Pamela J. Salsberry

The Impact of Prepregnancy Obesity on Children's Cognitive Test Scores

To examine the association between maternal prepregnancy obesity and cognitive test scores of children at early primary school age. A descriptive observational design was used. Study subjects consist of 3,412 US children aged 60–83xa0months from the National Longitudinal Survey of Youth 1979 Mother and Child Survey. Cognitive test scores using the Peabody Individual Achievement Test reading recognition and mathematics tests were used as the outcomes of interest. Association with maternal prepregnancy obesity was examined using the ordinary least square regression controlling for intrauterine, family background, maternal and child factors. Children of obese women had 3 points (0.23 SD units) lower peabody individual achievement test (PIAT) reading recognition score (pxa0=xa00.007), and 2 points (0.16 SD units) lower PIAT mathematics scores (pxa0<xa00.0001), holding all other factors constant. As expected, cognitive test score was associated with stimulating home environment (reading: βxa0=xa00.15, pxa0<xa00.0001, and math: βxa0=xa00.15, pxa0<xa00.0001), household income (reading: βxa0=xa00.03, pxa0=xa00.02 and math: βxa0=xa00.04, pxa0=xa00.004), maternal education (reading: βxa0=xa00.42, pxa0=xa00.0005, and math: βxa0=xa00.32, pxa0=xa00.008), and maternal cognitive skills (reading: βxa0=xa00.11, pxa0<xa00.0001, and math: βxa0=xa00.09, pxa0<xa00.0001). There was a significant association between maternal prepregnancy obesity and child cognitive test scores that could not be explained by other intrauterine, family background, maternal, and child factors. Children who live in disadvantaged postnatal environments may be most affected by the effects of maternal prepregnancy obesity. Replications of the current study using different cohorts are warranted to confirm the association between maternal prepregnancy obesity and child cognitive test scores.

The effects of state-level scope-of-practice regulations on the number and growth of nurse practitioners

BACKGROUNDnIt is widely recognized that there is significant state-level variation in scope-of-practice regulations (SSoPRs) for nurse practitioners (NPs).nnnPURPOSEnThis study was designed to examine whether SSoPRs influence labor markets for NPs.nnnMETHODnCross-sectional analysis examining how SSoPRs influence the number and growth in NPs; data from the Area Resource File and 2008 Pearson report were used.nnnDISCUSSIONnRestrictive SSoPRs reduced the number of NPs by about 10 per 100,000 and reduced the growth rate by 25%. No difference was found between states with the most restriction and those with some restrictions.nnnCONCLUSIONSnThese results imply that changes to practice regulations should not be incremental but should follow the current practices in the least restrictive states. Results also indicate that other factors (poverty, uninsurance rates, rurality) decreased the number of NPs, suggesting that solving the primary care provider shortage will require multiple strategies.

Growth Differences by Age of Menarche in African American and White Girls

Background:Because of the rapid increases in childhood obesity coupled with decreases in the median age of menarche, there is interest in how growth (body mass index [BMI] and height) in childhood may be associated with timing of menarche. Objectives:Two research questions were addressed in this article: (a) Within each race, at what ages were BMI and height differences evident among the early-, the mid-, and the late-onset groups? And (b) within each timing group, at what ages were BMI and height differences evident between White and African American girls? Methods:The mother/child files of the National Longitudinal Survey of Youth were used for this study. Menarcheal timing groups were identified using the 25th and the 75th percentile of the age distribution for each race. Longitudinal statistical techniques were used to estimate BMI and height as polynomial functions of age and age relative to menarche for African American and White girls. Results:Significant differences in BMI by timing group were found. By 3 years of age, significant differences were found between early- and mid-onset African American girls, by 5 years of age between mid- and late-onset African American girls, and by 6 years of age among the three timing groups of White girls. Significant height differences were evident by 5 years of age when comparing early- to mid-onset and mid- to late-onset girls in both race groups. Comparing across race and within timing group, BMI and height differences were evident. African American girls were more likely than White girls to experience accelerated growth and earlier menarche. Discussion:This is one of the few longitudinal studies of differences in growth by timing of menarche that includes data on girls younger than 5 years with large samples of both African American and White girls. Understanding when differences are first apparent is critical in establishing the critical period for prevention of these high-risk growth patterns.

African-American/white differences in the age of menarche: Accounting for the difference

Lifetime health disparity between African-American and white females begins with lower birthweight and higher rates of childhood overweight. In adolescence, African-American girls experience earlier menarche. Understanding the origins of these health disparities is a national priority. There is growing literature suggesting that the life course health development model is a useful framework for studying disparities. The purpose of this study was to quantify the influence of explanatory factors from key developmental stages on the age of menarche and to determine how much of the overall race difference in age of menarche they could explain. The factors were maternal age of menarche, birthweight, poverty during early childhood (age 0 through 5 years), and child BMI z-scores at 6 years. The sample, drawn from the US National Longitudinal Surveys of Youth Child-Mother file, consisted of 2337 girls born between 1978 and 1998. Mean age of menarche in months was 144 for African-American girls and 150 for whites. An instrumental variable approach was used to estimate a causal effect of child BMI z-score on age of menarche. The instrumental variables were pre-pregnancy BMI, high gestational weight gain and smoking during pregnancy. We found strong effects of maternal age of menarche, birthweight, and child BMI z-score (-5.23, 95% CI [-7.35,-3.12]) for both African-Americans and whites. Age of menarche declined with increases in exposure to poverty during early childhood for whites. There was no effect of poverty for African-Americans. We used Oaxaca decomposition techniques to determine how much of the overall race difference in age of menarche was attributable to race differences in observable factors and how much was due to race dependent responses. The African-American/white difference in childhood BMI explained about 18% of the overall difference in age of menarche and birthweight differences explained another 11%.

Effects of heritability, shared environment, and nonshared intrauterine conditions on child and adolescent BMI.

Heritability studies of BMI, based upon twin samples, have identified genetic and shared environmental components of BMI, but have been largely silent about the nonshared environmental factors. Intrauterine factors have been identified as having significant long‐term effects on BMI and may be a critical source of nonshared environmental influence. Extant studies based on samples of either unrelated individuals or twins cannot separate the effects of genetics, shared environments, and nonshared intrauterine conditions because the one lacks variation in the degree of relatedness and the other has insufficient variation in intrauterine conditions. This study improves upon these prior studies by using a large, sibling‐based sample to examine heritability, shared environmental, and nonshared intrauterine influences on BMI during two age periods in childhood (6–8 years; 12–14 years). The primary interest was in determining the effects of the intrauterine environment on BMI as a component of the nonshared environment and in determining whether there were sex‐specific differences in heritability and/or in the intrauterine factors. These were estimated using regression‐based techniques introduced by DeFries and Fulker. Heritability of BMI was estimated to be 0.20–0.28 at 6–8 years and 0.46–0.61 at 12–14 years. Differences in heritability were found at 12–14 years between same‐sex as compared to mixed‐sex pairs. The shared environmental effect was significant at 6–8 years but insignificant at 12–14 years. Differences in birth weight were significant in all groups at 6–8 years suggesting long‐term effects of the nonshared intrauterine environment; at 12–14 years, birth weight was no longer significant for girls.

Comparing the Influence of Childhood and Adult Economic Status on Midlife Obesity in Mexican American, White, and African American Women

OBJECTIVEnThis research addresses the following 2 questions. What is the effect of childhood and adult economic status on midlife obesity in Mexican American women? How do these economic patterns in Mexican American women compare with patterns seen in White women and in African American women?nnnMETHODnData were drawn from the U.S. National Longitudinal Survey of Youths 1979-2002 waves. The sample consisted of 422 Mexican Americans, 2,090 Whites, and 1,195 African Americans. The economic indicator used for childhood economic status was parent education; for adult economic status, the participants own education and adult per capita income were used. Unadjusted and adjusted odds ratios were estimated for the relationship between midlife obesity and economic indicator, stratified by race/ethnic group.nnnRESULTSnThere was an increased risk for midlife obesity with disadvantaged economic status measured during childhood and at midlife in Mexican American women. The economic effects on midlife obesity in Mexican American women were similar to those found for White, but not African American women. Few economic influences on obesity at midlife were found for African American women.nnnCONCLUSIONSnStrategies that broadly improve the economic conditions of Mexican American women may be one important way to address the obesity epidemic in this population.

Racial differences in the health of childbearing-aged women.

The incidence of preterm birth in the United States varies by race/ethnicity and socioeconomic status. Given the unsatisfactory reduction in preterm birth with interventions directed at single risk factors, we examined the preconceptional health of childbearing-aged women of different racial/ethnic groups to understand the risk prior to pregnancy. PurposeTo evaluate the preconceptional health of childbearing-aged women by examining specific health factors implicated in preterm birth in light of racial/ethnic and socioeconomic factors. We tested the hypothesis that subgroups with historically high levels of preterm birth would have poorer preconceptional health compared to other groups and that the economic influence would be similar across groups. Study Design and MethodsWe performed a secondary analysis of cross-sectional population-based data from the National Health and Nutrition Examination Survey 2001–2002 and 2003–2004 data sets, including 1,497 of 2,108 eligible White, African American, and Mexican American women. We measured health using select indicators of cardiovascular and metabolic disorders, infectious disease, and sexual and substance-use behaviors associated with increased risk for preterm birth and conducted comparisons within and across racial groups. We used adjusted logistic regression by race. ResultsIn addition to increased rates of preterm birth shown in the literature, childbearing-aged African American women have poorer overall preconceptional health than the other groups. Measures of socioeconomic status affect preconceptional health differently for each racial/ethnic group. Clinical ImplicationsRacial/ethnic subgroups with higher rates of preterm birth experience poorer health preconceptionally. Clinicians should address preconceptional health risks for preterm birth in all childbearing-aged women, paying attention to racial/ethnic-specific risks identified here.

Racial differences in the association between maternal prepregnancy obesity and children's behavior problems.

Objective: Evidence for the adverse effects of prepregnancy obesity on offsprings neurodevelopmental outcomes has begun to emerge. The authors examined the association between prepregnancy obesity and childrens behavioral problems and if the association would differ by race. Methods: This observational study used a total of 3395 white (n = 2127) and African-American (n = 1268) children aged 96 to 119 months from the National Longitudinal Survey of Youth. Behavior Problem Index (BPI) total and subscale scores were used to measure childrens behavioral problems. The association between maternal prepregnancy obesity and the BPI scores for each racial group was examined using multivariate linear and logistic regressions, controlling for prenatal, child, maternal, and family background factors. Results: Maternal prepregnancy obesity was independently associated with an increase in the BPI total scores among the white sample only. Among the African-Americans, prepregnancy obesity was not associated with the BPI scores. Subsample analyses using externalizing and internalizing subscales also revealed similar trends. Among the white sample, children born to obese women were more socially disadvantaged than those born to nonobese women, whereas no such trend was observed in children of African-American obese and nonobese women. Conclusion: The impact of maternal prepregnancy obesity on childrens behavioral problems differed by racial groups. Obesity-related metabolic dysregulations during the intrauterine period may not contribute to later childrens behavioral problems. Social and psychological factors seem to play key roles in the association between prepregnancy obesity and childhood behavioral problems among whites.

Douching Patterns in Women Related to Socioeconomic and Racial/Ethnic Characteristics

OBJECTIVEnTo examine whether socioeconomic and racial/ethnic characteristics contribute independently and in combination to influence douching behavior.nnnDESIGNnA cross-sectional design.nnnSETTINGnUnited States.nnnPARTICIPANTSnWomen between 14 and 49 years of age who were both interviewed and examined as part of the National Health and Nutrition Examination Survey data collection process.nnnMAIN OUTCOME MEASURESnDouching rates in women categorized on socioeconomic and racial and ethnic characteristics.nnnRESULTSnBased on data from 3,522 women, 21% reported recent douching. Separated by race, Black women douche at much higher percentage (47%) than non-Hispanic White (17%), Mexico-born Mexican American women (12.5%), or U.S.-born Mexican American women (19%). Although increasing age and low socioeconomic status are both associated with increased douching, the effects of socioeconomic status on douching vary by race/ethnicity.nnnCONCLUSIONSnLow income and minority racial status contribute both independently and together to influence douching behavior in women. These findings suggest cultural contributions to douching may be especially prevalent in the Black population while Mexican American women born in Mexico may be relatively immune to U.S. cultural influences.

Integrating Risks for Type 2 Diabetes Across Childhood: A Life Course Perspective

Type 2 diabetes (T2DM) emerged among children, due in large measure to a strong physiological link between increased weight states and T2DM. In this article, cumulative risk factors for T2DM across childhood and its underlying mechanisms are reviewed. The points of intervention for T2DM should occur throughout childhood. The use of Halfon and Hochsteins framework enables practitioners and researchers in the nursing field to better understand a childs individual risk for T2DM. Only with this long view will prevention and interventions be successful in stemming the tide of the twin epidemic threatening children worldwide.