Christa Ice

The effect of giving global coronary risk information to adults: a systematic review.

BACKGROUND Global coronary heart disease (CHD) risk estimation (ie, a quantitative estimate of a patients chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all US adults. Whether it improves outcomes is currently unknown. METHODS To assess the effect of providing global CHD risk information to adults, we performed a systematic evidence review. We searched MEDLINE for the years 1980 to 2008, Psych Info, CINAHL, and the Cochrane Database and included English-language articles that met prespecified inclusion criteria. Two reviewers independently reviewed titles, abstracts, and articles for inclusion and assessed study quality. RESULTS We identified 20 articles, reporting on 18 unique fair or good quality studies (including 14 randomized controlled studies). These showed that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. Studies with repeated risk information or risk information and repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, -0.2% to -2% over 10 years in studies using risk estimates derived from Framingham equations). Studies providing global risk information at only 1 point in time seemed ineffective. CONCLUSIONS Global CHD risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk. The effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.

Metabolic Abnormalities in Children with Asthma

RATIONALE Childhood asthma and obesity have reached epidemic proportions worldwide, and the latter is also contributing to increasing rates of related metabolic disorders, such as diabetes. Yet, the relationship between asthma, obesity, and abnormal lipid and glucose metabolism is not well understood, nor has it been adequately explored in children. OBJECTIVES To analyze the relationship between asthma diagnosis and body mass in children across the entire range of weight percentile categories, and to test the hypothesis that early derangement in lipid and glucose metabolism is independently associated with increased risk for asthma. METHODS Cross-sectional analysis of a representative sample of public school children from a statewide community-based screening program, including a total of 17,994 children, 4 to 12 years old, living in predominantly rural West Virginia, and enrolled in kindergarten, second, or fifth grade classrooms. MEASUREMENTS AND MAIN RESULTS We analyzed demographics; family history; smoke exposure; parent-reported asthma diagnosis; body mass index; evidence of acanthosis nigricans as a marker for developing insulin resistance; and fasting serum lipid profile including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Regardless of their body mass index percentile, children diagnosed with asthma were more likely than children without asthma to have higher triglyceride levels and acanthosis nigricans after controlling for sex differences and smoke exposure. CONCLUSIONS This study provides the first set of community-based data linking asthma, body mass, and metabolic variables in children. In particular, these findings uniquely describe a statistically significant association between asthma and abnormal lipid and glucose metabolism beyond body mass index associations.

Universal versus targeted blood cholesterol screening among youth: The CARDIAC project.

OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein ≥130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein ≥160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.

A confirmatory factor analysis of the metabolic syndrome in adolescents: an examination of sex and racial/ethnic differences

ObjectiveThe metabolic syndrome (MetS) is a cluster of clinical indices that signals increased risk for cardiovascular disease and Type 2 diabetes. The diagnosis of MetS is typically based on cut-off points for various components, e.g. waist circumference and blood pressure. Because current MetS criteria result in racial/ethnic discrepancies, our goal was to use confirmatory factor analysis to delineate differential contributions to MetS by sub-group.Research Design and MethodsUsing 1999–2010 data from the National Health and Nutrition Examination Survey (NHANES), we performed a confirmatory factor analysis of a single MetS factor that allowed differential loadings across sex and race/ethnicity, resulting in a continuous MetS risk score that is sex and race/ethnicity-specific.ResultsLoadings to the MetS score differed by racial/ethnic and gender subgroup with respect to triglycerides and HDL-cholesterol. ROC-curve analysis revealed high area-under-the-curve concordance with MetS by traditional criteria (0.96), and with elevations in MetS-associated risk markers, including high-sensitivity C-reactive protein (0.71), uric acid (0.75) and fasting insulin (0.82). Using a cut off for this score derived from ROC-curve analysis, the MetS risk score exhibited increased sensitivity for predicting elevations in ≥2 of these risk markers as compared with traditional pediatric MetS criteria.ConclusionsThe equations from this sex- and race/ethnicity-specific analysis provide a clinically-accessible and interpretable continuous measure of MetS that can be used to identify children at higher risk for developing adult diseases related to MetS, who could then be targeted for intervention. These equations also provide a powerful new outcome for use in childhood obesity and MetS research.

Linking Parental Motivations for Involvement and Student Proximal Achievement Outcomes in Homeschooling and Public Schooling Settings

A notable increase in the number of U.S. families choosing to homeschool their children in recent years has underscored the need to develop more systematic knowledge about this approach to education. Drawing on a theoretical model of parental involvement as well as research on families’ social networks, this study longitudinally examines home- and public-school parents’ motivations for home-based involvement in their fourth through eighth grade children’s education at two time points. The study also examines whether involvement activities predicted student proximal achievement outcomes (academic self-efficacy, intrinsic motivation for learning, and self-regulatory strategy use) across the two groups. Results suggest that parental self-efficacy for involvement, specific invitations from the child, and parent social networks are positively related to home-based parental involvement across the groups, although home- and public-school parents recorded significantly different perceptions of personal self-efficacy, role activity beliefs, social networks, and child proximal achievement outcomes. Findings are discussed with reference to implications for future research and practice.

Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project

BackgroundA number of cardiovascular disease (CVD) risk factors have been linked to obesity and associated negative health outcomes in children. However, no consistent definition of metabolic syndrome exists for children. In addition, research is needed to systematically examine the prevalence of metabolic syndrome in high-risk children, including those with insulin resistance. This study explores several definitions of metabolic syndrome and determines the prevalence of metabolic syndrome in a large sample of children with acanthosis nigricans (AN).MethodsThe study used results from a large-scale screening of fifth-grade students in West Virginia to explore the prevalence of metabolic syndrome among 676 male and female participants who had mild to severe AN.ResultsIn this high-risk sample of students who had AN, 49% met the criteria, i.e., three risk factors including insulin resistance, high body-mass index, and elevated blood pressure or dyslipidemia, when tested for metabolic syndrome. Children with AN who were classified as obese or morbidly obese were at significantly increased odds of having metabolic syndrome.ConclusionsResults are discussed in terms of systematically defining metabolic syndrome for high-risk children, as well as public health and clinical interventions targeting children who are overweight or obese. The presence of AN and morbid obesity might be easily observed markers for metabolic syndrome.

Body mass index as a surrogate measure of cardiovascular risk factor clustering in fifth-grade children: Results from the coronary artery risk detection in the Appalachian Communities Project

BACKGROUND Obesity, an increasing problem in children in the United States and abroad, has been associated with risk factors for cardiovascular disease (CVD). Consequently, there is a need to determine body mass index (BMI) cut-off values for recommending comprehensive assessment and intervention for high-risk children. The objective of this study was to use results from a large-scale cross-sectional screening project, the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC), to derive BMI cut-off values that predict clustering of CVD risk factors. Design. 29 436 fifth grade West Virginia students in the United States participated in a comprehensive risk factor screening between 1997 and 2006. METHODS Screening included the calculation of BMI, resting blood pressure, presence or absence of acanthosis nigricans, and a fasting lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). Factor analysis and receiver operating characteristic curves were used to examine BMI as a predictor for CVD risk factor clustering. RESULTS BMI at the 95th percentile or higher were shown to be specific and sensitive predictors when three or more CVD risk factor clusters were present. CONCLUSION These findings suggest that BMI, a cost-effective assessment tool, can be used to identify CVD risk-factor clustering at the 95th percentile.

Physical Activity Correlates for Native Hawaiians and Pacific Islanders in the Mainland United States

Native Hawaiian and Pacific Islander (NHPI) people are an understudied population that demonstrates high obesity rates and low physical activity levels. This studys aim was to examine possible correlates of physical activity in NHPI adults. Height and weight were recorded in N=100 NHPIs (46.9±5.4 years; 56% males) following completion of an anonymous questionnaire addressing health behaviors (physical activity, smoking, diet), psychosocial characteristics (social support, barriers, stage of change), neighborhood environment attributes, and knowledge of physical activity recommendations. This study sample demonstrated low physical activity (20% met recommendations) and fruit and vegetable (F&V) consumption (1% met recommendations), and a high prevalence of overweight or obesity (94%). After adjusting for gender and education, F&V intake was the only significant correlate of physical activity (p<.001). Common correlates of physical activity did not generalize to NHPIs. Further investigations of culturally-specific correlates are needed so that physical activity interventions can be culturally tailored for NHPIs.

Health Behaviors of Native Hawaiian and Pacific Islander Adults in California

Smoking, diet and physical activity are associated with chronic diseases, but representative prevalence data on these behaviors for Native Hawaiian and Pacific Islander (NHPI) adults are scarce. Data from the 2005 California Health Interview Survey were analyzed for self-identified NHPI and non-Hispanic white (NHW) adults. Ethnic and NHPI gender differences were examined for socio-demographic variables, obesity and health behaviors. Compared to NHW, NHPI displayed higher prevalence of obesity (p<0.001), smoking (p<0.05) and consumption of unhealthy foods and beverages (p<0.05). NHPI males were more likely than females to smoke (p<0.001). NHPI adults appear to be at higher risk for chronic disease than NHW due to obesity, smoking and intake of unhealthy foods and beverages. Culturally-specific health promotion interventions are needed to reduce risks among the underrepresented NHPI population.

Parental Efficacy and Role Responsibility for Assisting in Child's Healthful Behaviors.

The epidemic of childhood obesity, and its subsequent impact on negative health outcomes, continues to plague the United States. Better health outcomes have been linked to increased child achievement in school. Due to the strong influence parents have on children’s healthful behaviors particularly in younger years, it’s imperative to examine the social cognitive impact parents have on this aspect of children’s development. The objective of this study was to determine the impact parental self-efficacy and parental role responsibility have on child’s nutritional, physical activity, and weight categories. Parents (N = 820) responded to a questionnaire after participating in a child health screening project. Parental self-efficacy for assisting in their child’s healthful behaviors has a strong association with the child’s weight status, nutrition and physical activity. In order to make an effective change on child health behaviors, which lead to increased child academic test scores, these results suggest that school health interventionists and clinicians need to target basic psychological motivators of parental involvement.