Janice F. Bell

Associations of Television Content Type and Obesity in Children

OBJECTIVES We tested the associations of content types of childrens television viewing with subsequent body mass index (BMI) to assess the plausibility of different causal pathways. METHODS We used time-use diary data from the Panel Survey of Income Dynamics to measure television viewing categorized by format and educational and commercial content. Analyses were stratified by age because children younger than 7 years are less able to understand the persuasive intent of advertising. BMI z scores in 2002 were regressed on television viewing, sociodemographic variables, mothers BMI, and BMI in 1997 (for older children only). RESULTS Among children aged 0 to 6 years in 1997, commercial viewing in 1997 was significantly associated with BMI z scores in 2002 in fully adjusted regressions. Among children older than 6 years, commercial viewing in 2002 was associated with 2002 BMI. These results were robust after adjustment for exercise and eating while watching television. CONCLUSIONS The evidence does not support the contention that television viewing contributes to obesity because it is a sedentary activity. Television advertising, rather than viewing per se, is associated with obesity.

Neighborhood greenness and 2-year changes in body mass index of children and youth.

BACKGROUND Available studies of the built environment and the BMI of children and youth suggest a contemporaneous association with neighborhood greenness in neighborhoods with high population density. The current study tests whether greenness and residential density are independently associated with 2-year changes in the BMI of children and youth. METHODS The sample included children and youth aged 3-16 years who lived at the same address for 24 consecutive months and received well-child care from a Marion County IN clinic network within the years 1996-2002 (n=3831). Multiple linear regression was used to examine associations among age- and gender-specific BMI z-scores in Year 2, residential density, and a satellite-derived measure of greenness, controlling for baseline BMI z-scores and other covariates. Logistic regression was used to model associations between an indicator of BMI z-score increase from baseline to Time 2 and the above-mentioned predictors. RESULTS Higher greenness was significantly associated with lower BMI z-scores at Time 2 regardless of residential density characteristics. Higher residential density was not associated with Time 2 BMI z-scores in models regardless of greenness. Higher greenness was also associated with lower odds of childrens and youths increasing their BMI z-scores over 2 years (OR=0.87; 95% CI=0.79, 0.97). CONCLUSIONS Greenness may present a target for environmental approaches to preventing child obesity. Children and youth living in greener neighborhoods had lower BMI z-scores at Time 2, presumably due to increased physical activity or time spent outdoors. Conceptualizations of walkability from adult studies, based solely on residential density, may not be relevant to children and youth in urban environments.

The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of Us Studies

Background:No current consensus exists on the causal effect of gaining or losing health insurance on health care utilization and health outcomes. Objective:To systemically search and review available evidence of estimated causal effects of health insurance on health care utilization and/or health outcomes among nonelderly adults in the United States. Research Design:A systematic search of 3 electronic databases (PubMed, JSTOR, EconLit) was performed. To be included in the review, studies had to have a publication date after 1991; a population of nonelderly adults; analyses comparing an uninsured group to an appropriate control group; and 1 of 3 study designs that account for potential reverse causality and provide estimates of causal effects (longitudinal cohort, instrumental variable analysis, or quasi-experimental design). Results:A total of 9701 studies, including duplicates, were primarily screened. Fourteen studies fulfilled the criteria to be included in this review—4 longitudinal cohort studies using standard regression or fixed effects analysis, 5 longitudinal cohort studies using instrumental variable regression analysis, and 5 quasi-experimental studies. Conclusions:Results of our review of empirical studies that estimate causal relationships between health insurance and health care utilization and/or health outcomes consistently show that health insurance increases utilization and improves health. Specifically, health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease. These results both confirm and contradict comparable results from the RAND Health Insurance Experiment, the gold standard on relationships between health insurance, utilization, and health.

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

Adolescent Well-Being in Washington State Military Families

OBJECTIVES We examined associations between parental military service and adolescent well-being. METHODS We used cross-sectional data from the 2008 Washington State Healthy Youth Survey collected in public school grades 8, 10, and 12 (n = 10,606). We conducted multivariable logistic regression analyses to test associations between parental military service and adolescent well-being (quality of life, depressed mood, thoughts of suicide). RESULTS In 8th grade, parental deployment was associated with higher odds of reporting thoughts of suicide among adolescent girls (odds ratio [OR] = 1.66; 95% confidence interval [CI] = 1.19, 2.32) and higher odds of low quality of life (OR = 2.10; 95% CI = 1.43, 3.10) and thoughts of suicide (OR = 1.75; 95% CI = 1.15, 2.67) among adolescent boys. In 10th and 12th grades, parental deployment was associated with higher odds of reporting low quality of life (OR = 2.74; 95% CI = 1.79, 4.20), depressed mood (OR = 1.50; 95% CI = 1.02, 2.20), and thoughts of suicide (OR = 1.64; 95% CI = 1.13, 2.38) among adolescent boys. CONCLUSIONS Parental military deployment is associated with increased odds of impaired well-being among adolescents, especially adolescent boys. Military, school-based, and public health professionals have a unique opportunity to develop school- and community-based interventions to improve the well-being of adolescents in military families.

Norms and Trends of Sleep Time Among US Children and Adolescents

OBJECTIVES To develop national sleep norms conditional on age and to examine stratification by sex, race/ethnicity, and changes over time. DESIGN Secondary analysis of a panel survey. SETTING The 3 waves (1997, 2002, and 2007) of the Child Development Supplement of the Panel Study of Income Dynamics, a nationally representative survey. PARTICIPANTS Children from birth to 18 years with time-diary data were included: 2832 children in 1997, 2520 children in 2002, and 1424 children in 2007. MAIN EXPOSURE Age. MAIN OUTCOME MEASURES Minutes of sleep for daytime and total sleep. RESULTS The 10th, 25th, 50th, 75th, and 90th percentiles of the distribution of childrens minutes of sleep conditional on age were estimated using a double-kernel estimator that incorporates sample weights. Total average sleep was estimated at more than 13 hours a day for infants, decreasing steadily throughout childhood and early adolescence, reaching about 9 hours a day for 14- to 18-year-olds. The estimated conditional percentiles were higher on weekends than on weekdays for older children. The conditional percentiles for the weekend sleep minutes were flatter with respect to age than the weekday sleep minutes. The interquartile ranges were greater for children younger than 6 years and for teenagers. The medians stratified by race/ethnicity and sex were similar for most ages. For different survey years, the estimated medians were within a few minutes of each other. CONCLUSIONS These estimates are consistent with the amount of sleep recommended for children, and no evidence was found of racial/ethnic differences.

Income inequality and physical and mental health: testing associations consistent with proposed causal pathways

Objectives: To test associations between individual health outcomes and ecological variables proposed in causal models of relations between income inequality and health. Design: Regression analysis of a large, nationally representative dataset, linked to US census and other county and state level sources of data on ecological covariates. The regressions control for individual economic and demographic covariates as well as relevant potential ecological confounders. Setting: The US population in the year 2000. Participants: 4817 US adults about age 40, representative of the US population. Main outcome measures: Two outcomes were studied: self reported general health status, dichotomised as “fair” or “poor” compared with “excellent”, “very good”, or “good”, and depression as measured by a score on the Center for Epidemiologic Studies depression instrument >16. Results: State generosity was significantly associated with a reduced odds of reporting poor general health (OR 0.84, 95%CI: 0.71 to 0.99), and the county unemployment rate with reduced odds of reporting depression (OR 0.91, 95%CI: 0.84 to 0.97). The measure of income inequality is a significant risk factor for reporting poor general health (OR 1.98, CI: 1.08 to 3.62), controlling for all ecological and individual covariates. In stratified models, the index of social capital is associated with reduced odds of reporting poor general health among black people and Hispanics (OR 0.40, CI: 0.18 to 0.90), but not significant among white people. The inequality measure is significantly associated with reporting poor general health among white people (OR 2.60, CI: 1.22 to 5.56) but not black people and Hispanics. Conclusions: The effect of income inequality on health may work through the influence of invidious social comparisons (particularly among white subjects) and (among black subjects and Latinos) through a reduction in social capital. Researchers may find it fruitful to recognise the cultural specificity of any such effects.

Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort.

Age‐ and sex‐specific annual health‐care expenditures (total, in‐patient, ambulatory care, and outpatient prescription drug) were estimated within established weight classifications in a nationally representative sample of children and adults aged 6–85 years (n = 80,516) in the Medical Expenditures Panel Survey (MEPS). The expenditures were estimated with two‐part regression models and standard errors accounted for the complex survey design. Compared to their normal‐weight counterparts, total expenditures were higher for overweight females between age 22 (

Jail incarceration and birth outcomes

85; 95% CI:

Bullying and Quality of Life in Youths Perceived as Gay, Lesbian, or Bisexual in Washington State, 2010

1,