David M. Gute

Feeding styles and child weight status among recent immigrant mother-child dyads

BackgroundResearch has shown that parental feeding styles may influence children’s food consumption, energy intake, and ultimately, weight status. We examine this relationship, among recent immigrants to the US. Given that immigrant parents and children are at greater risk for becoming overweight/obese with increased time in the US, identification of risk factors for weight gain is critical.MethodsBaseline data was collected on 383 mother-child dyads enrolled in Live Well, a community-based, participatory, randomized controlled lifestyle intervention to prevent weight gain in recent immigrant mothers. Socio-demographic information together with heights and weights were collected for both mother and child. Acculturation, behavioral data, and responses to the Caregiver’s Feeding Styles Questionnaire (CFSQ) were also obtained from the mother.ResultsThe children’s average age was 6.2 ± 2.7 years, 58% male. Mothers had been in the country for an average of 6.0 ± 3.3 years, and are Brazilian (36%), Haitian (34%) and Latino (30%). Seventy-two percent of the mothers were overweight/obese, while 43% of the children were overweight/obese. Fifteen percent of mothers reported their feeding style as being high demanding/high responsive; 32% as being high demanding/low responsive; 34% as being low demanding/high responsive and 18% as being low demanding/low responsive. In bivariate analyses, feeding styles significantly differed by child BMIz-score, ethnic group, and mother’s perceived stress. In multiple linear regression, a low demanding/high responsive feeding style was found to be positively associated (ß = 0.56) with a higher child weight as compared to high demanding/high responsive, controlling for known covariates (p = 0.01).ConclusionsMost mothers report having a low demanding/high responsive feeding style, which is associated with higher child weight status in this diverse immigrant population. This finding adds to the growing literature that suggests this type of feeding style may be a risk factor for childhood obesity. Further research is needed to help understand the larger socio-cultural context and its influence on feeding dynamics among immigrant families and families of lower incomes. How parents establish a certain feeding style in their home country compared to when they move to the US “obesogenic” environment, should also be explored.

Residential Traffic Exposure, Pulse Pressure, and C-reactive Protein: Consistency and Contrast among Exposure Characterization Methods

Background Traffic exposure may increase cardiovascular disease (CVD) risk via systemic inflammation and elevated blood pressure, two important clinical markers for managing disease progression. Objectives We assessed degree and consistency of association between traffic exposure indicators as predictors of C-reactive protein (CRP) and pulse pressure (PP) in an adult U.S. Puerto Rican population (n = 1,017). Methods Cross-sectional information on health and demographics and blood data was collected. Using multiple linear regression, we tested for associations between CRP, PP, and six traffic exposure indicators including residential proximity to roads with > 20,000 vehicles/day and traffic density [vehicle miles traveled per square mile (VMT/mi2)]. Diabetes and obesity [body mass index (BMI) ≥ 30 kg/m2] were tested as effect modifiers. Results CRP was positively associated with traffic density in the total population [36% CRP difference with 95% confidence interval (CI) 2.5–81%] for residence within the highest versus lowest VMT/mi2 level. With BMI ≥ 30, CRP showed significant positive associations with five of six traffic indices including residence ≤ 200 m versus > 200 m of a roadway [22.7% CRP difference (95% CI, 3.15–46.1)] and traffic density in the third highest versus lowest VMT/mi2 level [28.1% difference (95% CI, 1.0–62.6)]. PP was positively associated with residence within ≤ 100 m of a roadway for the total population [2.2 mmHg (95% CI, 0.13–4.3 mmHg)] and persons with BMI ≥ 30 [3.8 mmHg (95% CI, 0.88–6.8)]. Effect estimates approximately doubled for residence within ≤ 200 m of two or more roadways, particularly in persons with diabetes [8.1 mmHg (95% CI, 2.2–14.1)]. Conclusions Traffic exposure at roadway volumes as low as 20,000–40,000 vehicles/day may increase CVD risk through adverse effects on blood pressure and inflammation. Individuals with elevated inflammation profiles, that is, BMI ≥ 30, may be more susceptible to the effects of traffic exposure.

Characterizing Urban Traffic Exposures Using Transportation Planning Tools: An Illustrated Methodology for Health Researchers

Exposure to elevated levels of vehicular traffic has been associated with adverse cardiovascular and respiratory health effects in a range of populations, including children, the elderly, and individuals with pre-existing heart conditions, diabetes, obesity, and genetic susceptibilities. As these relationships become clearer, public health officials will need to have access to methods to identify areas of concern in terms of elevated traffic levels and susceptible populations. This paper briefly reviews current approaches for characterizing traffic exposure and then presents a detailed method that can be employed by public health officials and other researchers in performing screening assessments to define areas of potential concern within a particular locale and, with appropriate caveats, in epidemiologic studies examining traffic-related health impacts at the intra-urban scale. The method is based on two exposure parameters extensively used in numerous epidemiologic studies of traffic and health—proximity to high traffic roadways and overall traffic density. The method is demonstrated with publically available information on susceptible populations, traffic volumes, and Traffic Analysis Zones, a transportation planning tool long used by Metropolitan Planning Agencies and planners across the USA but presented here as a new application which can be used to spatially assess possible traffic-related impacts on susceptible populations. Recommendations are provided for the appropriate use of this methodology, along with its limitations.

Effective control of Schistosoma haematobium infection in a Ghanaian community following installation of a water recreation area.

Background Urogenital schistosomiasis caused by Schistosoma haematobium was endemic in Adasawase, Ghana in 2007. Transmission was reported to be primarily through recreational water contact. Methods We designed a water recreation area (WRA) to prevent transmission to school-aged children. The WRA features a concrete pool supplied by a borehole well and a gravity-driven rainwater collection system; it is 30 m2 and is split into shallow and deep sections to accommodate a variety of age groups. The WRA opened in 2009 and children were encouraged to use it for recreation as opposed to the local river. We screened children annually for S. haematobium eggs in their urine in 2008, 2009, and 2010 and established differences in infection rates before (2008–09) and after (2009–10) installation of the WRA. After each annual screening, children were treated with praziquantel and rescreened to confirm parasite clearance. Principal Findings Initial baseline testing in 2008 established that 105 of 247 (42.5%) children were egg-positive. In 2009, with drug treatment alone, the pre-WRA annual cumulative incidence of infection was 29 of 216 (13.4%). In 2010, this incidence rate fell significantly (p<0.001, chi-squared) to 9 of 245 (3.7%) children after installation of the WRA. Logistic regression analysis was used to determine correlates of infection among the variables age, sex, distance between home and river, minutes observed at the river, low height-for-age, low weight-for-age, low Body Mass Index (BMI)-for-age, and previous infection status. Conclusion/Significance The installation and use of a WRA is a feasible and highly effective means to reduce the incidence of schistosomiasis in school-aged children in a rural Ghanaian community. In conjunction with drug treatment and education, such an intervention can represent a significant step towards the control of schistosomiasis. The WRA should be tested in other water-rich endemic areas to determine whether infection prevalence can be substantially reduced.

Immigrating to the US: what Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity.

Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is “less natural,” there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.

Diagnostic accuracy of urine filtration and dipstick tests for Schistosoma haematobium infection in a lightly infected population of Ghanaian schoolchildren

Two screening methods, reagent dipsticks for hematuria and urine filtration for Schistosoma haematobium eggs, were evaluated for their sensitivity and specificity in diagnosing infection with S. haematobium in lightly infected Ghanaian children. Schoolchildren aged 8-18 years (n=255) provided urine samples on three occasions. Overall, 36.4% of girls and 50.7% of boys presented with eggs at least once; 3.3% of girls and 7.5% of boys presented with both eggs and hematuria three times. Many children presented with eggs but without hematuria, or with hematuria but without eggs. When each child was screened three times, the sensitivity of each test method improved by at least 22.9% as compared with single screening, but previously unidentified infections were detected at the third screening, indicating that even three screenings is insufficient. Nearly half of lightly infected children (<50 eggs/10 ml urine, by maximum egg count) were egg-positive during only one of three screenings. Thus, data presented here indicate that when individuals are screened repeatedly, infection status can be assessed more accurately, control programs can be properly evaluated, and population estimates of S. haematobium infection may be made with increased confidence, as compared with single screening.

Ischemic heart disease and acute myocardial infarction mortality among police officers.

The relationship between the occupation of police officer and ischemic heart disease (IHD) mortality was examined through case-control studies using 1968/78 death certificate records from Rhode Island and Utah. IHD was divided into two subcategories--acute myocardial infarction (AMI) and other IHD. In both states, the odds ratio (OR) for AMI was significantly elevated (Rhode Island, OR = 1.3; Utah, OR = 1.8), and was higher than the OR for other IHD (Rhode Island, OR = 1.1; Utah, OR = 1.4). The odds ratio for AMI was higher in the less than 65 yr age group (Rhode Island, OR = 2.1; Utah, OR = 2.1) than in the greater than or equal to 65 yr age group (Rhode Island, OR = 0.9; Utah, OR = 1.6). These results suggest that the elevated risk for IHD among police officers observed in this and other studies is primarily due to an elevated risk for AMI. The pattern of diminishing risk with age suggests a risk factor, possibly stress, the effect of which diminishes when exposure ceases at retirement.

Survey of Risk Reduction and Pollution Prevention Practices in the Rhode Island Automotive Refinishing Industry

In 1996 a survey of pollution prevention, environmental control, and occupational health and safety practices was conducted in the Rhode Island automotive refinishing industry sector. In conjunction with project partners, the Rhode Island Department of Environmental Management developed a multidimensional survey instrument to identify risk reduction opportunities. Investigators sought to characterize the range of environmental and industrial hygiene control employed by Rhode Island facilities for the purposes of focusing state technical and compliance assistance efforts. Data were collected on a diverse range of subject areas including work force demographics; source reduction; potential health hazards; worker protection and safety; solid and hazardous waste management; and air pollution control. Nearly one-half of the shops employ three or fewer people, and in many cases, spray painters double as body repair technicians thereby increasing their potential exposure to workplace contaminants. While nearly all of the shops reported that they use spray painting booths, only 38% own booths the more effective downdraft design. Based on the self-reported data, recently promulgated state air pollution control regulations (requiring the use of compliant coatings, enclosed or modified spray gun cleaners, and high-volume, low-pressure, spray guns) appear to be effective at motivating companies toward source reduction. A range of risk reduction opportunities were identified as input material changes, technology changes, and improved operating practices. Better methods of risk communication; a professional licensing requirement; and targeted training, compliance, and technical assistance would help to achieve greater levels of risk reduction in this mature, high-hazard industry.

Reinforcing cholera intervention through prediction-aided prevention

This article was published in the Bulletin of the World Health Organization [

Human exposure to polychlorinated biphenyls in greater New Bedford, Massachusetts : a prevalence study

A study was conducted in the community of Greater New Bedford, Massachusetts, from 1984 through 1987 to assess the prevalence of elevated levels of polychlorinated biphenyls (PCBs) in the serum of individuals aged 18 to 64 years who had resided in the area for at least 5 years. Eight hundred and forty subjects were interviewed, examined, and tested in a cross-sectional sample of the towns of Acushnet, Dartmouth, and Fairhaven and the city of New Bedford. Serum PCBs were measured to estimate the extent of human exposure. Because of documented environmental contamination by PCBs in the New Bedford area, and the practice of recreational fishing in the harbor for food, a significant number of persons with elevated serum PCB levels were expected to be identified. Instead, the prevalence of elevated serum PCBs in the sample was found to be typical of “unexposed” urban populations in the United States. Only 1.3% of the subjects had serum PCB levels greater than 30 ppb. The same percentage was observed among males (n =391) and females (n=449). The geometric means of PCB levels were 4.3 ppb among males (Range=0.50–60.9) and 4.2 ppb among females (Range=0.38–154). We conclude that the prevalence of elevated serum PCBs is low in the population of Greater New Bedford.