not eat any of the food themselves. 2 possible channels for health
and nutrition education are the formal education system and the permanent family
health clinic in Horsecamp. The researchers proposed that appropriate health
education, including practical demonstrations, be conducted at every opportunity
at the clinic, in the settlement, and in the schools.

PMID: 8266727 [PubMed - indexed for MEDLINE]

176. Afr Dev Rev. 1992 Dec;4(2):1-32.

Population trends, issues and implications.

Vaidyanathan KE.

"The aim of the paper is to provide an overview of the population trends in
Africa, the critical population issues of the region and their implications, as
well as linkages with important social and economic sectors such as education,
health, employment, food and nutrition etc. The time frame for the paper is the
recent past and the immediate future until 2025 for which United Nations
projections are available. The data utilized in the paper are the United Nations
Population Projections as assessed in 1988 supplemented by information available
from various surveys and studies, particularly the World Fertility Surveys and
Demographic and Health Surveys." excerpt

PMID: 12287265 [PubMed - indexed for MEDLINE]

177. Pediatrics. 1992 Aug;90(2 Pt 1):245-9.

Maternal employment and the quality of young children's diets: empirical evidence
based on the 1987-1988 Nationwide Food Consumption Survey.

Johnson RK, Smiciklas-Wright H, Crouter AC, Willits FK.

Department of Nutrition, College of Health and Human Development, Pennsylvania
State University, University Park.

Data from 442 children, aged 2 to 5, who were participants in the 1987-1988
Nationwide Food Consumption Survey, were examined to determine the effect of
maternal employment on the quality of their diets. Diet quality was assessed by
examining nutrient adequacy and nutrient overconsumption using the 3-day average
of one 24-hour recall and 2 days of written diet records. To assess dietary
adequacy, a mean adequacy ratio of the four nutrients (zinc, vitamin E, iron, and
calcium) for which 30% or more of the children fell below 77% of the Recommended
Dietary Allowances was constructed. Percent calories from fat and saturated fat,
and intake of cholesterol and sodium were examined to assess overconsumption.
Multiple correlation regression analysis was used to control for household
income, maternal education and age, child's age, race, number of siblings aged 5
or younger, presence of male head of household, and number of meals eaten away
from home. Maternal employment did not contribute significantly to the variation
in any of the dietary variables. Although a number of dietary problems existed
among the sample children, the variation in intakes of these nutrients was not
directly related to maternal employment status.

PMID: 1641290 [PubMed - indexed for MEDLINE]

178. Med J Islam Repub Iran. 1992 Summer;6(2):93-5.

Duration and causes of cessation of breast feeding in working mothers in Ghazvin,
Iran.

Froozani MD, Zavoshi R, Azordeghan F.

PIP: This study determines the duration and reasons for stopping breast feeding
among working mothers in the city of Ghazvin near Tehran, Iran, in 1988. The
study sample included 259 working mothers who were paramedical and nonmedical
personnel, had ended breast feeding, and had one living child aged under 3 years.
100% of mothers had initiated breast feeding at birth. Breast feeding
introduction ranged from 0 to 99 hours after delivery. 68.2% received breast milk
between 7 and 24 hours after birth. The duration of breast feeding was
significantly negatively correlated with the time of introduction of breast milk
after delivery. The difference between the mean duration of breast feeding and
the first introduction of food was statistically significant. Duration of breast
feeding was significantly correlated with the age of introduction of food
supplements. Duration of breast feeding was significantly negatively correlated
with maternal age at first marriage, at pregnancy and delivery, and at last
delivery. Duration of breast feeding was significantly related to insufficient
supplies of milk and work outside the home.

PMID: 12292287 [PubMed - indexed for MEDLINE]

179. Am J Public Health. 1992 Jun;82(6):821-6.

Socioeconomic and behavioral correlates of body mass index in black adults: the
Pitt County Study.

Croft JB, Strogatz DS, James SA, Keenan NL, Ammerman AS, Malarcher AM, Haines PS.

Department of Epidemiology, University of North Carolina, Chapel Hill.

Comment in:
Am J Public Health. 1992 Jun;82(6):785-7.

BACKGROUND. Obesity is more prevalent among Black women than Black men, but there
is little information on the correlates of obesity in Blacks. This study
describes the relations of sociodemographic factors and health behaviors to body
mass index in a southern, Black population. METHODS. In 1988, a community
probability sample of 1784 Black adults, aged 25 to 50, was examined in Pitt
County, NC. RESULTS. More women than men were at least 20% overweight (57% vs
36%). The relation of socioeconomic status (a composite of education and
occupation) to age-adjusted body mass index level was inverse in women but not in
men. Body mass index did not differ with either current energy intake or energy
expenditure. Smokers and drinkers had lower age-adjusted levels than non-smokers
and abstainers. CONCLUSIONS. Since the excess body mass index levels associated
with low socioeconomic status in women could not be explained after controlling
for adverse health behaviors, further epidemiologic study of risk factors for
obesity in Black women is recommended.

PMCID: PMC1694167
PMID: 1585962 [PubMed - indexed for MEDLINE]

180. Am J Public Health. 1992 Mar;82(3):401-6.

Living arrangements and survival among middle-aged and older adults in the NHANES
I epidemiologic follow-up study.

Davis MA, Neuhaus JM, Moritz DJ, Segal MR.

Department of Epidemiology and Biostatistics, School of Medicine, University of
California, San Francisco 94143-0560.

BACKGROUND. There is concern about but little information on how living alone
affects the health and survival of older adults. METHODS. We examined the
association between living arrangements (living alone, with a spouse, or with
someone other than a spouse) and survival among 7651 adults, aged 45 to 74 years
in the National Health and Nutrition Examination Survey (NHANES I) (1971-1975)
and traced at the NHANES I Follow-up Study (1982-1984), to see whether certain
sociodemographic factors (race, education, income, and employment), health
behaviors (alcohol, smoking, physical activity, and obesity), or chronic medical
conditions were influential in the association. RESULTS. We found a stronger
association of living arrangements with survival for men than for women, and for
middle-aged men than for older men. For men, those living alone and those living
with someone other than a spouse were equally disadvantaged in terms of survival.
Income, race, employment, and physical activity influenced the association of
living arrangements and survival, but their impact varied by age, gender, and
living arrangement. CONCLUSION. Living arrangements had a weak impact on survival
among men, but had no effect among women.

PMCID: PMC1694385
PMID: 1536356 [PubMed - indexed for MEDLINE]

181. J Trop Med Hyg. 1992 Feb;95(1):75.

Health and population data for developing countries available through USAID
project.

[No authors listed]

PIP: The USAID funded Demographic and Health Survey (DHS) Program has data
collected from surveys in 35 countries including in Botswana, Kenya, Nigeria,
Senegal, Zimbabwe, Indonesia, Sri Lanka, Peru, Bolivia, Ecuador, Egypt, and
Morocco. DHS also has in-depth survey data on subjects pertaining to health or
family planning programs from Nepal and Bolivia and data on questionnaire design
and data processing concerns from Peru and Dominican Republic. Further DHS has
data from male surveys conducted in Burundi, Ghana, Kenya, and Mali. A main
purpose of the DHS Program is to help developing countries strengthen technical
skills and resources so they can conduct demographic and health surveys
themselves. An equally important goal is for the surveys to provide the
governments of these countries information which they can determine solid health
and population policies based on concrete information. DHS uses a core
questionnaire which researchers adapt to local needs and cultures. It consists of
2 parts: a household schedule and a woman's questionnaire. The surveys gather
data on infant and child mortality, prenatal and delivery care, fertility, family
planning, breastfeeding, immunization, diarrhea, acute respiratory infections,
fever, child nutrition status, and background and employment status of women and
husbands. Some of these surveys even have data on causes of child death, maternal
mortality, AIDS knowledge, social marketing, and availability of health services.
As of early 1992, DHS computerized archive had datasets for 28 countries. Each
country tends to have datasets on women's data, household data, and service
availability data. Questionnaires, machine readable descriptions, and associated
documentation accompany each dataset (US$200 and US$50 for researchers in
developing countries). Attain request forms from DHS Data Archive, Institute for
Resource Development, 8850 Stanford Blvd., Columbia, MD 21045 USA; tel.
301-290-2977; telex 87775; fax 301-290-2999.

PMID: 1740825 [PubMed - indexed for MEDLINE]

182. Vaccine. 1992;10 Suppl 1:S59-62.

Epidemiology of hepatitis A: seroepidemiology and risk groups in the USA.

Shapiro CN, Coleman PJ, McQuillan GM, Alter MJ, Margolis HS.

Hepatitis Branch, Centers for Disease Control, Atlanta, GA 30333.

Surveillance and seroepidemiological data are important in determining optimal
hepatitis A vaccine strategies. In the USA, after a decade of declining rates,
reported hepatitis A rates gradually increased from 9.2 cases per 100,000
population in 1983 to a peak of 14.4 per 100,000 in 1989. In 1991, 23,144 cases
were reported, for a rate of 9.1 per 100,000. Since 1983, rates in males have
been consistently 20% higher than in females. Rates in children, adolescents and
adults up to 39 years old have been roughly equivalent and approximately
threefold higher than for persons > or = 40 years old. Among reported cases in
1989, the most commonly reported risk factor was personal contact with a
hepatitis A case (26%), followed by employment or attendance at a day-care centre
(14%), a history of injecting drug use (11%), a history of recent international
travel (4%), and association with a suspected food or waterborne outbreak (3%).
Of cases, 42% had no known risk factor for infection. The prevalence of antibody
to hepatitis A virus in the general US population was 38.2%, based upon testing
of 9516 participants from the second National Health and Nutrition Examination
Survey conducted from 1976 to 1980. Prevalence increased steadily with age,
ranging from 11% in persons < 5 years of age to 74% in persons > or = 50 years
old. Because some groups may be difficult to vaccinate prior to disease exposure
(contacts of cases) or are difficult to reach (drug users or persons with
unidentified risk), a selected risk group vaccination strategy may not be
successful in reducing the disease burden in the USA.(ABSTRACT TRUNCATED AT 250
WORDS)

PMID: 1476001 [PubMed - indexed for MEDLINE]

183. Eur J Clin Nutr. 1991 Dec;45 Suppl 3:23-9.

Description of survey towns and populations. Euronut SENECA investigators.

de Groot LC, van Staveren WA.

Some 2600 elderly people born between 1913 and 1918 have been enrolled in the
Euronut SENECA study. In 12 European countries they were randomly selected from
the resident populations of 19 'traditional' towns, mostly with a population size
between 10,000 and 30,000 inhabitants. Site characteristics of these towns differ
from mainly rural to urban and from lowland to mountainous with a range of
temperate climates. In the rural areas work opportunities are primarily
agricultural whereas in mixed rural/urban, suburban and urban areas most of the
working population are engaged in industry, administration and commerce. The
percentage of people over the age of 65 ranged from 8% to 22%. Medical and social
facilities for the aged vary widely from site to site.

PMID: 1809566 [PubMed - indexed for MEDLINE]

184. Child Dev. 1991 Oct;62(5):954-65.

Maternal work and child-care strategies in peri-urban Guatemala: nutritional
effects.

Engle PL.

California Polytechnic State University, San Luis Obispo.

Associations of 293 mothers' work for earnings and child-care arrangements with
the anthropometric status of their children were examined in urban Guatemala. It
was hypothesized that during the period of life in which growth often falters (8
through 35 months), maternal employment could be beneficial for children.
Informal workers tended to be poorer, less educated, and have more undernourished
children than formal workers or nonworkers. When poverty and mother's education
were controlled for, no effects of maternal employment on children's
anthropometric growth patterns were seen. However, the percent of the family
income the mother earned was positively associated with all anthropometric
indicators, controlling for confounds. Children taken care of by preteen siblings
had significantly lower weight for height than those in other situations, even
controlling for SES and maternal employment status. These effects were not found
in a 36-48-month-old sample.

PIP: A child development researchers analyzed data on 239 8-35 month old children
living in 2 villages 20 km from Guatemala City, Guatemala to determine the
effects of maternal work and child care arrangements on children's nutritional
status. Women who worked flexible hours and had no defined job skills (informal
workers) were more likely to be poor (p.01), less educated (p.0001), and have
undernourished children (p.02 for height for age and p.01 for weight for age)
than those women who either owned a business, had a trade, or worked in a store
or factory (formal workers). Yet informal work was statistically related to those
socioeconomic factors than jeopardize adequate growth of children. When the
researcher controlled for poverty and maternal education, mother's work did not
affect growth, however. This suggested that mother's work may have a positive
effect on growth because if mothers did not work, the children may have actually
experienced even poorer nutritional status. The data showed the arduous
circumstances informal workers encounter, their poverty, and inadequate income
for their labor. The children of full-time workers had a somewhat better weight
for height status than nonworkers. Percent of family income earned by the mother
had a significant effect on all anthropometric indicators (p.01 for height for
age and weight for age; p.05 for weight for height). In both the 1-way analysis
of variance and the same analysis controlling for socioeconomic status and
mother's work, children cared for by a 13-year old sibling had a considerably
lower weight for height than those cared for by nonworking mothers (p.008 and
p.01 respectively). None of the effects existed in the 36-48 month old children
in these villages.

PMID: 1756668 [PubMed - indexed for MEDLINE]

185. Ann Hum Biol. 1991 Sep-Oct;18(5):441-8.

Father's unemployment and height of primary school children in Britain.

Rona RJ, Chinn S.

Division of Community Health, United Medical School, Guy's Hospital, London, UK.

In a nutritional surveillance system of 5-11-year-old children the association
between father's employment status and his child's height, weight-for-height and
their rates of change over 2 years were assessed. The study was carried out in
three samples: quasi-representative English sample 1984-86; quasi-representative
Scottish samples 1983/84-1985/86; and a sample of English inner city areas
1983-85. For the cross-sectional analysis the sample sizes were 6527 for the
English representative sample, 4285 for the Scottish representative sample and
6709 for the English inner city areas sample. In an analysis of height gain in 2
years the samples comprised 3814, 2676 and 3682 children respectively. In the
analysis the following data were used: father's employment status and social
class; number of children in the family; parents' reported height and child's
reported birth weight; and child's height and weight measurements and a
classification of ethnic origin obtained during fieldwork. Children with an
unemployed father were shorter, especially if the father was unemployed for more
than a year, than children with a currently employed father. After adjustment for
parents' height, child's birth weight, father's social class and family size the
difference persisted but reduced, to approximately 1.2 cm. Height gain in a
2-year period was not associated with father's employment status. If father's
unemployment is causally linked to child's height a child is most vulnerable at
pre-school age.

PMID: 1952802 [PubMed - indexed for MEDLINE]

186. Stud Fam Plann. 1991 Jul-Aug;22(4):255-63.

Birth spacing patterns and correlates in Shaanxi, China.

Tu P.

Institute of Population Research, Peking University, Beijing, People's Republic
of China.

This study shows that most women in Shaanxi Province, China try to have their
first birth as soon as possible after their first marriage, and that the length
of the interval between marriage and first birth is strongly correlated with the
woman's age at first marriage. The length of the second and third birth intervals
and the likelihood of going on to have a second or third birth are strongly
influenced by the sex composition of children already born, the survival time of
the child initiating the interval, the duration of breastfeeding, and the woman's
occupation. There is significant regional variation in the length of birth
intervals and in the prevalence of second and third births in Shaanxi. The
findings indicate that China's one-child policy is far from being universally
accepted in Shaanxi, including its urban areas. The persistence of many social,
economic, institutional, and cultural factors promoting high fertility poses many
obstacles to further fertility decline.

PIP: A researcher applied data from the 1985 In-Depth Fertility Survey to Cox's
hazard regression model and the actuarial life table method to determine birth
spacing patterns and their correlates in Shaanxi Province in China. In the 1970s,
China encouraged later marriage, longer birth spacing, and fewer births after
which fertility declined quickly in Shaanxi (5.5-2.9 between 1970 and 1979).
Fertility hovered around 2.6 in the 1980s, however, when China promoted the one
child policy. Newly married women tended not to use effective contraceptives in
Shaanxi so 1st birth intervals bascially depended on fecundity. In fact, the
median 1st birth interval was only 14.2 months. In addition, woman's age at 1st
marriage had a very significant effect on the length of the 1st birth interval
(p.001). Further 71.5% had a 2nd birth within 5 years of the 1st birth (50.3%
urban and 76.9% rural). The 2nd birth interval was much longer than the 1st birth
interval, however (38 months: 55.7 urban and 34.5 rural). Breast feeding played a
significant role in having a 2nd birth (p.01) and 3rd birth (p.001). Further if
the index child was a girl or if the 1st 2 children were girls, the women were
highly likely to have another child (p.001) in hopes of having a son. Women's
occupation also played a considerable role in having a 2nd or 3rd birth (p.001).
For example, an agricultural worker or housewife were 3.6 times more likely to
have a 2nd birth than nonagricultural workers. The death of the index child
significantly affected the probability of having a subsequent birth for parity 1
women (p.01) but not for those of parity 2. Regional variations in the length of
birth intervals and in occurrence of 2nd and 3rd births occurred. In conclusion,
the people of Shaanxi have not accepted the one child policy. Many social,
economic, institutional, and cultural factors which foster high fertility remain.

PMID: 1949107 [PubMed - indexed for MEDLINE]

187. Stud Fam Plann. 1991 Mar-Apr;22(2):116-23.

Family planning in rural Uganda: knowledge and use of modern and traditional
methods in Ankole.

Ntozi JP, Kabera JB.

Institute of Statistics and Applied Economics, Makerere University, Kampala,
Uganda.

Ankole has recorded the highest fertility in Uganda over the past several
decades. One of the main proximate determinants of fertility in the area is the
low level of contraception. A study of knowledge and use of modern and
traditional contraceptive methods is reported in this paper. It is shown that
higher proportions of women known and practice traditional methods compared with
modern ones. Several factors contributing to past low use of modern
contraceptives in the area are examined and current contraceptive use is also
examined.

PIP: The Ankole have demonstrated the highest fertility in Uganda over the past
several decades. The low level of contraceptive prevalence constituting a main
proximate determinant of fertility in the region, a study of the knowledge and
use of modern and traditional methods was conducted. 2-stage sample survey data
from 1984 were employed, and revealed that more women know and practice
traditional methods compared with modern ones. Use of any form of contraception,
however, remains low. Low use of modern methods was due to lack of knowledge of
supply sources, low education, low levels of employment outside of the home,
unavailability of supplies, and pronatalist cultures. The author, therefore,
recommends several courses of action to reduce fertility in the Ankole.
Better-educated women have shown a higher degree of modern contraceptive method
use suggesting that government encourage young women to attain higher education
levels. Improved employment opportunities for women will also hopefully serve as
incentives to limit fertility. The Family Planning Association of Kenya should
take advantage of unmet demand for family planning services and supplies, and
make supplies more readily available. Additionally, more efficient follow-up
services should be developed. Prolonged breast feeding should be encouraged,
child health improved, and research conducted on the traditions, norms, customs,
and taboos of target populations. As such cultural conflicts serving as obstacles
to program success may be more easily overcome. Finally, the author comments that
adopting and improving upon some traditional methods will be better accepted than
relying wholly upon modern, foreign contraceptive methods.

PMID: 1858104 [PubMed - indexed for MEDLINE]

188. Ethn Dis. 1991 Summer;1(3):273-9.

Health status of diabetic Mexican Americans: results from the Hispanic HANES.

Zhang J, Markides KS, Lee DJ.

Department of Preventive Medicine and Community Health, University of Texas
Medical Branch, Galveston 77550.

We examined the physical, sociodemographic, and psychosocial health status of
diabetic Mexican Americans aged 45 to 74 years using data from the Hispanic
Health and Nutrition Examination Survey. Diabetic Mexican-American women had
lower education levels and lower employment rates in comparison with
nondiabetics. Glaucoma, retinopathy, and activity limitation were more prevalent
in diabetic than in nondiabetic men and women. Diabetic women also had a higher
prevalence of hypertension, kidney problems, and cataracts. No significant
differences were found in depression levels between diabetic and nondiabetic
Mexican Americans of either sex. Among diabetics, duration of diabetes was
associated with increased prevalence of stroke and activity limitation. These
findings on the health status of diabetic Mexican Americans furthers our
understanding of the health service needs of this population.

PMID: 1842540 [PubMed - indexed for MEDLINE]

189. Egypt Popul Fam Plann Rev. 1990 Dec;24(2):60-79.

Gender difference in child mortality.

Ahmed FA.

PIP: 1976 census data and data on births to 8788 ever married women from the 1980
Egyptian Fertility Survey were analyzed to determine if son preference was
responsible for higher mortality among girls than among boys and what factors
were associated with this higher mortality. During 0-3 years, boys were more
likely to die than females. For example, the overall male-female sex ratio for
the 1st year was 118:100. At ages 5, 10, 15, and 2 0, however, girls were more
likely to die. The sex rations for these years were 98, 95, 93, and 91. In fact,
the excess mortality among illiterate mothers accounted for most of the overall
excess mortality. As mother's educational level rose, the excess mortality of
girls fell, so that by university level boys experienced excess mortality (130,
111, 112, 105). Less educated mothers breast fed sons longer and waited more
months after birth of a son to have another child indicating son preference, but
these factors did not necessarily contribute to excess mortality. The major cause
of female excess mortality in Egypt was that boys received favored treatment of
digestive and respiratory illnesses as indicated by accessibility to a pharmacy
(p.01). Norms/traditions and religion played a significant role in excess
mortality. The effect of norms/traditions was greater than religion, however.
Mother's current and past employment strongly contributed to reducing girls'
mortality levels (p.01). These results indicated that Egypt should strive to
increase the educational level of females and work opportunities for women to
reduce female child mortality. Further, it should work to improve women's status
which in turn will reduce norms/traditions that encourage son preference and
higher mortality level for girls.

PMID: 12343742 [PubMed - indexed for MEDLINE]

190. Asia Pac Popul J. 1990 Dec;5(4):57-66.

Further evidence of the onset of fertility decline in Nepal.

Niraula BB.

PIP: A village-level study of fertility trends was conducted in Benighat to
provide supporting evidence of fertility decline in Nepal. Subjecting
socioeconomic and fertility data obtained from questionnaires through the reverse
survival technique, the study found evidence supporting fertility decline in the
study population, and most probably in Nepal overall. Total fertility rate (TFR)
declined 9% from 6.4 to 5.8, over the period 1976/79-1980/82, and 8.5% from 5.8
to 5.3 over the period 1980/82-1983/86. Similar trends were observed for the
age-specific fertility rate (ASFR), except that fertility for women 15-19 and
20-24 increased during 1976/79-1980-82, most probably due to better nutritional
standards available from improved economic opportunities in the village. The
highest ASFR is for the group aged 20-24, followed by the 25-29 and 15-19 groups.
Greatest declines were seen amongst groups aged 30-34 and 40-44 in 1976/79 and
1983/86, ASFRs dropping by 38.9% and 33.2% respectively. Steadily rising
contraceptive prevalence rates by age ranging from the 15-19 group with coverage
of 6.9% to the 40-44 group covered at 27/5% influenced ASFR decline among older
age groups. Overall contraception coverage for the study population is 17.2%.
Fertility rate decline is observed in conjunction with increased contraception
use, literacy rate, mean age at marriage, and declining infant mortality rates.
These trends are observed across Nepal. Additionally, populations are
increasingly leaving the agricultural sector for other economic sectors. More
research is needed to identify causal factors necessary for continued fertility
decline.

PMID: 12343032 [PubMed - indexed for MEDLINE]

191. Hum Ecol. 1990 Dec;18(4):403-16.

Changing household composition, labor patterns, and fertility in a highland New
Guinea population.

Johnson PL.

PIP: A multidisciplinary team of researchers have studied the Gainj population in
Papua New Guinea's central highlands since the late 1960s. Even though they do
not use effective contraception nor practice induced abortion, the total
fertility rate (TFR) is very low (4.3). In fact, it is one of the lowest TFRs for
a noncontracepting population in the world. Further sexually transmitted diseases
are rare thus the Gainj have a low primary sterility rate (1.1%). Moreover
premarital pregnancy does not occur. A late median age at 1st birth and long
median interbirth intervals contribute to low fertility (25.7 years and 36.5
months). Besides a sizable lag between median age at marriage (21.2 years) and
1st birth exists (4.5 years). In addition, median age at menarche is quite high
(18.4 years). Median age at weaning is 38 months. Median lactational anovulation
lasts for 20.4 months. These data have inspired the team to determine what effect
continuing economic development (Gainj women now grow and market coffee) will
have on age at 1st birth, lactational anovulation, and TFR. In 1983, the team
surveyed 86 households in 10 Gainj parishes. They consisted of a male head of
household and at least 1 wife (conjugal family). It is the cultural and
statistical norm and the basic unit of production and consumption among the
Gainj. The largest and most significant positive effects on coffee growing
success were the number of nonwives, who were the producers, (t=7.4; p.001) and
wives (t=2.35; p.05) in the household. In fact, 54% of the nonwives were of
marriageable age. Between 1978-1983, the more successful households decreased
their dependency ratios while the less successful households increased them. The
team surmised that the demands of coffee growing may result in a decrease in the
weaning age resulting in a higher TFR. In conclusion, the demographic transition
model does not apply to the Gainj.

PMID: 12285381 [PubMed - indexed for MEDLINE]

192. Child Care Health Dev. 1990 Jul-Aug;16(4):219-26.

The incidence of unplanned and unwanted pregnancies among live births from health
visitor records.

While AE.

Department of Nursing Studies, King's College, London.

A survey of health visitor records has indicated that approximately one-third of
pregnancies resulting in live births are unplanned. The data further revealed an
association between planning of pregnancies and socio-demographic variables and
use of preventive health care for infants.

PIP: A survey of health visitor records of all children under 2 from 3 London
districts, inner city (756), suburb (127) and affluent suburb (96), was made to
discover associations between mothers' attitudes towards pregnancy and
socioeconomic factors. The incidence of planned pregnancy was significantly
higher in the affluent suburb (83.3%), than in the suburb (69.3%) or the inner
city (62.8%), while that of unwanted or unwelcomed pregnancy was higher in the
inner city (20.6%), than the suburb (6.3%) or the affluent suburb (12.5%).
Planned pregnancy was associated with stable unions, increasing maternal age,
parental employment, high social class. Unplanned pregnancy was associated with
Irish or Afro-Caribbean background, later onset of prenatal care, residential
mobility, homelessness, and use of social services. Unplanned pregnancies were
significantly more likely to result in bottle feeding, infant morbidity, infant
hospital admission, late entry into infant preventive health care. There were no
signs of associations between unplanned pregnancy and maternal attitudes toward
pregnancy or childbirth per se. No predictions could be made linking these
variables and child abuse, since only 4 children in this survey were subject to a
Court Order.

PMID: 2387033 [PubMed - indexed for MEDLINE]

193. J Am Diet Assoc. 1990 Apr;90(4):543-9.

Characteristics of diet among a culturally diverse group of low-income pregnant
women.

Suitor CW, Gardner JD, Feldstein ML.

Department of Maternal and Child Health, Harvard School of Public Health, Boston,
Massachusetts 02115.

This study reports on diet quality and variety in food selection among a
culturally diverse group of 335 low-income pregnant Massachusetts women. The
Index for Nutritional Quality (INQ), which is the observed nutrient density
divided by the recommended nutrient density, was estimated for seven nutrients
from data reported on food frequency questionnaires and diet recalls. Mean INQs
for protein and vitamin C were above the recommended level of 1.0, whereas INQ
for iron was 0.6 or less. Mean INQ for calcium was 1.2 for whites and between 0.9
and 1.0 for non-whites. When comparisons were made among ethnic groups by site of
prenatal care, significant differences in INQ were found for all nutrients except
iron and vitamin B-6. WIC participants had higher diet quality for protein,
calcium, iron, and vitamin B-6 than did non-participants. Employed women had
higher protein and zinc INQs than did unemployed women, and non-smokers had
higher iron and vitamin B-6 INQs than did smokers. Variety was not significantly
correlated with diet quality but differed (p less than .001) among site-specific
ethnic groups. We conclude that there is a need for investigation of factors
influencing dietary practices that are associated with sites of prenatal care.

PMID: 2319074 [PubMed - indexed for MEDLINE]

194. Asia Pac Popul J. 1990 Mar;5(1):57-70.

Breast-feeding patterns and correlates in Shaanxi, China.

Ping T.

PIP: This study shows a significant change in the breastfeeding (BF) pattern by
parity and sex after the transition from a natural fertility regime to a
controlled fertility regime in Shaanxi, a less-developed, inland province of
China. BF has increased in Shaanxi although the age at which supplemental food is
given has declined. The rapid increase in the length of subsequent birth
intervals has been partly responsible for the increase in the duration of BF for
the high order child. However, BF may also have been used to prevent additional
births under the controlled fertility regime. The duration of BF increases
significantly with parity, especially if the child is a son. Theses findings are
based on the 1985 In-depth Fertility Survey (phase I) called data by the State
Statistical Bureau on Shaanxi province. It also shows the change in BF practice
after the introduction of the "one child" policy. Infant mortality is high in
Shaanxi. BF is very important for child survival and birth spacing. The In-depth
Fertility Survey used a stratified, multistage, self-weighing sample. A complete
reproductive history and detailed background information were gathered on 4084
ever-married women under age 50 in Shaanxi. Overall response rate was 93.4%. The
infant mortality rate decreased from over 100/1000 before 1062 to about 36/1000
in the early 80s. The whole sample consists of 11438 live births. During 1979-83,
there were 2055 liver births recorded by the survey, 988 females and 1067 males,
giving a sex ration of 108 at birth. The sex ratio at birth increases with birth
order, from 99.1 parity (N=880) to 134.7 for parity 4 or above (N=277). BF is
almost universal; the proportion never breast fed being only 3.7%. Many children
are being weaned at ages that are multiples of 6 months. About 35% are 1st order
births. The number of births goes down fast alert parity 2, but there are a few
(about 7% births of parity 5 or above). The dependent variables are the duration
of BF and the duration of unsupplemented BF which can be censored by either the
death of the child or the date of the survey. Therefore, there is a proportion of
children whose duration of BF is unknown. author's modified

PMID: 12283349 [PubMed - indexed for MEDLINE]

195. Acta Paediatr Jpn. 1989 Aug;31(4):399-403.

Breast-feeding and fertility in Macau.

da Silva P, Ribeiro I, Barbosa M, Vieira MH.

That fact that only a small percentage of women in Macau breast-feed induced the
need to investigate this attitude. In collaboration with the Maternal & Child
Health Division of the W.H.O., Geneva, it was decided that a methodology which
had already been applied in other places should be used to investigate the
relation between breast-feeding and fertility. In this way, information was
obtained about the situation, within a given period of time which permitted a
description of the duration of amenorrhea due to breast-feeding, as well as the
patterns of frequency and duration of breast-feeding.

PIP: In 1984 during a month-long study, only 28% of postpartum women in Macau
started breast feeding. Using WHO methodology a total of 1607 women aged 15-44
who had been pregnant 12 months previously were contacted to collect data on
amenorrhea and breast feeding. The 25-29 year old age group has 245 or 42.8% of
births, although they numbered 519 or only, 33% of the total. Housewives made up
47%, public employees 6%, and other 47% of the sample. 36% of housewives were
breastfeeding vs. 18% of civil servants, but after 5 months this dropped to 21%
for both groups. Younger mothers were breast feeding least; only 21% of the 15-
19 age group vs. 41% of those aged 35-39. Half of 160 breast feeding women were
amenorrheic vs. 46 of 413 non-breast feeding mothers. Those breast feeding more
than 6 times/day had the highest rate of amenorrhea (58%) while those nursing
once or twice daily had the lowest rate (20%). After 4 months, additional food
items were introduced by 37% of mothers. 49% of women never breast-fed, and older
women were nursing more in contradiction to the result of Chinese studies. Early
introduction of additional food indicated the need for education by health
professionals.

PMID: 2514561 [PubMed - indexed for MEDLINE]

196. Integration. 1989 Mar;(19):23-33.

The integrated project in Tanzania.

International Planned Parenthood Federation IPPF. Evaluation and Management Audit
Department.

PIP: The 1st Integrated Project (IP) in Africa was started in Tanzania in 1983 by
the International Planned Parenthood (IPPF) Africa Bureau. It was to be done by
the Family Planning Association of Tanzania (UMATI). 2 pilot areas are in the
Kilimanjaro region. 1 covers Modio and Roo villages in rural Masama; the other is
a sugar cane plantation run by Tanganyika Planting Company Ltd. (TPC). The IP
National Steering Committee (NSC) was formed in 1983 with representatives from
the Ministry of Health and a parasitologist. No nutritionist was included. In
1983 a survey of population, health care activities, and demographic
characteristics was undertaken. In 1984 house-to-house visits were made.
Information was gathered on family planning knowledge, practice, and sanitary
conditions. Mass stool examinations and blanket treatment for both children and
adults began in August, 1984. Family planning information is fully integrated
with education about sanitation and nutrition. 11 films were shown at TPC to
about 500 children and adults and almost 20,000 children and adults received some
form of health education. Health educators and laboratory technicians moved to
accommodations in TPC and Modio village to live among the people they were
serving. At the end of 1986, the number of family planning acceptors had risen
quite a bit. It continued to do so in 1987. At TPC mass stool tests and deworming
were done in 1985. This was completed in Masama in May, 1987. For follow-up
selective treatments twice a year was done. The focus of environmental sanitation
activity, especially in Masama, was the search for a cheap, well-built latrine.
The IP staff in Masama trained 43 of the 90 traditional birth attendants (TBAs).
UMATI has realized in 1984 that thought IP they can more effectively involve the
community in family planning. By working on parasite infection, the IP staff
aroused community interest in family planning. The NSC has set the tone of this
project because it understood the relationship between family planning and
parasite control. It developed regional links with the Ministry of Health. The
evaluation team has made recommendations to the NSC regarding project expansion.
1 of these is that the project area be expanded to 1 or 2 areas next to the
present Moshi site. There is a need to establish an overall work plan. Appendix 1
lists the evaluation the team's work schedule; appendix 2, principal people
contacted.

PMID: 12282130 [PubMed - indexed for MEDLINE]

197. Food Policy. 1989 Feb;14(1):58-66.

Socioeconomic impacts of school feeding programmes: empirical evidence from a
South Indian village.

Babu SC, Hallam JA.

PIP: Tamil Nadu a poverty-stricken rural community in South India, funds a school
feeding program with about 10% of the state budget. Comparisons of nutrition and
literacy show that they are significantly related. No studies have yet been
performed to analyse the effect of the feeding programs on aspects of a
household's economic and social welfare. The feeding program in Tamil Nadu
extends throughout the year, 7 days a week. It provides not only a reason for
children to attend school, but also employment opportunities for those who wish
to cook. 455 households were surveyed from 1 village using. A Gini coefficient of
inequality to determine inequality levels of nutrition, food, and consumption
expenditure. Sen's index of poverty was used to calculate the reduction in
poverty levels. 3 household groups were defined: the agricultural labor, the silk
weaver, and the cultivator. Linear program modelling utilized these 3 groups to
study the total effect of nutrition on education. Linear regression was then used
to determine the effect of the feeding program on participation in school. At the
village level, a reduction of inequality in consumption and intake, an increase
in energy intake, and a decrease in poverty level were found. In agricultural
labor and silk weaver households, most of the money was spent on cereal food
grains and children were mostly uneducated. If modelled to assume that children
must be educated and are educated in schools providing food, results suggest that
the increase in nutrition helps retain the children in the schools. Cultivator
household response to the food programs was poor, since they usually have enough
money to meet nutritional needs. Household income and school nutrition, but not
adult literacy affect school participation. In general, nutrition offered in
school caused a subsequent increase in household purchases of non-cereal items in
the first 2 household types.

PMID: 12281938 [PubMed - indexed for MEDLINE]

198. Am J Ind Med. 1989;16(5):477-84.

Relationship of mortality, occupation, and pulmonary diffusing capacity to
pleural thickening in the First National Health and Nutrition Examination Survey.

Loomis DP, Collman GW, Rogan WJ.

Epidemiology Branch, National Institute of Environmental Health Sciences,
Research Triangle Park, NC 27709.

We studied the relationship of pleural thickening consistent with asbestos
exposure to mortality, career employment in asbestos-related jobs, and pulmonary
diffusing capacity among participants in the first National Health and Nutrition
Examination Survey. Three "B" readers examined chest X-rays to identify 59
individuals with such pleural abnormalities. From 1975 to 1984, the all-cause
mortality rate ratio (RR) comparing males with and without occupational pleural
thickening was 1.3 (95% C.I. 0.8-2.2). For lung cancer, the mortality RR for
males was 3.0 (95% C.I. 1.0-9.1). Career asbestos work was not associated with
occupational pleural thickening among men, probably because some with the
condition had only short-term exposure to asbestos. Pulmonary diffusing capacity
was lower in those with occupational pleural thickening, taking smoking into
account. These results suggest that individuals in the general population who
have occupational pleural thickening are at risk for some of the health
consequences of asbestos work, including lung cancer, even if they were not
career asbestos workers.

PMID: 2589326 [PubMed - indexed for MEDLINE]

199. Bangladesh Dev Stud. 1988 Dec;16(4):99-113.

Exploring the relationship between women's work and fertility: the Bangladesh
context.

Mahmud S.

PIP: In Bangladesh, research is being done on the relationship between women's
work and fertility. It is believed that one of the leading factors in the high
fertility of women in Bangladesh is their total dependence on men for economic
support. This is further evidenced by women's low status in society, home, and in
areas of health care, nutrition, education, employment, leisure, etc. A survey
revealed that when women did work outside the home, they had on average 3
children, versus 4 children for women that never worked. This has not been true
in all societies, as documented in Western industrialized countries. Factors that
may affect these trends include the availability of child care, the need of
children for support in times of crisis, and sickness or death of the household
head. A negative relationship between employment and fertility was more prevalent
in wife-dominant and egalitarian couples than male-dominated ones. Other factors
such as the number of some, marriage duration, education, and family makeup could
effect the desire for additional children more than the work status of the wife.
Among illiterate women of Bangladesh, the use of birth control was 50% higher for
those who worked before marriage and continued than for those who worked at some
time. Working women have access to more sources of knowledge and communication
with other women, that may effect their attitudes on delayed marriage and
marriage disruption. In addition access to public health facilities and other
commercial market places makes them less dependent on male family members.

PMID: 12342714 [PubMed - indexed for MEDLINE]

200. Am J Epidemiol. 1988 Dec;128(6):1340-51.

Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up
Study.

Farmer ME, Locke BZ, Mościcki EK, Dannenberg AL, Larson DB, Radloff LS.

Epidemiology and Psychopathology Research Branch, National Institute of Mental
Health, Rockville, MD 20857.

The relation between self-reported physical activity and depressive symptoms was
analyzed for 1,900 healthy subjects aged 25-77 years in the Epidemiologic
Follow-up Study (1982-1984) to the first National Health and Nutrition
Examination Survey (NHANES I). Depressive symptomatology as measured by the
Center for Epidemiologic Studies Depression Scale (CES-D) was examined by sex and
race in relation to recreational physical activity and physical activity apart
from recreation, controlling for age, education, income, employment status, and
chronic conditions. Little or no recreational physical activity and little or no
physical activity apart from recreation were cross-sectionally associated with
depressive symptoms in whites and in blacks. After exclusion of those with
depressive symptoms at baseline, recreational physical activity was an
independent predictor of depressive symptoms an average of eight years later in
white women. The adjusted odds of depressive symptoms at follow-up were
approximately 2 for women with little or no recreational physical activity
compared with women with much or moderate recreational physical activity (95%
confidence interval 1.1-3.2). These findings are the first indication from a
prospective study of a large community sample that physical inactivity may be a
risk factor for depressive symptoms.

PMID: 3264110 [PubMed - indexed for MEDLINE]