Gita Mirchandani

Crime rates and sedentary behavior among 4th grade Texas school children

IntroductionAlthough per capita crime has generally fallen over the period which coincides with the obesity epidemic, it has not fallen uniformly across communities. It also has not fallen enough to allay fears on the part of parents. Over the past 30 years, technological changes have made the indoor alternatives to playing outside, where children are more vulnerable to criminal activity, more enjoyable (cable TV, video games, and the internet) and comfortable (the spread of air conditioning to low income neighborhoods). We determined whether indoor sedentary behavior patterns are associated with community crime statistics. 4thgraders in the U.S. are typically 9 or 10 years old.MethodsWe used data from the 2004–2005 Texas School Physical Activity and Nutrition (SPAN) survey linked with U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics data for the years 2000 through 2005 and Texas State data on sexual offenders. The probability-based sample included a total of 7,907 children in grade four. Multistage probability sampling weights were used. The dependent variables included were hours of TV watching, video game playing, computer use and total indoor sedentary behavior after school. Incremental Relative Rates were computed for community crime rates including robberies, all violent crimes, murders, assaults, property crimes, rapes, burglaries, larcenies and motor vehicle thefts as well as for sexual offenders living in the neighborhood. The neighborhood refers to the areas where the students at each school live. In the case of sexual offenders, sexual offenders per capita are estimated using the per capita rate in the zip code of the school attended; all other crime statistics are estimated by the crimes per capita in the police department jurisdiction covering the school attended. After controlling for sex, age, and African-American and Hispanic, cross-sectional associations were determined using multivariate Poisson regression.Results4thgrade boys were more likely to play video games in communities with increased per 100 population rates of larceny and burglary as well as in communities with increased per capita sexual offenders; 4thgrade girls were more likely to watch television in communities with increased per capita sexual offenders. While 4thgrade girls were more likely to watch TV in communities with increased per capita sex offenders, they were less likely to use computers. Per capita sexual offenders were negatively related to computer use amongst 4thgrade girls.ConclusionBy combining community crime and cross-sectional individual level data on indoor sedentary behavior, we found that there is an association between community crimes/sex offender rates and certain types of indoor sedentary behavior. The development of technologies in recent decades which makes supervising children easier indoors, where children are much less vulnerable to crime, may be contributing to the epidemic of childhood obesity.

Are adolescents' perceptions of dietary practices associated with their dietary behaviors?

Despite interventions designed to change behavior, many adolescents continue to consume unhealthy foods. Dietary patterns are important for disease prevention, making it necessary to understand the reasons for these poor choices. This cross-sectional study explored the relationship between perception of dietary practices and dietary behaviors among adolescents. Participants (n=15,283; mean age=15 years; 50.7% female) completed the 2004-2005 Texas School Physical Activity and Nutrition survey. Perception of dietary practices included fat content of foods usually eaten and healthiness of usual eating habits. Dietary behavior was measured by self-report of foods eaten the day before survey administration. Composite scores of unhealthy and healthy eating were created. Regression analyses examined whether perception of dietary practices was consistent with actual dietary behavior, controlling for sex, grade, and race/ethnicity, and accounting for the complex sampling design. Higher perceived fat content was associated with increased consumption of unhealthy foods, while higher perceived healthiness of eating was associated with increased consumption of healthy foods. For perceived fat content, the difference in the Healthy Eating Index between extreme categories was 26% (P<0.001), while the difference in the Unhealthy Eating Index between extreme categories was 81% (P<0.001). For perceived healthiness, the difference in the Healthy Eating Index between extreme categories was 23% (P<0.001), while the difference for the Unhealthy Eating Index was 44% (P<0.001). Self-perceptions of dietary practices were significantly associated with dietary behaviors, indicating awareness about the relative nutrient content of foods consumed. Interventions that move beyond dietary knowledge and create changes in the social and physical environment are needed.

Observable weight distributions and children's individual weight assessment.

Social networks theory suggests obesity is “contagious” within peer groups in that known friends highly influence weight. On the other hand, an alternative model suggests that observable weight distributions affect perception of ones own obesity level. We examine whether the BMI levels of the most obese classmates in the individual students grade by gender is positively associated with “under‐assessment” of obesity and overweight (i.e., independently measured obesity or overweight, but subjective self‐assessment of normal weight). The data are the 2004–2005 School Physical Activity and Nutrition III (SPAN), a stratified, multistage probability sample of 4th, 8th, and 11th grade public school children in Texas. We used logistic regression to test whether the gender‐specific 85th percentile BMI level within the individual students grade at their school is positively associated with “under‐assessment” of obesity and overweight. The results show that students are much more likely to under‐assess their own weight if the gender‐specific 85th percentile BMI level is higher in their grade at their school. These data suggest that observable weight distributions play a key role in the obesity epidemic.

Association between depressed mood and perceived weight in middle and high school age students: Texas 2004-2005

Research exploring the relationship between weight perception and depressed mood among adolescents is limited in the United States. The purpose of this study is to examine the association of perceived versus actual body weight and depressed mood in a representative sample of 8th and 11th grade public school students in Texas. Using data from the 2004–2005 School Physical Activity and Nutrition (SPAN) study, logistic regression analyses were conducted to assess the association of weight perception with depressed mood. Healthy weight students who perceived themselves to be a healthy weight were the reference group for all analyses. A high prevalence of misperception of body weight was observed. Overweight and obese 8th grade girls and boys who perceived themselves to be overweight had increased odds of depressed mood [Girls: OR 1.70 (95% CI: 1.07–2.69), Boys: OR 2.05 (95% CI: 1.16–3.62)]. Healthy weight 8th grade girls who perceived themselves to be overweight had 2.5 times greater odds of depressed mood (OR 2.63, 95% CI: 1.54–4.50). Healthy weight boys who perceived themselves to be underweight had more than twice the odds (OR 2.18, 95% CI: 1.23–3.89) of depressed mood. No weight category was significantly associated with depressed mood in boys or girls in 11th grade. The present study suggests that weight misperceptions are associated with depressed mood in young adolescents. Education about healthy body size is necessary to correct the common weight misperceptions observed. The high prevalence rates of depressed mood suggest a greater need for research into understanding factors that may contribute to depressed mood in adolescents.

The effects of acculturation on healthy lifestyle characteristics among Hispanic fourth-grade children in Texas public schools, 2004-2005.

BACKGROUND Childhood obesity is a national epidemic that disproportionately affects Hispanic children. Evidence suggests that increased acculturation among this population adversely affects diet and other healthy lifestyle characteristics, leading to higher rates of overweight and obesity. Healthy lifestyle characteristics must be understood in order to prevent or decrease overweight and obesity among Hispanic children. METHODS Using the School Physical Activity and Nutrition (SPAN) study, we examined cross-sectional data on healthy lifestyle characteristics collected in Texas public schools from Hispanic fourth-grade children in 2004-2005. We calculated adjusted odds ratios and associated confidence intervals using multivariate logistic regression analyses to analyze the association between acculturation and healthy lifestyle characteristics among Spanish-speaking Hispanic children compared to English-speaking Hispanic children. RESULTS Spanish-speaking Hispanic boys consumed more milk and fruit than English-speaking Hispanic boys (milk: adjusted odds ratio [AOR]: 1.7, p = .02; fruit: AOR: 2.5, p = .0001). The likelihood that Spanish-speaking Hispanic boys and girls did not know that there is a relationship between overweight and health problems were 2 times greater (boys: AOR: 1.7, p = .03; girls: AOR: 2.2, p = .006) than their English-speaking Hispanic counterparts. Likelihood of weight loss attempts was greater among Spanish-speaking Hispanic boys than English-speaking Hispanic boys (AOR: 1.9, p = .04). CONCLUSIONS Results are mixed. Lower levels of acculturation appear to be associated with both positive and negative healthy lifestyle characteristics, depending on sex. These findings have important implications for school health policies and programs and should be distributed to school administrators.

Overweight among Low-Income Texas Preschoolers Aged 2 to 4 Years.

OBJECTIVE Determine child/maternal factors associated with overweight among 2- to 4-year-olds enrolled in the Texas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN Matched child and maternal data collected by self-report of the mother during WIC certification. These data were extracted from existing statewide WIC databases and merged. SETTING Texas WIC children aged 2 to 4 years in April 2006. PARTICIPANTS Final sample was 22,837 mother-child dyads. MAIN OUTCOME MEASURE Dependent variable--child overweight; independent variables: Child-related--gender, age, race/ethnicity, Medicaid status, living area, and dental problems; Maternal-related--certification status, age, times certified, overweight, high maternal weight gain, and gestational diabetes. ANALYSIS Bivariate relationships at P < .05 were included in the logistic regression. RESULTS Living in a nonborder urban area associated with greater odds of overweight compared to living in a border area. Mothers overweight, high gestational weight gain, and gestational diabetes associated with greater odds of child overweight. CONCLUSIONS AND IMPLICATIONS Several child- and maternal-related factors were found to be associated with overweight in Texas WIC preschoolers. Health interventions should target 4-year-old Hispanic children living in nonborder urban areas and mothers who are overweight, have high gestational weight gain, or have gestational diabetes.

History of maltreatment among unintentional injury deaths: analyses of Texas child fatality review data, 2005–2007

Objective This report examines unintentional injury deaths among children with and without a history of child maltreatment. Methods Data are from reviews of 1192 unintentional injury deaths occurring among children in Texas during 2005–2007. The study examined differences in child demographic characteristics, injury mechanism, and supervisor status at time of death between children with and without maltreatment history by using descriptive statistics and χ2 tests. Separate analyses compared characteristics of asphyxia, drowning, and poisoning deaths. Results In 10% of the unintentional injury deaths that were reviewed, the child had a history of maltreatment. The prevalence of a history of maltreatment was highest among black decedents and lowest among white decedents. Prevalence of a history of maltreatment was highest among infant decedents and lowest among youth decedents, ages 10–14 years. Among deaths where there was no maltreatment history, 54% were due to motor vehicle related incidents, whereas 51% of deaths among children with maltreatment history were caused by drowning, asphyxia, and poisoning. Supervisors of child decedents with a history of maltreatment were significantly more likely to have been alcohol impaired (6.9% vs 1.6%; p<0.0005), or asleep (12.1% vs 6.6%; p=0.03) at the time of death. Differences between child decedents with and without maltreatment history were observed in infant sleep surface in suffocation deaths, location and barrier type in drowning deaths, and substance type in poisoning deaths. Conclusions These data show that the mechanisms and circumstances surrounding unintentional injury deaths among children with a history of maltreatment differ from those without a history of maltreatment. This underscores the need for appropriate interventions to prevent unintentional and intentional injuries in families with a history of maltreatment.

Surveillance of Bleeding Disorders, Texas, 2007

BACKGROUND In 2007, some 1261 patients with hemophilia or other bleeding disorders were seen at federally funded hemophilia treatment centers (HTCs) in Texas. Although HTCs function as sites for passive surveillance of bleeding disorders, annual HTC visit data likely underestimate true prevalence of the disease due to the infrequent nature of healthcare utilization for this population. PURPOSE The main aim of this study was to compare two alternative methods for estimating prevalence of hemophilia and to describe the challenges associated with making valid prevalence estimates. Each method utilized a separate data source, with the goal of validating one or both of the methods, compared to the gold standard of active case finding. METHODS Two data sets, one describing treatment of hemophilia in an outpatient setting at HTCs and one describing treatment and care of patients in a hospital inpatient setting, were used to calculate annual prevalence estimates of hemophilia among men in Texas in 2007. The prevalence estimates resulting from each of the two methods were compared to each other and to past estimates based on active surveillance. RESULTS Calculations based on HTC data resulted in estimated prevalence rates of 8.9 and 2.1/100,000 male population for hemophilia A and B, respectively. Prevalence estimates based on hospital discharge data yielded rates of 12.3 and 2.9/100,000 males for hemophilia A and B, respectively. CONCLUSIONS Hemophilia is a rare, chronic disease with high treatment costs. Prevalence estimates based on HTC and hospital discharge data were similar to each other as well as to active surveillance prevalence estimates in published literature.