Mary O. Hearst

Does Residential Density Increase Walking and Other Physical Activity

Many agree that increasing physical activity will improve public health. This paper reports on empirical findings on the relationship between the density of the residential environment, walking and total physical activity. Using multiple objective and self-reported measures for 715 participants in the US, and improved techniques for sampling and analysis, it finds that density is associated with the purpose of walking (travel, leisure) but not the amount of overall walking or overall physical activity, although there are sub-group differences by race/ ethnicity. Overall, higher densities have many benefits in terms of efficient use of infrastructure, housing affordability, energy efficiency and possibly vibrant street life. But higher densities alone, like other built environment features, do not appear to be the silver bullet in the public health campaign to increase physical activity.

Away-from-Home Family Dinner Sources and Associations with Weight Status, Body Composition, and Related Biomarkers of Chronic Disease among Adolescents and Their Parents

Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietetics practitioners. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and takeout foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006-2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly vs none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z score, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, triglycerides, fasting glucose, insulin, and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency, and demographic characteristics. The odds of overweight/obesity were considerably greater when families reported at least one away-from-home dinner purchase in the past week (odds ratio=1.2 to 2.6). Mean percent body fat, metabolic risk cluster z scores, and insulin levels were significantly greater with weekly purchases of family dinner from fast-food restaurants (P<0.05). Mean percent body fat, metabolic risk cluster z scores, and high-density lipoprotein levels were significantly higher for families who purchased weekly family dinner from takeout sources (P<0.05). Although frequent family dinners may be beneficial for adolescents, the source of dinners is likely as important in maintaining a healthy weight. Interventions should focus on encouragement of healthful family meals.

The Effect of Racial Residential Segregation on Black Infant Mortality

Economic differences and proximal risk factors do not fully explain the persistent high infant mortality rates of African Americans (blacks). The authors hypothesized that racial residential segregation plays an independent role in high black infant mortality rates. Segregation restricts social and economic advantage and imposes negative environmental exposures that black women and infants experience. The study sample was obtained from the 2000-2002 US Linked Birth/Infant Death records and included 677,777 black infants residing in 64 cities with 250,000 or more residents. Outcomes were rates of all-cause infant mortality, postneonatal mortality, and external causes of death. Segregation was measured by using the isolation index (dichotomized at 0.60) from the 2000 US Census Housing Patterns. Propensity score matching methods were used. After matching on propensity scores, no independent effect of segregation on black infant mortality rates was found. Results show little statistical evidence that segregation plays an independent role in black infant mortality. However, a key finding is that it is difficult to disentangle contextual effects from the characteristics of individuals.

Effects of variation in temperature management on cerebral performance category scores in patients who received therapeutic hypothermia post cardiac arrest.

AIM To assess differences in cerebral performance category (CPC) in patients who received therapeutic hypothermia post cardiac arrest by time to initiation, time to target temperature, and duration of therapeutic hypothermia (TH). METHODS A secondary data analysis was conducted using hospital-specific data from the international cardiac arrest registry (INTCAR) database. The analytic sample included 172 adult patients who experienced an out-of-hospital cardiac arrest and were treated in one Midwestern hospital. Measures included time from arrest to ROSC, arrest to TH, arrest to target temperature, and length of time target temperature was maintained. CPC was assessed at three points: transfer from ICU, discharge from hospital, and post discharge follow-up. RESULTS Average age was 63.6 years and 74.4% of subjects were male. Subjects had TH initiation a mean of 94.4 min (SD 81.6) after cardiac arrest and reached target temperature after 309.0 min (SD 151.0). In adjusted models, the odds of a poor neurological outcome increased with each 5 min delay in initiating TH at transfer from ICU (OR=1.06, 95% C.I. 1.02-1.10). Similar results were seen for neurological outcomes at hospital discharge (OR=1.06, 95% C.I. 1.02-1.11) and post-discharge follow-up (OR=1.08, 95% C.I. 1.03-1.13). Additionally the odds of a poor neurological outcome increased for every 30 min delay in time to target temperature at post-discharge follow-up (OR=1.17, 95% C.I. 1.01-1.36). CONCLUSION In adults undergoing TH post cardiac arrest, delay in initiation of TH and reaching target temperature differentiated poor versus good neurologic outcomes. Randomized trials assessing the range of current recommended guidelines for TH should be conducted to establish optimal treatment protocols.

Rate of Decline of Forced Vital Capacity Predicts Future Arterial Hypertension: The Coronary Artery Risk Development in Young Adults Study

Lung function studies in middle-aged subjects predict cardiovascular disease mortality. We studied whether greater loss of forced vital capacity (FVC) early in life predicted incident hypertension. The sample was 3205 black and white men and women in the Coronary Artery Risk Development in Young Adults Study examined between 1985 and 1986 (Coronary Artery Risk Development in Young Adults year 0, ages 18–30 years) and 2005–2006 and who were not hypertensive by year 10. FVC was assessed at years 0, 2, 5, 10, and 20. Proportional hazard ratios and linear regression models predicted incident hypertension at years 15 or 20 (n=508) from the change in FVC (FVC at year 10 − peak FVC, where peak FVC was estimated as the maximum across years 0, 2, 5, and 10). Covariates included demographics, center, systolic blood pressure, FVC maximum, smoking, physical activity, asthma, and body mass index. Unadjusted cumulative incident hypertension was 25% in the lowest FVC loss quartile (Q1; median loss: 370 mL) compared with 12% cumulative incident hypertension in those who achieved peak FVC at year 10 (Q4). Minimally adjusted hazard ratio for Q1 versus Q4 was 2.21 (95% CI: 1.73–2.83), and this association remained significant in the fully adjusted model (1.37; 95% CI: 1.05–1.80). Decline in FVC from average age at peak (29.4 years) to 35 years old predicted incident hypertension between average ages 35 and 45 years. The findings may represent a common pathway that may link low normal FVC to cardiovascular disease morbidity and mortality.

Multilevel predictors of adolescent physical activity: a longitudinal analysis.

BackgroundTo examine how factors from a social ecologic model predict physical activity (PA) among adolescents using a longitudinal analysis.MethodsParticipants in this longitudinal study were adolescents (ages 10-16 at baseline) and one parent enrolled in the Transdisciplinary Research on Energetics and Cancer-Identifying Determinants of Eating and Activity (TREC-IDEA) and the Etiology of Childhood Obesity (ECHO). Both studies were designed to assess a socio-ecologic model of adolescent obesity risk. PA was collected using ActiGraph activity monitors at two time points 24 months apart. Other measures included objective height and weight, adolescent and parent questionnaires on multilevel psychological, behavioral and social determinants of PA, and a home PA equipment inventory. Analysis was conducted using SAS, including descriptive characteristics, bivariate and stepped multivariate mixed models, using baseline adjustment. Models were stratified by gender.ResultsThere were 578 adolescents with complete data. Results suggest few statistically significant longitudinal associations with physical activity measured as minutes of MVPA or total counts from accelerometers. For boys, greater self-efficacy (B = 0.75, p = 0.01) and baseline MVPA (B = 0.55, p < 0.01) remained significantly associated with MVPA at follow-up. A similar pattern was observed for total counts. For girls, baseline MVPA (B = 0.58, p = 0.01) and barriers (B = -0.32, p = 0.05) significantly predicted MVPA at follow-up in the full model. The full multilevel model explained 30% of the variance in PA among boys and 24% among girls.ConclusionsPA change in adolescents is a complex issue that is not easily understood. Our findings suggest early PA habits are the most important predictor of PA levels in adolescence. Intervention may be necessary prior to middle school to maintain PA through adolescence.

Meaningful Differences: Comparison of Adult Women Who First Traded Sex as a Juvenile Versus as an Adult

The authors analyzed experiences, characteristics, and risks of adult women who trade sex in Minneapolis, MN (n = 117), and found significant differences between women who first traded sex as a juvenile compared with those who first traded sex as an adult. Adult starters were 3.44 times more likely to use drugs prior to their first sex trade. They were also more likely to have children. Juvenile starters were more likely to trade sex prior to their first instance of drug use and they had worse outcomes in most other domains that were measured. The study findings showed that they can be useful in shaping prevention of prostitution and methods to be used for its intervention.

Examining the relationships between family meal practices, family stressors, and the weight of youth in the family

BackgroundResearch is limited on how the social environment of the home is related to childhood obesity.PurposeThe purpose of this research was to examine the relationships between positive family meal practices, family stressors, and the weight of youth and to examine parental weight status as a moderator of these relationships.MethodsThe study enrolled 368 parent/child dyads from a Minnesota sample. We used mediation analysis to examine the associationsResultsFamilies represented by an overweight parent reported fewer positive family meal practices (p < 0.001), higher levels of depression (p = 0.01), and fewer family rules (p = 0.02) as compared to families represented by a healthy weight parent. For overweight parents, positive family meal practices mediated the relationship between some family stressors and child weight.ConclusionsThis research suggests that the home environment may affect the weight of children in the family, and the effect is more pronounced in families with at least one overweight parent.

Energy Content of U.S. Fast-Food Restaurant Offerings 14-Year Trends

BACKGROUND Within the past decade, there has been increasing attention to the role of fast food in the American diet, including a rise in legislative and media-based efforts that address the healthfulness of fast food. However, no studies have been undertaken to evaluate changes in the energy content of fast-food chain restaurant menu items during this period. PURPOSE To examine changes in the energy content of lunch/dinner menu offerings at eight of the leading fast-food chain restaurants in the U.S. between 1997-1998 and 2009-2010. METHODS Menu offerings and nutrient composition information were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database. Nutrient composition information for items was updated biannually. Changes in median energy content of all lunch/dinner menu offerings and specific categories of menu items among all restaurants and for individual restaurants were examined. Data were collected between 1997 and 2010 and analysis was conducted in 2011. RESULTS Spanning 1997-1998 and 2009-2010, the number of lunch/dinner menu items offered by the restaurants in the study increased by 53%. Across all menu items, the median energy content remained relatively stable over the study period. Examining specific food categories, the median energy content of desserts and condiments increased, the energy content of side items decreased, and energy content of entrées and drinks remained level. CONCLUSIONS Although large increases in the number of menu items were observed, there have been few changes in the energy content of menu offerings at the leading fast-food chain restaurants examined in this study.

Does the built environment relate to the metabolic syndrome in adolescents

This article examines the influence of the neighborhood environment on blood profiles, percent body fat, blood pressure, and the metabolic syndrome (MetS) in adolescents. One hundred and eighty-eight adolescents (10-16 yr) agreed to have a fasting blood sample drawn in addition to measures of weight, height, percent fat, and blood pressure. A MetS cluster score was derived by calculating the sum of the sample-specific z-scores from the percent body fat, fasting glucose, high-density lipoprotein cholesterol (negative), triglyceride, and systolic blood pressure. Geographic Information Systems (GIS) technology was used to calculate the distance to and density of built environmental features. Spearman correlation was used to identify significant (p<0.05) relationships between the built environment and the MetS. Statistically significant correlations were added to linear regression models, adjusted for pubertal status, age, and sex. Multivariate linear regression models revealed significant associations between an increased distance to convenience stores and the MetS. The results of this study suggest a role for the built environment in the development of the MetS.