Larissa R. Brunner Huber

Validity of Self-reported Height and Weight in Women of Reproductive Age

Objectives: Height and weight are key variables in epidemiologic research, including studies of reproductive outcomes. Optimally, this information is collected by trained study personnel. However, direct measurements are not always feasible. The purpose of this study was to investigate the accuracy of self-reported height and weight, as well as the resultant body mass index (BMI) calculated from self-reported height and weight (referred to as self-reported BMI), among a group of women of reproductive age according to select demographic variables. Methods: A total of 381 women provided self-reported height, weight, and demographic information on a questionnaire for a study of contraceptive trends while attending a Family Medicine clinic. Height and weight were also abstracted from medical records for 275 of these study participants. Self-reported and measured values for height, weight, and BMI were compared using paired t-tests. Analysis of variance, chi-square tests, and Fisher’s Exact tests were used to examine how differences between self-reported and measured values varied by select demographic factors. Results: Women underestimated weight by 4.6 pounds, overestimated height by 0.1 inches, and underestimated BMI by 0.8 kg/m2. All women, regardless of age, education, race/ethnicity, or marital status, underestimated their weight. These differences were statistically significant for all groups (p<0.01) with the exception of women with a high school education. Self-reported height and weight measures classified 84% of women into appropriate BMI categories. Conclusions: Overall, self-reported height and weight were found to give an accurate representation of true BMI in this study. There were some demographic differences in the ability to accurately report height and weight, particularly with respect to race/ethnicity. Future studies should investigate these racial/ethnic differences among a larger population.AbstractObjectives: Height and weight are key variables in epidemiologic research, including studies of reproductive outcomes. Optimally, this information is collected by trained study personnel. However, direct measurements are not always feasible. The purpose of this study was to investigate the accuracy of self-reported height and weight, as well as the resultant body mass index (BMI) calculated from self-reported height and weight (referred to as self-reported BMI), among a group of women of reproductive age according to select demographic variables. Methods: A total of 381 women provided self-reported height, weight, and demographic information on a questionnaire for a study of contraceptive trends while attending a Family Medicine clinic. Height and weight were also abstracted from medical records for 275 of these study participants. Self-reported and measured values for height, weight, and BMI were compared using paired t-tests. Analysis of variance, chi-square tests, and Fisher’s Exact tests were used to examine how differences between self-reported and measured values varied by select demographic factors. Results: Women underestimated weight by 4.6 pounds, overestimated height by 0.1 inches, and underestimated BMI by 0.8 kg/m2. All women, regardless of age, education, race/ethnicity, or marital status, underestimated their weight. These differences were statistically significant for all groups (p<0.01) with the exception of women with a high school education. Self-reported height and weight measures classified 84% of women into appropriate BMI categories. Conclusions: Overall, self-reported height and weight were found to give an accurate representation of true BMI in this study. There were some demographic differences in the ability to accurately report height and weight, particularly with respect to race/ethnicity. Future studies should investigate these racial/ethnic differences among a larger population.

Contraceptive Use among Sexually Active University Students

AIMS The purpose of this exploratory study was to investigate factors related to contraceptive use and nonuse among a group of sexually active women attending a university. METHODS From October 2006 to August 2007, 326 female students participated in a cross-sectional study at a large, public university. Women self-reported information on contraceptive behaviors via web-based and postal mail questionnaires. Among sexually active women, odds ratios (ORs) and 95% confidence intervals (Cls) were calculated to examine the association between various characteristics and the decision to use contraception. Reasons for contraceptive use and nonuse were also further explored. RESULTS Of sexually active women, 77.1% reported using contraception. The most popular methods of contraception used were oral contraceptives and male condoms. Twenty-five percent of women not using contraception indicated that cost was an issue. Women who reported that a healthcare worker had ever talked to them about contraception had 6.63 times the odds of currently using contraception (95% CI 2.30, 19.18). CONCLUSIONS The most common reason for contraceptive nonuse was related to cost. In addition to educating students on the availability of effective, low-cost methods of contraception, healthcare workers can take advantage of well-woman visits to discuss contraceptive use and methods that suit an individuals needs. Such interventions and personalized counseling may lead to higher continuation rates and increased user satisfaction.

Physical Activity and Hypertensive Complications During Pregnancy: Findings from 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System

BACKGROUND Hypertensive complications during pregnancy occur in nearly 8 percent of pregnancies and account for 15 percent of all maternal mortalities in the United States. The purpose of this study was to investigate further the association between physical activity and hypertensive complications during pregnancy using data from a population-based surveillance system. METHODS This study included 3,348 participants from the 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System. Hypertensive complications during pregnancy were assessed using birth certificate data, and physical activity levels before pregnancy and during pregnancy were self-reported on questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders. RESULTS Although no strong association was found between physical activity before pregnancy and hypertensive complications during pregnancy, a dose-response relationship emerged for the physical activity during pregnancy-hypertensive complications association after adjustment for prepregnancy body mass index (physical activity for 1-4 days per week: OR=0.63, 95% CI: 0.45-0.90; physical activity for 5+ days per week: OR=0.46, 95% CI: 0.20-1.02). When levels of physical activity before and during pregnancy were combined, a statistically significant protective effect was seen only for women who indicated that they were physically active both before and during pregnancy (adjusted OR=0.65, 95% CI: 0.44-0.96). CONCLUSIONS In this population-based study, physical activity, particularly during pregnancy, was associated with a lower risk of hypertensive complications during pregnancy. During a healthy pregnancy, health care practitioners may recommend that women engage in physical activity as one way to potentially prevent the development of this critical condition.

The association between recreational parks, facilities and childhood obesity: a cross-sectional study of the 2007 National Survey of Children's Health

Background Despite the rising childhood obesity rates, few studies have examined the association between access to recreational parks and facilities and obesity. Methods A cross-sectional study was performed among 42 278 US children who participated in the 2007 National Survey of Childrens Health. Access to parks and recreational facilities was self-reported by parents, and body mass index was calculated from parents’ self-report of the childs height and weight. Logistic regression was used to obtain ORs and 95% CIs. Since obesity was not a rare occurrence, an OR correction method was used to provide a more reliable estimate of the prevalence ratio (PR). Results Children with access to parks and facilities had decreased prevalence of obesity as compared to children without access (PR=0.79, 95% CI 0.69 to 0.91). After adjustment for covariates, the magnitude of the association remained unchanged; however, results were no longer statistically significant (PR=0.77, 95% CI 0.55 to 1.07). Race/ethnicity was an effect modifier of the access–obesity relationship (p<0.0001). Among Non-Hispanic White children, there was no strong association (PR=0.89, 95% CI 0.64 to 1.23). However, among Non-Hispanic Black children, those who had access to recreational parks and facilities had 0.40 times the prevalence of obesity as compared to those without access, and this result was statistically significant (95% CI 0.17 to 0.90). Conclusions This research highlights potential health disparities in childhood obesity due to limited access to recreational parks and facilities. Additional studies are needed to further investigate this association. If confirmed, providing safe, accessible parks and facilities may be one way to combat childhood obesity, particularly among minority children.

Does Amount of Weight Gain During Pregnancy Modify the Association Between Obesity and Cesarean Section Delivery

BACKGROUND Two-thirds of reproductive-aged women in the United States are overweight or obese and at risk for numerous associated adverse pregnancy outcomes. This study examined whether the amount of weight gained during pregnancy modifies the prepregnancy body mass index (BMI)-cesarean delivery association. METHODS A total of 2,157 women aged 18-45 who participated in the 2008-2009 North Carolina Pregnancy Risk Assessment Monitoring System had complete information on prepregnancy BMI, maternal weight gain, and mode of delivery on infant birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95 percent confidence intervals (CIs) to model the association between prepregnancy BMI and cesarean delivery, and a stratified analysis was conducted to determine whether maternal weight gain was an effect modifier of the prepregnancy BMI-cesarean delivery association. RESULTS Obese women had 1.78 times the odds of cesarean delivery as compared with women with a normal BMI (95% CI: 1.44-2.16). When adjusted for race/ethnicity, live birth order, household income, and education, the association increased in magnitude and remained statistically significant (OR = 2.01, 95% CI: 1.63-2.43). In stratified analyses, the obesity-cesarean delivery association persisted and remained statistically significant among all maternal weight gain categories. CONCLUSIONS Health care practitioners should stress the importance of achieving a healthy prepregnancy weight and gaining an appropriate amount of weight during pregnancy to reduce the risk of cesarean delivery and other adverse pregnancy outcomes.

Contraceptive choices of women 35-44 years of age: findings from the behavioral risk factor surveillance system.

PURPOSE With an estimated 3.1 million unintended pregnancies in the United States each year, patterns of contraceptive use have significant public health importance. Little literature has focused on these patterns in women over age 35. METHODS Using data from the 2004 Behavioral Risk Factor Surveillance System, we conducted a population-based analysis of 22,890 women between the ages of 35-44 years who completed information on family planning. Lifestyle, demographic, and medical history covariates were assessed and multinomial logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI). RESULTS Female sterilization was the most popular contraceptive method among women aged 35-44 years (28.5%). Relative to non-Hispanic white women, Hispanic and non-Hispanic black women were less likely to use effective methods of contraception such as male sterilization (OR = 0.33, 95% CI: 0.23, 0.46; and OR = 0.10, 95% CI: 0.06, 0.16, respectively) and oral contraceptives (OR = 0.55, 95% CI: 0.41, 0.73; and OR = 0.42, 95% CI: 0.31, 0.57, respectively) after adjustment for demographic, lifestyle, and medical factors. CONCLUSIONS Although fecundity is reduced in women of this age group, increased rates of maternal and fetal complications make unintended pregnancies riskier. This study demonstrates opportunities for targeted counseling and increased awareness of the diversity of contraceptive choices for older women.

Serum Micronutrient Concentrations and Risk of Uterine Fibroids

BACKGROUND Although uterine fibroids are among the most common gynecologic conditions affecting women in the United States, research on uterine fibroids is sparse. This study explored the association between micronutrients and uterine fibroids. METHODS We conducted a population-based, cross-sectional analysis of 887 women aged 20-49 who participated in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Serum micronutrient levels were collected during the health examinations, and information on uterine fibroids was assessed on self-reported questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders. RESULTS A statistically significant dose-response relationship was observed between vitamin A and uterine fibroids, after adjustment for age, race, education, body mass index (BMI), and oral contraceptive (OC) use (middle vs. low: OR 2.43, 95% CI 1.35-4.37; high vs. low: OR 2.66, 95% CI 1.16-6.10, p for trend=0.02). After adjustment, a dose-response relationship also emerged for vitamin C, although these associations were not statistically significant. CONCLUSIONS It is possible that certain micronutrients affect uterine fibroid development. If this is confirmed in large prospective studies, clinicians could advise susceptible populations on dietary changes to reduce their risk of uterine fibroids.

The role of family conflict on risky sexual behavior in adolescents aged 15 to 21

PURPOSE Family conflict is related to numerous risky behavioral outcomes during adolescence; however, few studies have examined how family conflict is associated with risky sexual behavior during adolescence. METHODS Data from 1104 adolescents aged 15 to 21 who completed the 2008 National Longitudinal Survey of Youth were analyzed. Information on family conflict (family fighting and family criticizing) and sexual behavior (number of sexual partners in past year and use of contraception at last intercourse) was self-reported. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS After adjustment, adolescents whose family members often fought had increased odds of not using contraception at last intercourse and having two or more sexual partners in the past year (OR, 1.40 [95% CI, 1.04-1.88] and OR, 1.62 [95% CI, 1.23-2.14], respectively). Adolescents whose family members often criticized each other also had increased odds of not using contraception at last intercourse and having two or more sexual partners in the past year (OR, 1.46 [95% CI, 1.12-1.90] and OR, 1.22 [95% CI, 0.96-1.55], respectively). CONCLUSIONS Family conflict was associated with risky sexual behaviors in this racially/ethnically diverse sample of adolescents. If confirmed in other studies, adolescents who experience family conflict may be an important population to target with information regarding safer sex practices.

Comparison of prospective daily diaries and retrospective recall to measure oral contraceptive adherence.

BACKGROUND The purpose of this study was to determine if retrospective recall of oral contraceptive (OC) adherence provides data that are similar to data collected via daily diaries over the same time period. Factors associated with inconsistent agreement between prospective and retrospective measurements of adherence also were explored. STUDY DESIGN A total of 185 women participated in a longitudinal, prospective cohort of OC users, and 113 of these women provided complete information on OC adherence during follow-ups. Concordance beyond chance was assessed using weighted kappa statistics, and logistic regression was used to identify factors associated with inconsistent reporting of adherence. RESULTS There was substantial agreement between prospective and retrospective adherence information (weighted kappa=0.64; 95% CI: 0.52-0.77). Participants with a high school education or less and those who had problems with feeling sad while using OCs had increased odds of inconsistent reporting of adherence (OR=4.38, 95% CI: 1.41-13.61 and OR=3.52, 95% CI: 1.25-9.94, respectively). CONCLUSION While prospective data collection via diaries may improve accuracy, the added expense and burden on study participants may not be necessary. However, the use of retrospective recall may not be appropriate for all study populations.

The well-being of children in food-insecure households: results from The Eastern Caribbean Child Vulnerability Study 2005.

OBJECTIVE To examine the relationship between food insecurity and child well-being indicators. DESIGN Cross-sectional survey conducted in 2344 households with children. The main exposure measure was food insecurity status, which was categorized as food secure or food insecure based on two or more food insecurity questions answered in the affirmative. Multiple logistic regression analysis was used to model the association between food insecurity status and selected child well-being indicators. SETTING Barbados, St. Lucia and St. Vincent and the Grenadines (hereafter St. Vincent), three Eastern Caribbean countries, 2005. SUBJECTS A random sample of households with children was identified by the governments of Barbados, St. Lucia and St. Vincent. In-home interviews were conducted by social workers. RESULTS One-third (33%) of households were categorized as food insecure. Food-insecure households were more likely to include a chronically ill parent (OR = 2.48; 95% CI 1.76, 3.49), a recently divorced parent (OR = 1.92; 95% CI 1.21, 3.05), a child requiring multiple visits to a health-care provider for a disability (OR = 3.98; 95% CI 1.20, 13.19) or injury (OR = 1.78; 95% CI 1.12, 2.83), a child with a learning disability (OR = 2.08; 95% CI 1.16, 3.74) or a child with a physical disability (OR = 2.54; 95% CI 1.22, 5.32) after adjustment for poverty and other demographic variables. CONCLUSIONS The results indicate that food-insecure households were more likely to be burdened by child disability (learning and physical), family system disruption (recent divorce and chronic illness) and child health-care needs (for disability and injury) than food-secure households. The implementation of programmes and policies to minimize food insecurity in the Eastern Caribbean may be warranted.