Dona Schneider

International trends in adolescent nutrition

This paper addresses international trends in adolescent nutrition by reviewing the literature from English-language indexed journals and online sources from around the world. Information is presented by geographic region and by nation within region. The literature shows that malnutrition remains a significant problem for adolescents, worldwide, but that the types of nutritional problems impacting this group have changed significantly over the past two decades. While undernutrition and wasting are reported, these conditions, as well as growth stunting, seem to be on the decline. In developed countries, social pressures to achieve a distorted body image are creating a malnutrition of affluence among some groups of adolescents. There appears to be an increasing prevalence of obesity among adolescents worldwide, explained by widespread nutrition transitions to lipid-rich diets and a decrease in physical activity, especially among urban adolescents. These trends are of international importance as they imply the world will see a shift towards longer life spans for this adolescent cohort, with a concomitant increase in the prevalence of chronic diseases as it ages. The epidemiologic transition that will result may be a mixed blessing. It is likely to produce a larger and healthier international workforce, but it also has the potential of becoming a serious burden as demands for health care and support services for those with chronic diseases increase. To prevent inordinate health care demands on the international economy in the future, dietary recommendations with nutritional education programs that are culturally appropriate need to become national priorities.

Violence in American cities: Young black males in the answer, but what was the question?

Many Americans believe that the public health problem of violence can be addressed by focusing on young black males. We hypothesize that our economic and political systems have created marginal urban areas of undesirable land uses and unwanted people which breed violence. Using three medium-sized cities (Camden, Newark, Trenton) located in an extremely affluent state (New Jersey) as illustrations, we show that violent death rates from homicides, poisoning/drug abuse, falls, fires, and suicide in these areas are high for whites and Hispanics, as well as blacks; females, as well as males; and middle-aged and elderly populations, as well as young populations. We conclude that marginalization (e.g. concentration, ghettoization, segregation) of unwanted land uses and unwanted people must be addressed to reduce urban violence.

Nocturnal Enuresis and Overweight Are Associated With Obstructive Sleep Apnea

OBJECTIVE: The objective of this study was to examine the relationship of obstructive sleep apnea (OSA), body weight (BMI percentage [BMI%]), and monosymptomatic nocturnal enuresis (MNE) in children. METHODS: A case-control study design was used. All children were 5 to 15 years of age; case patients were recruited from a comprehensive sleep disorders center (n = 149), and control subjects were recruited from a general pediatric practice in the same catchment area (n = 139). Case patients were subject to overnight polysomnograms and grouped into apnea severity categories (minimal, mild, moderate, or severe) on the basis of respiratory disturbance index and minimum arterial oxygen saturation levels. Data for all children included age; gender; height; weight; and history of MNE, snoring, diabetes, nasal allergies, and/or enlarged tonsils. BMI% was used to group children into weight categories as suggested by the Centers for Disease Control and Prevention (underweight, normal weight, at risk for overweight, and overweight). Two age groupings were created (5–10 years and 11–15 years). Descriptive statistics provided the prevalence of OSA, weight category, and MNE among case patients and control subjects. Cross-tabulations examined the relationship of severity of OSA with weight categories and MNE, stratified by age and gender. A series of logistic regression models explored the interrelationship of the grouping variables. RESULTS: A large majority (79.9%) of control subjects were at risk for overweight, and a large majority (80.0%) of children with MNE also had some degree of OSA. Logistic regression demonstrated that both MNE (odds ratio: 5.29) and overweight (odds ratio 4.16) were significantly associated with OSA but not with each other. CONCLUSIONS: Overweight and MNE are associated with OSA but not with each other. OSA should be considered in overweight children with MNE, especially when they display other symptoms of OSA or fail to respond to standard MNE treatment programs.

Household exposure factors, asthma, and school absenteeism in a predominantly Hispanic community

The Passaic Asthma Reduction Effort (PARÉ) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARÉ questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.

The Relationship of Health Insurance to the Diagnosis and Management of Asthma and Respiratory Problems in Children in a Predominantly Hispanic Urban Community

OBJECTIVES As part of an asthma screening study, we evaluated the relationship of health care insurance coverage to the diagnosis and treatment of elementary school children for asthma and related respiratory problems from 1998 through 2001. METHODS A bilingual questionnaire assessing health care coverage, asthma diagnosis, respiratory symptoms, and use of medications was distributed to parents of 6235 public and private school children in grades 2 through 5 in Passaic, NJ. RESULTS Responses for 4380 children (70%) revealed disparities in health care coverage and asthma diagnosis among racial and ethnic groups. Mexican and Dominican children had significant increases in health care coverage over the 4 years. CONCLUSIONS The percentage of children with health insurance grew from 67% in 1998 to 81% in 2001, and the increase was related to NJ KidCare. Diagnosis of asthma and treatment were related to health care coverage.

Later toilet training is associated with urge incontinence in children

OBJECTIVE The objective of this study was to determine if later toilet training is associated with urge incontinence in children. METHODS We used a case-control study design to yield level 2 evidence. RESULTS Initiation of toilet training after 32 months of age was associated with urge incontinence (P=0.02). CONCLUSION For children who display signs of toilet-training readiness, training should be initiated prior to 32 months of age to reduce the risk for urge incontinence.

Children's environmental health risks : A state-of-the-art conference

Abstract More than 100 academic and private-sector researchers, government officials, politicians, and public health practitioners met to discuss issues regarding childrens environmental health. Of special concern were the lack of toxicological data on many chemicals, the paucity of studies of childrens exposure to these chemicals, and our limited understanding of pediatric toxicology. The increased incidence of childhood cancers and asthma were also of concern, as was our lack of understanding of how exposures to multiple environmental chemicals in low doses may influence child growth and development, disrupt endocrine function, and stimulate development of chronic diseases. An agenda for basic research, education and outreach, and policy and program development was created, with a goal of moving childrens environmental health issues forward in a logical and thoughtful manner.

Choice of Exercise: A Predictor of Behavioral Risks?

After controlling for differences in gender, educational achievement, and exercise duration among a sample of 7,248 Americans 18-34 years old, we found that runners-joggers-fast walkers (RJWs) and tennis players were less likely to be obese, smoke, consume large quantities of alcohol, and drive without seat belts than those who participate in team and an aggregate of other sports. These behavioral differences might be explained by imprecise data, intervening variables such as exercise intensity, or other variables that were not measured. But a more interesting explanation is that running-jogging-fast walking and playing tennis are integral components of healthy lifestyles, and team sports and some other exercise behaviors are part of riskier ways of living. No consistent association was found between duration of exercise and behavioral risk.

Effect of weed pollen on children's hospital admissions for asthma during the fall season.

The authors analyzed temporal variations in asthma hospital admissions for New Jersey children (0-14 years of age) over a 3-year period. Significant spikes in childrens asthma hospital admissions occurred during late September and early October of each of the 3 years of the study. The authors report on an in-depth analysis of the fall peak periods, in an effort to determine whether there was an association between childrens asthma hospital admissions and environmental variables. Hospital admission peaks occurred approximately 3 weeks after school started and before heating systems were turned on in New Jersey public schools. They also preceded the point at which schools begin to report increased absences that are due to infectious illnesses. An examination of environmental variables showed only weed pollen as a statistically significant predictor of childrens asthma hospital admissions during the fall peaks (p < .001). The counseling of parents about childrens exposure to pollen and possible ways to reduce such exposure should be part of the asthma management protocols for children living in high-pollen environments.

Breastfeeding During Infancy May Protect Against Bed-wetting During Childhood

OBJECTIVE. Our goal was to test the hypothesis that children who exhibit bed-wetting during childhood were less likely to be breastfed during infancy compared with normal controls. METHODS. A case-control study was conducted in a pediatric continence center and a general pediatric practice. Cases (n = 55) were recruited from the continence center and defined as children 5 to 13 years of age who experienced lifetime involuntary voiding of urine during nighttime sleep at least 2 times a week in the absence of defects of the central nervous system or urinary tract. Age- and gender-matched controls (n = 117) who did not exhibit bed-wetting were enrolled from a general pediatric practice. Infant feeding practices were measured as breastfeeding (yes/no) and, for those who were breastfeed, by the duration of breastfeeding and the time of formula supplementation. RESULTS. Among the case subjects, 45.5% were breastfed, whereas among the controls 81.2% were breastfed. The controls reported higher household incomes than the case subjects, and their mean family size (number of children) was slightly lower. After adjusting for race, income, and family size, the odds ratio was 0.283, indicating that case subjects were significantly less likely than controls to be breastfeed. Among all the study subjects who were breastfed, controls were breastfed for a significantly longer period than case subjects (an average of 3 months longer). Although breastfed controls were less likely to be supplemented with formula than breastfed case subjects, this difference was not statistically significant. CONCLUSIONS. Breastfeeding longer than 3 months may protect against bed-wetting during childhood. Breast milk supplemented with formula did not make a difference in the rate of enuresis.