Clark H. Denny

Trends in Fruit and Vegetable Consumption Among Adults in the United States: Behavioral Risk Factor Surveillance System, 1994–2000

OBJECTIVES We examined trends in fruit and vegetable consumption in the United States. METHODS A 6-item food frequency questionnaire was used to assess consumption among 434 121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000. RESULTS Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups. CONCLUSIONS Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed.

The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis.

BACKGROUND The objective of this review is to evaluate the literature on the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment. METHODS Meta-analysis with systematic searches of MEDLINE (1970 through August 2012), EMBASE (1988 through August 2012), and PsycINFO(®) (1970 through August 2012) and examination of selected references. RESULTS From 1,593 articles, we identified 34 presenting data from cohort studies that met our inclusion criteria. Information on study population, outcomes, measurement instruments, timing and quantification of alcohol exposure, covariates, and results was abstracted. Outcomes included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The quality of each article was assessed by 2 researchers using the Newcastle-Ottawa Scale. Based on 8 studies of 10,000 children aged 6 months through 14 years, we observed a significant detrimental association between any binge prenatal alcohol exposure and child cognition (Cohens d [a standardized mean difference score] -0.13; 95% confidence interval [CI], -0.21, -0.05). Based on 3 high-quality studies of 11,900 children aged 9 months to 5 years, we observed a statistically significant detrimental association between moderate prenatal alcohol exposure and child behavior (Cohens d -0.15; 95% CI, -0.28, -0.03). We observed a significant, albeit small, positive association between mild-to-moderate prenatal alcohol exposure and child cognition (Cohens d 0.04; 95% CI, 0.00, 0.08), but the association was not significant after post hoc exclusion of 1 large study that assessed mild consumption nor was it significant when including only studies that assessed moderate alcohol consumption. None of the other completed meta-analyses resulted in statistically significant associations between mild, moderate, or binge prenatal alcohol exposure and child neuropsychological outcomes. CONCLUSIONS Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant.

Physician advice about smoking and drinking: Are U.S. adults being informed?

BACKGROUND Population-based estimates for the prevalence of smokers receiving advice from a health professional to quit smoking and the prevalence of binge drinkers being talked to about alcohol use are lacking for U.S. adults. This information is useful for clinicians and public health professionals. METHODS Data are from the Behavioral Risk Factor Surveillance System, a continuous random-digit-dial telephone survey of U.S. adults. In 1997, 10 states collected data on these health interventions for tobacco and alcohol use. The prevalence of professional advice to quit smoking and about alcohol use was calculated and examined by demographic characteristics. The number of at-risk adults who had a routine checkup in the last year and had not received these interventions was also estimated. RESULTS By self-report, 70% of smokers were advised to quit, and 23% of binge drinkers were talked to about their alcohol use. Using multivariate logistic regression analyses, we found among smokers that women and older persons were more likely to receive advice; among binge drinkers, health intervention was more likely to occur for men and non-Hispanic blacks. Across the 10 states, approximately 2 million smokers and 2 million binge drinkers with a routine checkup in the past 12 months were not advised to quit smoking or talked to about their alcohol use. CONCLUSIONS Many opportunities to intervene with smokers and binge drinkers are lost. Efforts to increase physician education and to identify and reduce other barriers may help.

Disparities in Chronic Disease Risk Factors and Health Status Between American Indian/Alaska Native and White Elders: Findings From a Telephone Survey, 2001 and 2002

We compared prevalence estimates of chronic disease risk factors and health status between American Indian/Alaska Native (AIAN) and White elders. We used 2001 and 2002 Behavioral Risk Factor Surveillance System data to estimate the prevalence of smoking, physical inactivity, obesity, diagnosed diabetes, and general health status. For all health behavior and status measures, American Indians/Alaska Natives reported greater risk than did Whites. Risk factors among AIAN elders need to be addressed to eliminate disparities in chronic diseases.

The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function

Please cite this paper as: Kesmodel U, Bertrand J, Støvring H, Skarpness B, Denny C, Mortensen E, the Lifestyle During Pregnancy Study Group. The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function. BJOG 2012;119:1180–1190.

PREVENTION OF FETAL ALCOHOL SPECTRUM DISORDERS

Alcohol use among women of childbearing age is a leading, preventable cause of birth defects and developmental disabilities in the United States. Although most women reduce their alcohol use upon pregnancy recognition, some women report drinking during pregnancy and others may continue to drink prior to realizing they are pregnant. These findings emphasize the need for effective prevention strategies for both pregnant and nonpregnant women who might be at risk for an alcohol-exposed pregnancy (AEP). This report reviews evidence supporting alcohol screening and brief intervention as an effective approach to reducing problem drinking and AEPs that can lead to fetal alcohol spectrum disorders. In addition, this article highlights a recent report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect that describes effective interventions to reduce alcohol use and AEPs, and outlines recommendations on promoting and improving these strategies. Utilizing evidence-based alcohol screening tools and brief counseling for women at risk for an AEP and other effective population-based strategies can help achieve future alcohol-free pregnancies.

Health-related quality of life and hypertension status, awareness, treatment, and control : National Health and Nutrition Examination Survey, 2001-2004

Objective We examined health-related quality of life measures by hypertension status, awareness, treatment, and control. Methods Five unfavorable health-related quality of life measures were analyzed among 8303 adults aged 20 years or older who participated in the 2001–2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analyses examined differences in health-related quality of life with adjustment for age, race, sex, healthcare coverage, and other medical conditions. Results The 30% of respondents with hypertension were more likely to report fair or poor health status (adjusted odds ratio 1.72, 95% confidence interval 1.44–2.05), 14 or more unhealthy days in the past 30 days (1.23, 1.06–1.43), 14 or more physically unhealthy days (1.39, 1.15–1.67), and 14 or more activity-limited days (1.55, 1.17–2.04) than those without hypertension. Among adults with hypertension, the 73.2% who were aware of their condition were more likely to report fair or poor health status (2.19, 1.54–3.12), 14 or more unhealthy days (1.53, 1.12–2.09), 14 or more physically unhealthy days (1.49, 1.10–2.03), 14 or more mentally unhealthy days (1.70, 1.05–2.75), and 14 or more activity-limited days (2.38, 1.39–4.05) than those who were unaware. Among those aware they had hypertension, 14 or more physically unhealthy days (0.50, 0.28–0.90) was associated with current treatment. Health-related quality of life measures did not differ by blood pressure control status. Conclusions Having hypertension and being aware of it was related to lower health-related quality of life. Antihypertensive medication was associated with more physically unhealthy days, while there were no differences in health-related quality of life by control status. Further study is needed to examine these differences including: disease severity, sex and racial/ethnic differences, comorbidities not examined, and impact of health-related quality of life and its changes on outcomes.

The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on behaviour in 5‐year‐old children: a prospective cohort study on 1628 children

To examine the effects of low to moderate maternal alcohol consumption and binge drinking in early pregnancy on behaviour in children at the age of 5 years.

Racial and Ethnic Disparities in Preconception Risk Factors and Preconception Care

OBJECTIVE At-risk drinking, cigarette smoking, obesity, diabetes, and frequent mental distress, as well as their co-occurrence in childbearing aged women, are risk factors for adverse pregnancy outcomes. This study estimated the prevalence of these five risk factors individually and in combination among nonpregnant women aged 18-44 years by demographic and psychosocial characteristics, with a focus on racial and ethnic disparities. METHODS Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) on nonpregnant women aged 18-44 years (n=54,612) were used to estimate the prevalences of five risk factors, pairs of co-occurring risk factors, and multiple risk factors for poor pregnancy outcomes. RESULTS The majority of women had at least one risk factor, and 18.7% had two or more risk factors. Having two or more risk factors was highest among women who were American Indian and Alaska Native (34.4%), had less than a high school education (28.7%), were unable to work (50.1%), were unmarried (23.3%), and reported sometimes, rarely, or never receiving sufficient social and emotional support (32.8%). The most prevalent pair of co-occurring risk factors was at-risk drinking and smoking (5.7%). CONCLUSIONS The high proportion of women of childbearing age with preconception risk factors highlights the need for preconception care. The common occurrence of multiple risk factors suggests the importance of developing screening tools and interventions that address risk factors that can lead to poor pregnancy outcomes. Increased attention should be given to high-risk subgroups.

Determinants of Health-Related Quality of Life Among Older American Indians and Alaska Natives

During the past decade, health-related quality of life (HRQoL) has been recognized in both clinical and community health research as an important health outcome and a needed supplement to conventional health outcomes. The authors provide a profile of HRQoL and examine its determinants among American Indians and Alaska Natives aged 50 or older. Multivariate analyses of cross-sectional survey data from the 1996-1998 Centers for Disease Control Behavioral Risk Factor Surveillance System were conducted. Thirty-four percent of the sample reported fair or poor self-rated health. The mean number of poor health days in the past month ranged from 4 to 6 on different measures. Age, sex, education, annual household income, employment status, hypertension, and obesity were associated with aspects of HRQoL. Further research aimed at eliminating health disparities among this population should focus on identifying additional indicators of poor HRQoL and on understanding variables that mediate the relationship between disease and HRQoL.