Heather J. Baer

Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses' Health Study.

Studies of patients with ductal carcinoma in situ (DCIS) “treated” by diagnostic biopsy alone have been rare, but provide important opportunities to gain insights into the natural history of these lesions.

Trends in the diagnosis of overweight and obesity in children and adolescents: 1999-2007.

OBJECTIVE. Pediatric overweight and obesity are increasingly prevalent problems and have received much attention in recent years, but it is unclear whether this publicity has affected diagnosis by clinicians. We undertook the current study to assess trends in diagnosis rates of overweight and obesity in children. PATIENTS AND METHODS. We analyzed electronic medical record data from 60711 patients aged 2 through 18 years with at least 1 well-child visit between June 1999 and October 2007 in a large academic medical system in northeast Ohio. Diagnosis of weight problems among children classified as overweight and obese was assessed by using International Classification of Diseases, Ninth Revision codes. Logistic regression was used to examine the impact of patient characteristics on diagnosis and to investigate trends over the study period. RESULTS. On retrospective review of BMI measurements recorded for patients during the study period, 19% of the children were overweight, 23% were obese, and 8% (33% of the obese patients) were severely obese; among these, 10% of overweight patients, 54% of obese patients, and 76% of severely obese patients had their conditions diagnosed. BMI, age, and number of overweight visits were positively associated with diagnosis. Female patients were more likely to have been diagnosed than male patients. Black and Hispanic patients were more likely to have been diagnosed than white patients. There was a statistically significant trend toward increasing diagnosis during the study period, although the percentage of patients diagnosed per year seemed to plateau or decrease after 2005. CONCLUSIONS. Although clear BMI definitions of pediatric weight problems exist, a large percentage of overweight and obese patients remain undiagnosed. Diagnosis increased during the study period but remained low among overweight children, for whom early intervention may be more effective. Identification of overweight and obese patients is the first step in addressing this growing epidemic.

Magnitude and laterality of breast cancer risk according to histologic type of atypical hyperplasia: results from the Nurses' Health Study.

Atypical hyperplasia (AH) in a benign breast biopsy is associated with an increased breast cancer risk. However, the influence of the histologic type of AH on the magnitude and laterality of breast cancer risk is poorly defined.

Health Behaviors and Racial Disparity in Blood Pressure Control in the National Health and Nutrition Examination Survey

Minorities have a higher prevalence of hypertension, a major risk factor for cardiovascular disease, which contributes to racial/ethnic disparities in morbidity and mortality in the United States. Many modifiable health behaviors have been associated with improved blood pressure control, but it is unclear how racial/ethnic differences in these behaviors are related to the observed disparities in blood pressure control. Cross-sectional analyses were conducted among 21 489 US adults aged >20 years participating in the National Health and Nutrition Examination Survey from 2001 to 2006. Secondary analyses were conducted among those with a self-reported diagnosis of hypertension. Blood pressure control was defined as systolic values <140 mm Hg and diastolic values <90 mm Hg (or <130 mm Hg and <80 mm Hg among diabetics, respectively). In primary analyses, non-Hispanic blacks had 90% higher odds of poorly controlled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). In secondary analyses among hypertensive subjects, non-Hispanic blacks and Mexican Americans had 40% higher odds of uncontrolled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). For both analyses, the racial/ethnic differences in blood pressure control persisted even after further adjustment for modifiable health behaviors, which included medication adherence in secondary analyses (P<0.001 for both analyses). Although population-level adoption of healthy behaviors may contribute to reduction of the societal burden of cardiovascular disease in general, these findings suggest that racial/ethnic differences in some health behaviors do not explain the disparities in hypertension prevalence and control.

Sources of Health Information Related to Preventive Health Behaviors in a National Study

BACKGROUND Current literature suggests that certain sources of information are used in varying degrees among different socioeconomic and demographic groups; therefore, it is important to determine if specific classes of health information sources are more effective than others in promoting health behaviors. PURPOSE This study aims to determine if interpersonal versus mass media sources of health information are associated with meeting recommendations for health behaviors (nonsmoking, fruit/vegetable intake, and exercise) and cancer screening. METHODS Multivariable logistic regression models were used to examine the relationship of health information sources (mass media sources including print, TV, Internet; and interpersonal sources including friends and family, community organizations, and healthcare providers) with meeting recommendations for healthy behaviors and cancer screening in the 2005 and 2007 Health Information National Trends Surveys (HINTS). Analyses were conducted in 2009. RESULTS In the 2005 HINTS, participants reporting use of print media and community organizations as sources of health information over the past year were mostly likely to meet recommendations for health behaviors. In the 2007 HINTS, utilization of healthcare providers for health information was associated with meeting recommendations for health behaviors, particularly cancer screening. CONCLUSIONS Use of print media and interpersonal sources of health information are most consistently associated with self-reported health behaviors. Additional research should explore the relationship of health information sources to clinical outcomes. Social network interventions to promote adoption of health behaviors should be further developed.

Use of a food frequency questionnaire in American Indian and Caucasian pregnant women: a validation study.

BackgroundFood frequency questionnaires (FFQs) have been validated in pregnant women, but few studies have focused specifically on low-income women and minorities. The purpose of this study was to examine the validity of the Harvard Service FFQ (HSFFQ) among low-income American Indian and Caucasian pregnant women.MethodsThe 100-item HSFFQ was administered three times to a sample of pregnant women, and two sets of 24-hour recalls (six total) were collected at approximately 12 and 28 weeks of gestation. The sample included a total of 283 pregnant women who completed Phase 1 of the study and 246 women who completed Phase 2 of the study. Deattenuated Pearson correlation coefficients were used to compare intakes of 24 nutrients estimated from the second and third FFQ to average intakes estimated from the week-12 and week-28 sets of diet recalls.ResultsDeattenuated correlations ranged from 0.09 (polyunsaturated fat) to 0.67 (calcium) for Phase 1 and from 0.27 (sucrose) to 0.63 (total fat) for Phase 2. Average deattenuated correlations for the two phases were 0.48 and 0.47, similar to those reported among other groups of pregnant women.ConclusionThe HSFFQ is a simple self-administered questionnaire that is useful in classifying low-income American Indian and Caucasian women according to relative dietary intake during pregnancy. Its use as a research tool in this population may provide important information about associations of nutrient intakes with pregnancy outcomes and may help to identify groups of women who would benefit most from nutritional interventions.

The influence of family history on breast cancer risk in women with biopsy-confirmed benign breast disease: results from the Nurses' Health Study.

An association between histologic category of benign breast disease (BBD) and breast cancer risk has been well documented. However, the influence of a positive family history (FH) on breast cancer risk among women with biopsy‐confirmed BBD is less certain.

Assessing diet quality in a population of low-income pregnant women: a comparison between Native Americans and whites.

Objective: To assess diet quality of pregnant women in the WIC program in North Dakota and to compare Native Americans with whites, we used a DQI-P (diet quality index for pregnancy) among low-income pregnant women enrolled in WIC, a special supplemental program for women, infants, and children. Methods: Dietary information was collected for all participants using the Harvard Service Food Frequency Questionnaire (HSFFQ). DQI-P scores were based on 10 components previously used in other diet quality indices: percent recommended intake of grains, vegetables, fruits, folate, calcium, and iron; total fat, saturated fat, and cholesterol; and dietary diversity. Each component contributed 10 points to the total possible DQI-P score of 100. Results: The mean DQI-P score was 53.9. Native Americans (51.8) had significantly lower DQI-P scores (51.8 vs. 54.2; p<0.0001); significantly higher scores for iron and folate; and significantly lower scores for cholesterol, total fat intake, and saturated fat components than did whites. As DQI-P scores increased, diet improved and scores for individual components increased. Conclusion: While there were significant differences between the diet quality of Native American and white pregnant women, the differences were minimal. The DQI-P scores for all women in this population indicate that their diets are not meeting dietary recommendations. Interventions should focus on decreasing fat intake and increasing iron and folate intake to meet national dietary recommendations. More emphasis should be placed on eating whole fruit and vegetables.

Adiposity and Sex Hormones in Girls

Greater body fatness during childhood is associated with reduced risk of premenopausal breast cancer, but few studies have addressed the relation of adiposity with sex hormones in girls. We prospectively examined associations between adiposity and circulating levels of sex hormones and sex hormone–binding globulin (SHBG) among 286 girls in the Dietary Intervention Study in Children. Participants were 8 to 10 years old at baseline and were followed for an average of 7 years. Anthropometric measurements were taken at baseline and at subsequent annual visits, and blood samples were collected every 2 years. Concentrations of dehydroepiandrosterone sulfate (DHEAS) during follow-up were higher among girls with greater body mass index (BMI) at baseline. The mean for the lowest BMI quartile was 63.0 μg/dL compared with 78.8 μg/dL for the highest quartile, and each kg/m2 increment in baseline BMI was associated with a 4.3% increase (95% confidence interval, 1.6-7.0%) in DHEAS levels during follow-up (Ptrend = 0.002). Concentrations of SHBG during follow-up were lower among girls with greater BMI at baseline. The mean for the lowest BMI quartile was 94.8 nmol compared with 57.5 nmol for the highest quartile, and each kg/m2 increment in baseline BMI was associated with an 8.8% decrease (95% confidence interval, 7.0-10.6%) in SHBG levels during follow-up (Ptrend < 0.0001). Estrogen and progesterone concentrations were similar across BMI quartiles. These findings suggest that adiposity may alter DHEAS and SHBG levels in girls. Whether and how these differences affect breast development and carcinogenesis requires further research. (Cancer Epidemiol Biomarkers Prev 2007;16(9):1880–8)

Lobule type and subsequent breast cancer risk: Results from the Nurses' Health Studies

Lobules in normal breast tissue can be classified based on their degree of development, which may affect their susceptibility to carcinogenesis. However, few epidemiologic studies to date have addressed this.