Nita Vangeepuram

Pubertal Assessment Method and Baseline Characteristics in a Mixed Longitudinal Study of Girls

OBJECTIVES: The objective of this study was to describe the assessment methods and maturation status for a multisite cohort of girls at baseline recruitment and at ages 7 and 8 years. METHODS: The method for pubertal maturation staging was developed collaboratively across 3 sites. Girls at ages 6 to 8 years were recruited at 3 sites: East Harlem, New York; greater Cincinnati metropolitan area; and San Francisco Bay area, California. Baseline characteristics were obtained through interviews with caregivers and anthropometric measurements by trained examiners; breast stage 2 was defined as onset of pubertal maturation. The κ statistic was used to evaluate agreement between master trainers and examiners. Logistic regression models were used to identify factors that are associated with pubertal maturation and linear regression models to examine factors that are associated with height velocity. RESULTS: The baseline cohort included 1239 girls. The proportion of girls who had attained breast stage 2 varied by age, race/ethnicity, BMI percentile, and site. At 7 years, 10.4% of white, 23.4% of black non-Hispanic, and 14.9% of Hispanic girls had attained breast stage ≥2; at 8 years, 18.3%, 42.9%, and 30.9%, respectively, had attained breast stage ≥2. The prime determinant of height velocity was pubertal status. CONCLUSIONS: In this multisite study, there was substantial agreement regarding pubertal staging between examiners across sites. The proportion of girls who had breast development at ages 7 and 8 years, particularly among white girls, is greater than that reported from studies of girls who were born 10 to 30 years earlier.

Associations between phthalate metabolite urinary concentrations and body size measures in New York City children

OBJECTIVE To examine prospectively associations between urinary phthalate metabolite concentrations and body size measures in children. METHODS Urinary concentrations of nine phthalate metabolites: monoethyl (MEP); mono-n-butyl (MBP); mono-(3-carboxypropyl) (MCPP); monobenzyl (MBzP); mono-isobutyl (MiBP); mono-(2-ethylhexyl) (MEHP); mono-(2-ethyl-5-oxohexyl) (MEOHP); mono-(2-ethyl-5-carboxypentyl) (MECPP); and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and the molar sum of the low molecular-weight phthalate metabolites (low MWP: MEP, MBP and MiBP) and high molecular-weight phthalate metabolites (high MWP: MECPP, MEHHP, MEOHP, MEHP and MBzP) and of four di-(2-ethylhexyl) phthalate (DEHP) metabolites (ΣDEHP: MEHP, MEHHP, MEOHP, MECPP) and anthropometry, including body mass index and waist circumference were measured among 387 Hispanic and Black, New York City children who were between six and eight years at cohort enrollment (2004-2007). Relationships between baseline metabolite concentrations and body size characteristics obtained one year later were examined using multivariate-adjusted geometric means for each body size characteristic by continuous and categories of phthalate metabolite concentrations. Stratified analyses by body size (age/sex specific) were conducted. RESULTS No significant associations are reported among all girls or boys. Dose response relationships were seen with monoethyl phthalate and the sum of low molecular-weight phthalates and body mass index and waist circumference among overweight children; for increasing monoethyl phthalate concentration quartiles among girls, adjusted mean body mass indexes were as follows: 21.3, 21.7, 23.8, 23.5 and adjusted mean waist circumference (cm) were as follows: 73.4, 73.5, 79.2, 78.8 (p-trend<0.001 for both). CONCLUSION In this prospective analysis we identified positive relationships between urinary concentrations of monoethyl phthalate and the sum of low molecular-weight phthalates and body size measures in overweight children. These are metabolites with concentrations above 1 μM.

The association between parental perception of neighborhood safety and asthma diagnosis in ethnic minority urban children.

Low-income populations, minorities, and children living in inner cities have high rates of asthma. Recent studies have emphasized the role of psychosocial stress in development of asthma. Residence in unsafe neighborhoods is one potential source of increased stress. The study objective was to examine the association between parental perception of neighborhood safety and asthma diagnosis among inner city, minority children. Cross-sectional data from a community-based study of 6–8-year-old New York City children were used. Asthma was defined as parental report of physician-diagnosed asthma and at least one asthma-related symptom. Parental perceptions of neighborhood safety were assessed with a questionnaire. Associations between perceived neighborhood safety and asthma were examined using chi-squared tests. Multivariate logistic regression analyses were then performed. Five hundred four children were included with 79% female, 26.5% non-Hispanic Black, and 73.5% Hispanic. Asthma was present in 23.8% of children. There was an inverse association between feeling safe walking in the neighborhood and asthma with 45.7% of parents of asthmatic children reporting they felt safe compared to 60.9% of parents of non-asthmatic children (p = 0.006). Fewer parents of asthmatic children than of non-asthmatic children reported that their neighborhood was safe from crime (21.7% versus 33.9%, p = 0.018). In multivariate analyses adjusting for race/ethnicity, age, gender, socioeconomic status, number of smokers in the home and breastfeeding history, parents reporting feeling unsafe walking in the neighborhood were more likely to have a child diagnosed with asthma (OR = 1.89, 95%CI 1.13–3.14). Psychosocial stressors such as living in unsafe neighborhoods may be associated with asthma diagnosis in urban ethnic minority children. Addressing the increased asthma burden in certain communities may require interventions to decrease urban stressors.

Measures of Obesity Associated with Asthma Diagnosis in Ethnic Minority Children

Objective. The study objective was to examine relationships between different body size measurements and asthma in ethnic minority children. Methods. We used data from a community-based study of 505 children aged 6-to-8 years old to study the association of percent body fat, fat distribution, and BMI percentile with asthma diagnosis. Poisson regression models were used to compute prevalence ratios (PRs) for sex-specific quintiles of the body fat measures on the main outcome of asthma. Results. When comparing the highest quintile of each body fat measure to the combined lowest two quintiles, higher body mass index percentile, percent body fat, and waist circumference all were associated with a higher likelihood of physician-diagnosed asthma (PR = 1.63 (95% CI 1.12–2.39), 1.50 (95% CI 1.02–2.21), and 1.56 (95% CI 1.04–2.34), resp.). Conclusions. This study found a significant association between increased body size and asthma diagnosis, regardless of the measurement examined.

Dietary and Physical Activity Behaviors of New York City Children From Different Ethnic Minority Subgroups

OBJECTIVE To examine racial/ethnic differences in diet and physical activity behaviors in ethnic minority New York City children. METHODS Cross-sectional data from a community-based study of 486 6- to 8-year-old children were used. Race/ethnicity was derived using a caregivers report of childs race and Hispanic ancestry. Dietary intake was obtained by 24-hour diet recalls using the Nutrition Data System for Research. Physical activity was assessed with pedometers and caregiver interviews. We compared diet and activity measures across racial/ethnic subgroups using chi-square and analysis of variance tests. Multivariate analyses adjusted for age, gender, body mass index, and caregiver education (with breastfeeding history and total energy intake included in diet models). RESULTS Participants (N = 486) were categorized as Mexican (29.4%), Dominican (8.4%), Puerto Rican (20.6%), other/mixed Hispanic (14.0%), or non-Hispanic black (27.6%). Obesity rates were lower in non-Hispanic blacks (18%) than in Hispanics (31%). Mexicans had the lowest obesity rates among Hispanic subgroups (25%), and Dominicans had the highest (39%). There were differences in mean daily servings of food groups, with Mexicans having healthier diets and Puerto Ricans and non-Hispanic Blacks having less healthy diets. Sedentary time was lower in Mexicans than in other groups in adjusted models. Examination of additional models, including home language, did not show significant differences in the estimates. CONCLUSION Diet and activity behaviors varied across racial/ethnic subgroups. Specifically, Mexican children had healthier diets, the least amount of sedentary time, and the lowest rates of obesity among the Hispanic subgroups examined. Targeted interventions in ethnic subgroups may be warranted to address specific behaviors.

Asthma and physical activity in multiracial girls from three US sites.

Abstract Objective: Studies comparing physical activity levels in children with and without asthma have had mixed results. Our objective was to investigate the association between asthma diagnosis and physical activity and to examine differences in these associations by race/ethnicity, weight status and caregiver education. Methods: We investigated the association between asthma (defined as report of physician-diagnosed asthma with at least one asthma related symptom) and measures of physical and sedentary activity in a study of 6- to 8-year-old girls in the Breast Cancer and the Environment Research Project. We compared reported activity and pedometer measurements among girls with and without asthma, and examined modification of these associations by race/ethnicity, weight status and caregiver education. Results: Girls (n = 1182) were included with 33.5% White, 4.8% Asian, 30.6% non Hispanic Black and 30.7% Hispanic. Asthma was present in 16.2% of girls. Overall, 38% of girls reported no participation in organized recreational activities and 58% had >2 h/day of television, video game and computer time combined. Girls with asthma whose parents were less educated reported fewer pedometer steps and less non-scheduled activity than girls without asthma with similar caregiver education level. Among girls with asthma, those on a controller medication had higher levels of sedentary activity and more structured physical activity but were less likely to report high intensity physical activity. Conclusions: Among girls whose parents are less educated, girls with asthma may have lower physical activity levels than girls without asthma. Use of a controller medication may be related to physical and sedentary activity.

Recruitment in Clinical Versus Community-Based Sites for a Pilot Youth Diabetes Prevention Program, East Harlem, New York, 2011–2012

Introduction Little is known about successful strategies for recruitment of youth for research. The objective of this study was to compare clinical sites with community sites in the recruitment of teenagers for a new youth diabetes prevention program in East Harlem, New York. Methods We assessed diabetes risk for youth (aged 13–19 y) by measuring body mass index (BMI). We then screened overweight and obese youth for prediabetes using oral glucose tolerance testing, had them complete a health and lifestyle survey, and enrolled prediabetic youth into peer-led workshops. The recruitment strategies were 1) clinical referrals and 2) screenings at community sites. We compared the number of adolescents screened, the proportion eligible for testing, the proportion diagnosed with prediabetes, baseline characteristics, and the retention rates between those recruited in clinical and community sites. Results In 3 months, we completed BMI screening for 156 adolescents from community sites and 30 from clinical sites. Overall, 47% were at risk for diabetes on the basis of BMI, and 63% returned for diabetes testing; 35% had prediabetes, and 1 teenager had diabetes. Clinical sites yielded higher rates of diabetes risk on the basis of BMI and higher rates of return for screening and diagnosed prediabetes. Although demographics and BMI did not vary by recruitment site, we found differences in behaviors, self-efficacy, body image, and social support. There were no differences by recruitment site in workshop enrollment or completion or return for follow-up. Conclusion Both recruitment strategies were successful, and participants from both groups had high rates of undiagnosed prediabetes. Our approach allowed access to more adolescents and opportunities for education about diabetes in the community.

Younger pubertal age is associated with allergy and other atopic conditions in girls

Early menarche is linked to higher incidence of adult asthma, suggesting that earlier puberty may influence type 2 immune response characteristics of allergic diseases. We examined the hypothesis that timing of breast and pubic hair development, which precede menarche, is associated with increased childhood atopic conditions.

Smartphone ownership and perspectives on health apps among a vulnerable population in East Harlem, New York

Background Individuals from low-income and racial/ethnic minority backgrounds have traditionally had less access to mobile health (mHealth) technologies, but there is evidence that this gap has been rapidly narrowing. Given the increase in access to mobile technologies recently seen in vulnerable populations, mHealth has been championed as a strategy for improving population health and reducing health disparities. However, members of low-income and racial/ethnic minority populations have had a limited role in the development and implementation of mHealth interventions designed to impact them. Methods We used community-based participatory research (CBPR), a research approach that is frequently employed to help reach communities that are disproportionately affected by illness but are difficult to engage. Our community-academic collaboration, the East Harlem Partnership for Diabetes Prevention, sought to create a mobile technology platform that would allow adults in East Harlem, New York to improve their own health and promote the health of the broader community. As a first step, we developed and conducted a survey of community residents to better understand access to, usage of, and attitudes towards mobile technologies among diverse, low-income adults. We administered the cross-sectional survey to a convenience sample of adults who utilized a variety of community-based organizations in East Harlem. We examined frequencies for each survey item and then used chi-square tests (or Fishers exact tests) and multivariate logistic regression to evaluate relationships between these outcomes and sociodemographic factors. Results We approached 154 people, of whom 104 (68%) agreed to participate. The majority of respondents were of Black and/or Hispanic/Latino descent with a mean age of 37 years. Our sample displayed a high percentage of smartphone ownership (82% of the participants reported that they owned a cell phone, and 88% of owners reported that their cell phone was a smartphone). We found lower rates of ownership among individuals who were older, self-identified as Latino, insured by Medicare, and had a household income of less than

Use of Focus Groups to Inform a Youth Diabetes Prevention Model.

30,000 per year. Multivariate logistic regression showed that after adjusting for age, gender and race, those with at least a high school education were seven times more likely to use health apps than those with less than a high school education (OR 6.8, 95% CI: 1.7-27.1). Participants expressed interest in health promoting apps that provide interactive, individualized diet, exercise and weight loss tools and offer information about local health resources and events. Conclusions Despite some notable disparities, our study results suggest that the digital divide is narrowing in the East Harlem community with relatively high rates of smartphone ownership and use, even among individuals from low-income, low education backgrounds and those without health insurance. Based on study results, our partnership developed an app supporting healthy lifestyle and diabetes prevention tailored to the East Harlem community.