Barbara Broffitt

Is there a reliable and valid self-report measure of sexual behavior?

A psychometric analysis of the Sexual Experience Scale (SES) from the Derogatis Sexual Functioning Inventory was conducted. This sexual behavior measure was administered on four occasions to a large sample of normal, heterosexual, sexually active women and a comparable sample which underwent gynecologic treatment that resulted in a predictable and clinical level of sexual dysfunction. In terms of reliability, internal consistency estimates for the SES were in the .85 to .90 range, but the stability of the SES was lower and ranged from .55 to .85. An evaluation of the validity revealed both strengths and limitations of the SES. The content analysis reveals that a wider range of sexual behaviors is sampled by the SES than comparable measures. To examine construct validity, a factor analysis provided a five-factor solution which would account for 82% of the variance, but the solution was not stable across groups or time and the factors were not sensitive to detecting important behavior changes. As many other psychological measures, the SES was poor in predicting a criterion (i.e., the occurrence of sexual dysfunction) concurrently or at the time of follow-up. The outcome of this analysis is discussed in the context of selecting reliable and valid self-report measures of sexual behavior.

Fluoride, Beverages and Dental Caries in the Primary Dentition

Knowledge concerning risk factors for primary dentition caries in young children is incomplete. Models are presented for caries development using longitudinally gathered fluoride exposure and dietary intake data in the Iowa Fluoride Study. Primary tooth caries examinations were conducted at age 5. Dietary (beverage) and fluoride exposure data were gathered longitudinally from age 6 weeks through 4 years (n = 291); 23% had decayed or filled surfaces. Logistic regression revealed that beverage components and toothbrushing made unique contributions to caries experience. Water consumption (36–48 months), milk consumption (24–36 months), and fluoridated toothpaste brushings (36–48 months) were negatively associated with caries; sugared beverages and milk (6 weeks to 12 months) were positively associated. Although fluoride exposure is important, sugared beverages contribute substantially to caries risk, while water and milk consumption and frequent toothbrushing early can have protective effects.

Genome-wide Association Scan for Childhood Caries Implicates Novel Genes

Dental caries is the most common chronic disease in children and a major public health concern due to its increasing incidence, serious health and social co-morbidities, and socio-demographic disparities in disease burden. We performed the first genome-wide association scan for dental caries to identify associated genetic loci and nominate candidate genes affecting tooth decay in 1305 US children ages 3-12 yrs. Affection status was defined as 1 or more primary teeth with evidence of decay based on intra-oral examination. No associations met strict criteria for genome-wide significance (p < 10E-7); however, several loci (ACTN2, MTR, and EDARADD, MPPED2, and LPO) with plausible biological roles in dental caries exhibited suggestive evidence for association. Analyses stratified by home fluoride level yielded additional suggestive loci, including TFIP11 in the low-fluoride group, and EPHA7 and ZMPSTE24 in the sufficient-fluoride group. Suggestive loci were tested but not significantly replicated in an independent sample (N = 1695, ages 2-7 yrs) after adjustment for multiple comparisons. This study reinforces the complexity of dental caries, suggesting that numerous loci, mostly having small effects, are involved in cariogenesis. Verification/replication of suggestive loci may highlight biological mechanisms and/or pathways leading to a fuller understanding of the genetic risks for dental caries.

Association between Enamel Hypoplasia and Dental Caries in Primary Second Molars: A Cohort Study

The purpose of this study was to assess the longitudinal relationships between enamel hypoplasia and caries experience of primary second molars. The study sample was 491 subjects who received dental examinations at both age 5 and 9 by the calibrated examiners. Four primary second molars (n = 1,892) were scored for the presence of enamel hypoplasia for each participant. Caries presence and number of decayed and filled surfaces (dfs) were determined at age 5 and 9. The relationships between enamel hypoplasia and caries experience were assessed. Among primary second molars, 3.9% of children and 1.7% of primary second molars had enamel hypoplasia. At age 5, 36.8% of children with hypoplasia had caries, while 16.9% of children without enamel hypoplasia had caries. At age 9, the corresponding numbers were 52.6% for children with hypoplasia and 34.5% for children without hypoplasia, respectively. At the tooth level, for age 5, 28.1% of teeth with hypoplasia had caries (mean dfs = 0.40), and 7.6% of teeth without hypoplasia had caries (mean dfs = 0.11). At age 9, the corresponding numbers were 41.9% (mean dfs = 0.76) for teeth with hypoplasia and 18.3% (mean dfs = 0.34) for teeth without hypoplasia. In multivariable logistic regression analyses, teeth of subjects with enamel hypoplasia had a significantly higher risk for caries at age 5 and 9 after controlling for other risk factors. Enamel hypoplasia appears to be a significant risk factor for caries and should be considered in caries risk assessment.

Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars.

Gaps remain in our knowledge about the levels of fluoride intake that cause dental fluorosis. The purpose of this study was to report the fluorosis prevalence by levels of estimated fluoride intake in an effort to understand the importance of different levels of daily fluoride intake. As part of the longitudinal Iowa Fluoride Study, subjects were followed from birth to 36 months with questionnaires every 3–4 months to gather information on fluoride intake from various sources. Daily fluoride intake in mg per kg body weight (BW) was estimated from water, beverages and selected foods, fluoride supplements and dentifrice. Six hundred and twenty-eight subjects were examined for fluorosis on permanent incisors and first molars at about age 9 by two calibrated examiners using the Fluorosis Risk Index categories. Fluorosis prevalence rates were determined separately for maxillary central incisors and first molars by levels of estimated fluoride intake. There were significant positive associations between fluorosis prevalence and levels of fluoride intake. Cumulatively from birth to 36 months, average daily intake of 0.04 mg F/kg BW or less carried relatively low risk for fluorosis (12.9% for maxillary central incisors, 6.8% for first molars). Average daily intake of 0.04–0.06 mg F/kg BW showed a significantly elevated risk for fluorosis (23.0% for maxillary central incisors, 14.5% for first molars), while fluorosis risk was even higher for average intake above 0.06 mg F/kg BW (38.0% for maxillary central incisors, 32.4% for first molars). The study suggests that fluorosis prevalence is related to elevated fluoride intake when averaged over the first 3 years of life, but is even more strongly related to fluoride intake that is elevated for all of the first 3 years of life.

Validation evidence for the netherlands physical activity questionnaire for young children : The Iowa bone development study

Survey instruments continue to serve an important function in population-based studies of children’s physical activity, despite limitations including accuracy of recall and varied interpretations of questions by responders. Because young children (i.e., less than 10 years old) do not have the cognitive skills to self-report, researchers using survey methods to assess activity generally rely on parents or teachers as proxy reporters (Kohl, Fulton, & Caspersen, 2000; Montoye, Kemper, Saris & Washburn, 1996; Sallis, & Owen, 1999). In a review of the status of children’s activity measurements, Sallis and Owen (1999) suggested that many children’s physical activity proxy reports are not valid, because they require reporters to observe children’s specific activities during an entire day. This is a difficult task even for the most attentive parent. Recently, the Centers for Disease Control and Prevention sponsored an expert panel to review current knowledge of existing methods for assessing physical activity in preschool-age children and set research priorities for using assessment instruments in this population (Fulton et al., 2001). The panel prioritized the need for new research assessing the validity and feasibility of proxy reports, because it felt proxy reports were one of the most viable assessment methods available (Fulton et al., 2001). At this time, however, little information exists on the measurement properties of even the most commonly used proxy report instruments for young children (Fulton et al., 2001; Kohl et al., 2000). This deficiency has been a barrier in conducting population-based research and evaluating the quality of research that exists. In this paper, we present reliability and validity information for the Netherlands (Health Education Project) Physical Activity Questionnaire (NPAQ), a global proxy report of children’s everyday activity preferences (Montoye, Kemper, Saris, & Washburn, 1996). The NPAQ was selected for study, because it addresses children’s typical behavioral traits (assumed to be associated with physical activity levels) rather than requiring proxy reporters to describe specific physical activity characteristics, such as duration, frequency, or intensity. If reliable and valid, the NPAQ would be a useful instrument for: (a) descriptive purposes, (b) sorting children into physical activity categories, and (c) clarifying qualitative information.

Genetic and Environmental Factors Associated with Dental Caries in Children: The Iowa Fluoride Study

Dental caries remains the most common chronic childhood disease. Despite strong evidence of genetic components, there have been few studies of candidate genes and caries. In this analysis we tried to assess genetic and environmental factors contributing to childhood caries in the Iowa Fluoride Study. Environmental factors (age, sex, race, tooth-brushing frequencies and water fluoride level) and three dental caries scores (d2fs-total, d2fs-pit/fissure, and d2fs-smooth surface) were assessed in 575 unrelated children (mean age 5.2 years). Regression analyses were applied to assess environmental correlates. The Family-Based Association Test was used to test genetic associations for 23 single nucleotide polymorphism (SNP) markers in 7 caries candidate genes on 333 Caucasian parent-child trios. We evaluated the associations between caries status and the level of both single and multiple SNPs (haplotype) respectively. Permutation procedure was performed for correction of inflated type I errors due to multiple testing. Age, tooth-brushing frequency and water fluoride level were significantly correlated to at least one carious score. Caries on pit and fissure surfaces was substantially higher than on smooth surfaces (61 vs. 39%). SNPs in three genes (DSPP, KLK4 and AQP5) showed consistent associations with protection against caries. Of note, KLK4 and AQP5 were also highlighted by subsequent haplotype analysis. Our results support the concept that genes can modify the susceptibility of caries in children. Replication analysis in independent cohorts is highly needed in order to verify the validity of our findings.

Longitudinal associations between children's dental caries and risk factors

UNLABELLED Dental caries is a common disease in children of all ages. It is desirable to know whether children with primary, mixed, and permanent dentitions share risk factors for cavitated and non-cavitated caries. OBJECTIVE To assess the longitudinal associations between caries outcomes and modifiable risk factors. METHODS One hundred and fifty-six children in the Iowa Fluoride Study met inclusion criteria of three dental examinations and caries-related risk factor assessments preceding each examination. Surface-specific counts of new non-cavitated caries and cavitated caries at the primary (Exam 1: age 5), mixed (Exam 2: age 9) and permanent (Exam 3: age 13) dentition examinations were outcome variables. Explanatory variables were caries-related factors, including averaged beverage exposure frequencies, tooth brushing frequencies, and composite water fluoride levels collected from 3-5, 6-8, and 11-13 years, dentition category, socioeconomic status, and gender. Generalized linear mixed models (GLMMs) were used to explore the relationships between new non-cavitated or cavitated caries and caries-related variables. RESULTS Greater frequency of 100 percent juice exposure was significantly associated with fewer non-cavitated and cavitated caries surfaces. Greater tooth brushing frequency and high socioeconomic status (SES) were significantly associated with fewer new non-cavitated caries. Children had significantly more new cavitated caries surfaces at the mixed dentition examination than at the primary and permanent dentition examinations. CONCLUSIONS There were common caries-related factors for more new non-cavitated caries across the three exams, including less frequent 100 percent juice exposure, lower tooth brushing frequency and lower SES. Less frequent 100 percent juice exposures might be associated with higher exposures to several other cariogenic beverages.

Associations between Intakes of Fluoride from Beverages during Infancy and Dental Fluorosis of Primary Teeth

Objective: We describe associations between primary tooth fluorosis status and intakes of beverages and fluoride from these beverages during infancy. Methods: Subjects (n = 677) are members of the Iowa Fluoride Study, a cohort of young children followed from birth. Food and nutrient intakes were obtained from 3-day diet records. Diets were analyzed at 6 weeks, 3, 6, 9, 12 and 16 months and cumulatively for 6 weeks through 16 months of age. Primary tooth fluorosis was assessed at 4.5–6.9 years of age and defined as present or absent. Multiple logistic regression analyses were used to develop models to predict fluorosis status. Results: Water-based beverage intakes were higher in subjects with fluorosis than in those without. Specifically, higher intakes of water used to reconstitute formulas at 3, 6 and 9 months; any intake of water as a beverage at 16 months; and higher intakes of combined 100% juice and miscellaneous beverages at 16 months were positively associated with fluorosis (p < 0.05). Fluoride intakes from water sources were also higher in subjects with fluorosis than in those without. Specifically, higher intakes of fluoride from water used to reconstitute formulas at 3, 6, 9 and 12 months and for 6 weeks through 16 months, and higher intakes of fluoride from water as a beverage at 16 months and for 6 weeks through 16 months were positively associated with fluorosis (p < 0.05). Conclusion: Infant beverages, particularly infant formulas prepared with fluoridated water, can increase the risk of fluorosis in primary teeth.

A Psychometric Analysis of the Sexual Arousability Index

The Sexual Arousability Index (SAI) assesses self-reported sexual arousal in women and was administered on four occasions to a group of normal sexually active women (n = 57) and to another group undergoing surgical gynecologic treatment (n = 66) that resulted in a predictable and clinical level of sexual dysfunction. These data were used for a psychometric analysis of the SAI. In terms of reliability, internal consistency estimates were in the .92-.96 range, and 4-month test-retest reliabilities ranged from .74 to .90. An evaluation of validity revealed both strengths and limitations of the SAI. The content analysis indicated that at least six domains are sampled, including seduction activities, body caressing, oral-genital and genital stimulation, intercourse, masturbation, and erotic media. To examine construct validity, we conducted a factor analysis that revealed a five-factor solution accounting for 85% of the variance. Furthermore, the factor solution was stable across groups and time, and the factors were sensitive to the occurrence of important behavior changes. The SAI, like other psychological measures, was poor in predicting a criterion (i.e., the occurrence of inhibited sexual excitement) concurrently or at the time of follow-up.