Leland K. Ackerson

Association of Maternal Height With Child Mortality, Anthropometric Failure, and Anemia in India

CONTEXT Prior research on the determinants of child health has focused on contemporaneous risk factors such as maternal behaviors, dietary factors, and immediate environmental conditions. Research on intergenerational factors that might also predispose a child to increased health adversity remains limited. OBJECTIVE To examine the association between maternal height and child mortality, anthropometric failure, and anemia. DESIGN, SETTING, AND POPULATION We retrieved data from the 2005-2006 National Family Health Survey in India (released in 2008). The study population constitutes a nationally representative cross-sectional sample of singleton children aged 0 to 59 months and born after January 2000 or January 2001 (n = 50 750) to mothers aged 15 to 49 years from all 29 states of India. Information on children was obtained by a face-to-face interview with mothers, with a response rate of 94.5%. Height was measured with an adjustable measuring board calibrated in millimeters. Demographic and socioeconomic variables were considered as covariates. Modified Poisson regression models that account for multistage survey design and sampling weights were estimated. MAIN OUTCOME MEASURES Mortality was the primary end point; underweight, stunting, wasting, and anemia were included as secondary outcomes. RESULTS In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (relative risk [RR], 0.978; 95% confidence interval [CI], 0.970-0.987; P < .001), underweight (RR, 0.971; 95% CI, 0.968-0.974; P < .001), stunting (RR, 0.971; 95% CI, 0.968-0.0973; P < .001), wasting (RR, 0.989; 95% CI, 0.984-0.994; P < .001), and anemia (RR, 0.998; 95% CI, 0.997-0.999; P = .02). Children born to mothers who were less than 145 cm in height were 1.71 times more likely to die (95% CI, 1.37-2.13) (absolute probability, 0.09; 95% CI, 0.07-0.12) compared with mothers who were at least 160 cm in height (absolute probability, 0.05; 95% CI, 0.04-0.07). Similar patterns were observed for anthropometric failure related to underweight and stunting. Paternal height was not associated with child mortality or anemia but was associated with child anthropometric failure. CONCLUSION In a nationally representative sample of households in India, maternal height was inversely associated with child mortality and anthropometric failure.

Domestic violence and chronic malnutrition among women and children in India.

Domestic violence has harmful physical and psychological health correlates, but there is little evidence regarding a relation between domestic violence and malnutrition. To investigate this relation, the authors analyzed data from 69,072 women aged 15-49 years and 14,552 children aged 12-35 months in the 1998-1999 Indian National Family Health Survey. Physical domestic violence victimization was self-reported by the women. Aspects of nutritional status included in this study were anemia and underweight. Anemia was measured with a blood test for hemoglobin. Underweight was calculated from anthropometric measurements and was determined as body mass index for women, and it included stunting and wasting for children. Results indicate associations of multiple incidents of domestic violence in the previous year with anemia (odds ratio = 1.11, 95% confidence interval: 1.04, 1.18) and underweight (odds ratio = 1.21, 95% confidence interval: 1.13, 1.29) in women and a suggested relation among children. Possible mechanisms for this relation include withholding of food as a form of abuse and stress-mediated influences of domestic violence on nutritional outcomes. These findings indicate that reducing domestic violence is important not only from a moral and intrinsic perspective but also because of the instrumental health benefits likely to accrue.

Effects of individual and proximate educational context on intimate partner violence: A population-based study of women in India.

OBJECTIVES We examined the role of womens education and proximate educational context on intimate partner violence (IPV). METHODS We examined a sample of 83627 married women aged 15 to 49 years from the 1998 to 1999 Indian National Family Health Survey. We used multilevel multiple logistic regression modeling to estimate the relative effect of womens and their husbands levels of education, spousal education differential, and community-level literacy on womens risk of recent and lifetime IPV. RESULTS In adjusted models, odds of recent IPV among women without any education were 5.61 times (95% confidence interval [CI] = 3.53, 8.92) those of college-educated women, and odds among wives of uneducated men were 1.84 times (95% CI=1.44, 2.35) those of wives of college-educated men. Women with more education than their husbands were more likely than those with educational parity to report recent IPV (odds ratio [OR]=1.18; 95% CI=1.05, 1.33). The results were similar for lifetime IPV. After we controlled for individual factors, as community male and female literacy levels increased, likelihood of IPV declined. CONCLUSIONS Although increasing womens levels of education is crucial to reducing IPV for women, proximate educational context is also an important factor in reducing this public health burden.

Race, Ethnicity, Language, Social Class, and Health Communication Inequalities: A Nationally-Representative Cross-Sectional Study

Background While mass media communications can be an important source of health information, there are substantial social disparities in health knowledge that may be related to media use. The purpose of this study is to investigate how the use of cancer-related health communications is patterned by race, ethnicity, language, and social class. Methodology/Principal Findings In a nationally-representative cross-sectional telephone survey, 5,187 U.S. adults provided information about demographic characteristics, cancer information seeking, and attention to and trust in health information from television, radio, newspaper, magazines, and the Internet. Cancer information seeking was lowest among Spanish-speaking Hispanics (odds ratio: 0.42; 95% confidence interval: 0.28–0.63) compared to non-Hispanic whites. Spanish-speaking Hispanics were more likely than non-Hispanic whites to pay attention to (odds ratio: 3.10; 95% confidence interval: 2.07–4.66) and trust (odds ratio: 2.61; 95% confidence interval: 1.53–4.47) health messages from the radio. Non-Hispanic blacks were more likely than non-Hispanic whites to pay attention to (odds ratio: 2.39; 95% confidence interval: 1.88–3.04) and trust (odds ratio: 2.16; 95% confidence interval: 1.61–2.90) health messages on television. Those who were college graduates tended to pay more attention to health information from newspapers (odds ratio: 1.98; 95% confidence interval: 1.42–2.75), magazines (odds ratio: 1.86; 95% confidence interval: 1.32–2.60), and the Internet (odds ratio: 4.74; 95% confidence interval: 2.70–8.31) and had less trust in cancer-related health information from television (odds ratio: 0.44; 95% confidence interval: 0.32–0.62) and radio (odds ratio: 0.54; 95% confidence interval: 0.34–0.86) compared to those who were not high school graduates. Conclusions/Significance Health media use is patterned by race, ethnicity, language and social class. Providing greater access to and enhancing the quality of health media by taking into account factors associated with social determinants may contribute to addressing social disparities in health.

The Social Context of Interpersonal Communication and Health

Recent years have seen an increased interest in the social context of interpersonal communication. This focus informs major public health topics including health disparities, social networks, social capital, and the penetration of new communication technologies. We use data from the 2003 and 2005 Health Information National Trends Surveys (HINTS) to illustrate the role of social context in interpersonal communication. Finally, we argue that addressing the social context may be an important tool for eliminating communication inequalities.

Intimate Partner Violence and Death Among Infants and Children in India

OBJECTIVE: The goal was to test the association between maternal intimate partner violence (IPV) victimization and child death. METHODS: Information was collected regarding 39096 children <60 months of age in the nationally representative 2005–2006 National Family Health Survey of India. The exposures were maternal reports of physical, sexual, psychological, and any IPV. Outcomes included infant (0 to <12 months), older child (12 to <60 months), and any child (0 to <60 months) deaths. RESULTS: Maternal experience of physical IPV was associated with increased mortality rates among all children (risk ratio [RR]: 1.21 [95% confidence interval [CI]: 1.13–1.30]), infants (RR: 1.24 [95% CI: 1.01–1.53]), and older children (RR: 1.25 [95% CI: 1.00–1.56]). Sexual and psychological IPV were less strongly associated with child death. The associations between maternal IPV and death did not differ according to the childs gender. CONCLUSION: The robust association between exposure to household IPV and infant and child death could be attributable to the mothers inability to care for her child, psychological stress associated with witnessing violence, and the use of maternal violence victimization as a proxy for child violence victimization.

Quality of Colon Cancer Outcomes in Hospitals with a High Percentage of Medicaid Patients

BACKGROUND There is evidence that patients with Medicaid insurance suffer worse outcomes from surgical conditions; but there is little research about whether this reflects clustering of such patients at hospitals with worse outcomes. We assess the outcomes of patients with colon and rectal cancers at hospitals with a high proportion of Medicaid patients. STUDY DESIGN California Cancer Registry patient-level records were linked to discharge abstracts from Californias Office of Statewide Health Planning and Development. All operative California Cancer Registry patients from 1998 and 1999 were included. Hospitals with > 40% Medicaid patients were labeled high Medicaid hospitals (HMH). We analyzed the odds of mortality at 30 days, 1, and 5 years for colon cancer and rectal cancer separately. Multilevel logistic regression models were constructed, using MLwiN 2.0, to include patient and hospital-level characteristics. RESULTS Thirty-day mortality after colon operation was worse in HMH (1% versus 0.6%; p = 0.04); as was 1-year mortality (3.4% versus 2.4%; p = 0.001). There was no substantial difference in rates of 5-year mortality. Individuals who were insured by Medicaid had worse outcomes at 5 years. Adjustment for surgical volume eliminated the effect of HMH at 30 days (1% versus 0.7%; p = 0.45) but not at 1 year (3.4% versus 2.5%; p = 0.01). Adjustment for academic affiliation did not alter these results. There were an insufficient number of rectal cancer patients to detect any differences by hospital type. CONCLUSIONS HMH have higher postoperative colon cancer mortality rates at 30 days and 1 year but not at 5 years. The early effect can be explained by surgical volume, but additional research is needed to determine which factors contribute to differences in intermediate outcomes after operations in HMH settings.

Geography of underweight and overweight among women in India: a multilevel analysis of 3204 neighborhoods in 26 states.

We investigated the geographic distribution and the relationship with neighborhood wealth of underweight and overweight in India. Using multilevel modeling techniques, we calculated state-specific smoothed shrunken state residuals of overweight and underweight, neighborhood and state variation of nutritional status, and the relationships between neighborhood wealth and nutritional status of 76,681 women living in 3204 neighborhoods in 26 Indian states. We found a substantial variation in overweight and underweight at the neighborhood and state levels, net of what could be attributed to individual-level factors. Neighborhood wealth was associated with increased levels of overweight and decreased levels of underweight, and was found to modify the relationship between personal living standard and nutritional status. These findings suggest that interventions to address the double burden of undernutrition and overnutrition in India must take into account state and neighborhood characteristics in order to be successful.

Parental BMI and Childhood Undernutrition in India: An Assessment of Intrauterine Influence

OBJECTIVE: The objective of this study was to examine the influence of parental BMI on childhood undernutrition in India. METHODS: The study population was a nationally representative cross-sectional sample of singleton children (n = 15976) who were aged 0 to 59 months from the 2005–2006 Indian National Family Health Survey. Information was obtained by a face-to-face interview with the mother with a 94.5% response rate. Modified Poisson regression models that account for multistage survey design and sampling weights were applied to estimate the associations between parental BMI and childhood undernutrition. The outcome measures were child underweight, stunting, and wasting; parental BMI was the primary exposure. RESULTS: In mutually adjusted models, an increase in 1 unit of maternal BMI was associated with a lower relative risk (RR) for childhood undernutrition (underweight RR: 0.957 [95% confidence interval [CI]: 0.947–0.967]; stunting RR: 0.985 [95% CI: 0.977–0.993]; wasting RR: 0. 941 [95% CI: 0.926–0.958]). The association between paternal BMI and childhood undernutrition was similar to that observed for maternal BMI (underweight RR: 0.961 [95% CI: 0.951–0.971]; stunting RR: 0.986 [95% CI: 0.978–0.995]; wasting RR: 0.965 [95% CI: 0.947–0.982]). CONCLUSIONS: Similarity in the association between paternal/maternal BMI and childhood undernutrition suggests that intergenerational associations in nutritional status are not driven by maternal intrauterine influences.

The relationship between mental vitality and cardiovascular health.

Past measurement of vitality has included both emotional and physical components. Since aspects of physical vitality such as fatigue can be indicative of physical illness, the usefulness of existing measures of vitality to predict health is limited. This research was designed to examine the psychometric properties of a new Mental Vitality Scale and to test its associations with measures of cardiovascular health over the course of 2 years. The measure of mental vitality was administered in a two-part study using three different samples. In part 1, the reliability and validity of the scale was assessed with a student and a clinic sample. In part 2, medical data on mental and physical health were abstracted over a two-year period from 1041 patient records from a multi-specialty medical practice, and mental vitality assessed through a mailed questionnaire. The findings indicate that the Mental Vitality Scale is a valid and reliable questionnaire for measuring this construct. Mental vitality was also associated with reduced odds of several cardiovascular outcomes and prospective analyses suggest that mental vitality may serve a protective function in the development of cardiovascular disease. The results lend support for the importance of mental vitality as a construct that may be relevant for considering resilience in relation to cardiovascular disease.