M. Janice Gilliland

Perceived Racial/Ethnic Discrimination Among Fifth-Grade Students and Its Association With Mental Health

OBJECTIVES We sought to describe the prevalence, characteristics, and mental health problems of children who experience perceived racial/ethnic discrimination. METHODS We analyzed cross-sectional data from a study of 5147 fifth-grade students and their parents from public schools in 3 US metropolitan areas. We used multivariate logistic regression (overall and stratified by race/ethnicity) to examine the associations of sociodemographic factors and mental health problems with perceived racial/ethnic discrimination. RESULTS Fifteen percent of children reported perceived racial/ethnic discrimination, with 80% reporting that discrimination occurred at school. A greater percentage of Black (20%), Hispanic (15%), and other (16%) children reported perceived racial/ethnic discrimination compared with White (7%) children. Children who reported perceived racial/ethnic discrimination were more likely to have symptoms of each of the 4 mental health conditions included in the analysis: depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. An association between perceived racial/ethnic discrimination and depressive symptoms was found for Black, Hispanic, and other children but not for White children. CONCLUSIONS Perceived racial/ethnic discrimination is not an uncommon experience among fifth-grade students and may be associated with a variety of mental health disorders.

Neighborhood characteristics favorable to outdoor physical activity: Disparities by socioeconomic and racial/ethnic composition

This paper uses a socioecological framework to investigate socioeconomic and racial/ethnic disparities in neighborhood characteristics that are associated with outdoor physical activity. We surveyed 632 parents of 5th graders about perceptions of their neighborhood social processes and collected systematic observations of the physical environment on their block-face of residence. Higher poverty neighborhoods and non-White neighborhoods have better accessibility; however, they are less safe, less comfortable, and less pleasurable for outdoor physical activity, and have less favorable social processes. Interventions to reduce disparities in physical activity should address not only the physical environment, but also social processes favorable to physical activity.

Mediators of Maternal Depression and Family Structure on Child BMI: Parenting Quality and Risk Factors for Child Overweight

Risk factors for child obesity may be influenced by family environment, including maternal depression, family structure, and parenting quality. We tested a path model in which maternal depression and single parent status are associated with parenting quality, which relates to three risk factors for child obesity: diet, leisure, and sedentary behavior. Participants included 4,601 5th‐grade children and their primary caregivers who participated in the Healthy Passages study. Results showed that associations of maternal depression and single parenthood with child BMI are mediated by parenting quality and its relation to childrens leisure activity and sedentary behavior. Interventions for child obesity may be more successful if they target family environment, particularly parenting quality and its impact on childrens active and sedentary behaviors.

Prevalence, Characteristics, and Associated Health and Health Care of Family Homelessness Among Fifth-Grade Students

OBJECTIVES We describe the lifetime prevalence and associated health-related concerns of family homelessness among fifth-grade students. METHODS We used a population-based, cross-sectional survey of 5147 fifth-grade students in 3 US cities to analyze parent-reported measures of family homelessness, child health status, health care access and use, and emotional, developmental, and behavioral health and child-reported measures of health-related quality of life and exposure to violence. RESULTS Seven percent of parents reported that they and their child had experienced homelessness (i.e., staying in shelters, cars, or on the street). Black children and children in the poorest families had the highest prevalence of homelessness (11%). In adjusted analyses, most general health measures were similar for children who had and had not been homeless. Children who had ever experienced homelessness were more likely to have an emotional, behavioral, or developmental problem (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1, 2.6; P = .01), to have received mental health care (OR = 2.2; 95% CI = 1.6, 3.2; P < .001), and to have witnessed serious violence with a knife (OR = 1.6; 95% CI = 1.1, 2.3; P = .007) than were children who were never homeless. CONCLUSIONS Family homelessness affects a substantial minority of fifth-grade children and may have an impact on their emotional, developmental, and behavioral health.

School Programs and Characteristics and Their Influence on Student BMI: Findings from Healthy Passages

Background Little is known about the contribution of school contextual factors to individual student body mass index (BMI). We set out to determine if school characteristics/resources: (1) are associated with student BMI; (2) explain racial/ethnic disparities in student BMI; and (3) explain school-level differences in student BMI. Methods Using gender-stratified multi-level modeling strategies we examined the association of school characteristics/resources and individual BMI in 4,387 5th graders in the Healthy Passages Longitudinal Study of Adolescent Health. Additionally, we examined the association of race/ethnicity and individual BMI as well as the between-school variance in BMI before and after adding individual and school characteristics to test for attenuation. Results The school-level median household income, but not physical activity or nutrition resources, was inversely associated with female BMI (β = −0.12, CI: −0.21,−0.02). Neither school demographics nor physical activity/nutrition resources were predictive of individual BMI in males. In Black females, school characteristics attenuated the association of race/ethnicity and BMI. Individual student characteristics—not school characteristics/resources-reduced the between-school variation in BMI in males by nearly one-third and eliminated it in females. Conclusions In this cohort of 5th graders, school SES was inversely associated with female BMI while school characteristics and resources largely explained Black/White disparities in female weight status. Between-school differences in average student weight status were largely explained by the composition of the student body not by school characteristics or programming.

Health-Care-Seeking Behaviors

Health-care-seeking behavior is that action taken by an individual in response to a stimulus (such as the perception of a symptom) that he or she decides is indicative of a condition needing evaluation by a health professional. This behavior is influenced by personal, physical, and psychological characteristics and by sociocultural and environmental factors. Structural barriers or facilitators can also hinder or abet the decision to seek care. Health-care-seeking behavior is closely related to symptom perception (Chapter 5) in that symptoms are often the stimulus or cue that initiates action by individuals. More urgent, unambiguous symptoms tend to encourage rapid care seeking (Alonzo, 1986; Ell et al., 1994; Hartford, Herlitz, Karlson, & Risenfors, 1990); but even so, people often delay for days, weeks, or even months with symptoms of acute myocardial infarction (AMI), stroke, or cancer. Symptoms and symptom perceptions may contribute to delay or avoidance of care seeking because of psychological responses such as fear, anxiety, or denial (Bosl {tiet al.}, 1981; Hackett & Cassem, 1969; Millar & Millar, 1996).

Planning Community Health Interventions

Public health as a discipline came into being in the mid-19th century and soon led to improvements in the prevention of infectious, nutritional, and parasitic diseases, mainly through amelioration in living conditions for the poorer segments of society. Medical treatment also improved during the same period with the development of better training for physicians and scientific discoveries in nutrition, bacteriology, and other basic sciences (Duffy, 1979). These successes helped to bring about what Omran (1980) has termed the epidemiological transition. This term was coined to describe the change in patterns of human illness from a time when most morbidity and mortality was caused by infectious and communicable diseases to a period when chronic diseases became the leading causes of deaths. Unfortunately, this change has created new challenges for prevention efforts in that oftentimes chronic disease risk is highly associated with certain lifestyle behaviors that may be difficult to change.

Women’s Health and Health Behaviors

Prior to the 1980s, the scientific community paid little serious attention to gender-specific health issues. Most clinical trials conducted before 1980 failed to include women. When women were included, gender differences were typically not reported and presumably not assessed. Findings from studies of men were generalized to women with little regard for the possibility that the results might lack validity across genders. This situation has finally begun to change, as reflected in events such as the 1986 National Institutes of Health (NIH) mandate that government-funded research include women and the 1990 formation within the NIH of the Office of Research on Women’s Health (Stanton, 1995).