Stuart H. Tedders

Low cholesterol is associated with depression among US household population

OBJECTIVE Serum cholesterol was reported to be associated with depressed mood, but the studies conducted among household population are rare. METHODS We used the data of 4115 men and 4275 women aged 18 or older, who completed a depression screening interview and had blood collected as a part of the National Health and Nutrition Examination Survey, 2005-2008. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were gender-specifically categorized into lower, intermediate, and upper quartiles. Depression was measured using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks. RESULTS After adjustment for socio-demographics and behavioral risks, a U-shaped association was detected between severe depression and LDL-C among men. The odds ratios (ORs) of severe depression were 5.13 (95% CI=1.74-15.09), 1 (reference) and 2.28 (1.07-4.86) respectively for the men with lower (<169 mg/dL), intermediate (169-221 mg/dL), and upper quartile (≥ 222 mg/dL) LDL-C. Among women, lower HDL-C was significantly associated with an elevated odds of severe depression [OR=2.96 (1.59-5.52)] compared with upper quartile of HDL-C, the association diminished after adjustment for covariates [OR=1.24 (0.66-2.32)]. No clear pattern of association between cholesterol and moderate depression was observed from either men or women. LIMITATION The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS A U-shaped association was identified between LDL-C and severe depression among men. Further studies are necessary to explore the biological mechanism and identify the clinical implication among populations vulnerable to psychiatric disorders.

Body Mass Index and Death Rate of Colorectal Cancer Among a National Cohort of U.S. Adults.

Substantial evidence suggests that increasing adiposity is associated with an increased death rate of colorectal cancer, but no studies were conducted among national representative populations in the United States. The current study examined the death rate across BMI levels in 7,016 adults who participated in the National Health and Nutrition Examination Survey in 1971–1975. BMI categories were defined as normal (18.5–24.9 kg/m2), overweight (25–29.9), and obese (≥30). A total of 519 cancer deaths were identified during a 17-yr follow-up with 118,998 person-years. No significantly increased death rates of total cancers, lung, breast, and prostate cancer were observed among participants with an increased BMI. However, colorectal cancer death rates were 0.39, 0.68, and 0.96/1,000 person-years, respectively, for normal weight, overweight, and obese (P value for log-rank trend test < 0.001), and the corresponding adjusted hazard ratios [95% confidence intervals (CI)] were 1.00 (reference), 1.25 (95% CI = 0.72–2.19), and 2.04 (1.08–3.83), respectively. No gender difference of the association was identified. The authors conclude that a significantly increased death rate of colorectal cancer was associated with excess body weight. The current study is an addition to the expanding body of literature indicating an increased risk of colorectal cancer development among the obese.

An Assessment of America’s Tobacco-Free Colleges and Universities

Abstract Objective: This study examined the extent to which US campuses identified as “100% tobacco-free” by the American Lung Association of Oregon adhered to the American College Health Associations the most recent guidelines and recommendations promoting tobacco-free environments in colleges and universities. Participants: A key informant from 162 of 175 institutions (92.6% response rate) completed an online survey between January 2010 and February 2010. Methods: The variables under study were assessed via a cross-sectional research design. Participants completed a 35-item survey regarding their schools tobacco policies, procedures, and enforcement practices. Results: Although the vast majority of schools had written policies and procedures in place, schools with current policies were the most compliant. Numerous opportunities for improved adherence were identified in the results. Conclusions: Findings from this study may help institutions in the development and implementation of a new tobacco policy, as well as strengthen policies among existing tobacco-free schools.

Spatial Variations in the Associations of Term Birth Weight with Ambient Air Pollution in Georgia, USA

Birth weight is an important indicator of overall infant health and a strong predictor of infant morbidity and mortality, and low birth weight (LBW) is a leading cause of infant mortality in the United States. Numerous studies have examined the associations of birth weight with ambient air pollution, but the results were inconsistent. In this study, a spatial statistical technique, geographically weighted regression (GWR) is applied to explore the spatial variations in the associations of birth weight with concentrations of ozone (O3) and fine particulate matter (PM2.5) in the State of Georgia, USA adjusted for gestational age, parity, and six other socioeconomic, behavioral, and land use factors. The results show considerable spatial variations in the associations of birth weight with both pollutants. Significant positive, non-significant, and significant negative relationships between birth weight and concentrations of each air pollutant are all found in different parts of the study area, and the different types of the relationships are affected by the socioeconomic and urban characteristics of the communities where the births are located. The significant negative relationships between birth weight and O3 indicate that O3 is a significant risk factor of LBW and these associations are primarily located in less-urbanized communities. On the other hand, PM2.5 is a significant risk factor of LBW in the more-urbanized communities with higher family income and education attainment. These findings suggest that environmental and health policies should be adjusted to address the different effects of air pollutants on birth outcomes across different types of communities to more effectively and efficiently improve birth outcomes.

Dietary protein and protein-rich food in relation to severely depressed mood: A 10 year follow-up of a national cohort

High-protein diets are advocated to facilitate weight loss, and improve cardiovascular risk factors, but data on psychiatric effects are lacking. We analyzed data from 1947 men and 2909 women aged 25-74 years when examined in 1971-1975 as the baseline of the National Health and Nutrition Examination Follow-Up Study. The amounts of macronutrients were obtained from a 24-hour recall, and frequencies of eating protein-rich foods were estimated using a 3-month food frequency questionnaire. Severely depressed mood (SDM) was defined as Center for Epidemiologic Studies Depression Scale score ≥ 22 or taking anti-depression medication after an average of 10.6 years of follow-up. A significant gender difference was observed in the prevalence of SDM and its association with protein intake. The weighted prevalence of SDM was 11.45 (SE = 0.96) % and 17.45(1.05) % respectively among men and women. Among men, the relative risk (RRs) of SDM were 1.00, 0.46 (95% CI = 0.22-0.99) and 0.38 (0.16-0.92) respectively for the lowest, middle and highest third protein intake (p for trend=0.0347). Among women, the RRs were 1.00, 1.93 (1.23-3.08) and 2.47 (1.24-4.90) respectively with lowest, middle and the highest third intakes (p for trend = 0.0023). These estimates were adjusted for cigarette smoking, alcohol consumption, BMI, socioeconomic status at baseline, and the history of cancer, stroke, heart attack and diabetes assessed at follow-up interview. The authors concluded that increased intake of protein demonstrated a protective effect among men but a deleterious effect among women.

Recommendations and Administration of the HPV Vaccine to 11- to 12-Year-Old Girls and Boys: A Statewide Survey of Georgia Vaccines for Children Provider Practices

Objective This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination. Materials and Methods This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design. Results Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated. Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices. Conclusions Despite the Advisory Committee on Immunization Practices’ recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

A Merged Model of Quality Improvement and Evaluation: Maximizing Return on Investment

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder’s return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.

Legume Consumption and Severe Depressed Mood, the Modifying Roles of Gender and Menopausal Status

OBJECTIVE Legumes have been recommended as staple foods in the anticipation of disease prevention. However, the scientific evidence of their benefits, particularly on mental well-being, remains preliminary. We longitudinally assessed the association between legume consumption and the risk of severe depressed mood (SDM) among a national cohort. DESIGN The study included adults aged 25-74 years who were examined in 1971-1975 as a part of the National Health and Nutrition Examination Survey. Legume consumption at baseline was obtained from a 3-month FFQ and categorised as infrequent (<1 time/week), moderate (1-2 times/week) and frequent (> or = 3 times/week). SDM was defined as Center for Epidemiologic Studies Depression Scale score > or = 22 or taking anti-depression medication after an average of 10.6 years of follow-up (from 8.0 to 12.5 years). RESULTS Among women, the proportion of individuals with SDM was 17.75 %. For premenopausal women (n 1778), a significant linear trend of deleterious effect from legume consumption was observed (P for trend = 0.0148). The relative risks (RR) for infrequent, moderate and frequent consumptions were 1 (reference), 1.24 (95 % CI = 0.91, 1.70) and 1.75 (1.12, 2.75), respectively. However, moderate consumption showed a significant protective effect (RR = 0.52 (0.27, 1.00)) among women undergoing the menopausal transition (n 454). No association was obtained from either postmenopausal women (n 601) or men (n 2036). CONCLUSIONS These findings suggest that gender and menopausal status were effect modifiers of the association between legume consumption and SDM. Detrimental effects of frequent consumption of legumes may exist among premenopausal women; moderate consumption, however, may protect perimenopausal women against SDM.

Estimating Neighbourhood-Level Socio-Economic Effect on Preterm Births Using a Multilevel Approach: A Case Study in Georgia, USA

This study investigates the contextual effect of neighbourhood socio-economic status (SES) on the risk of preterm birth (PTB) using multilevel models. Birth data retrieved from 2000 Georgia Vital Records were geocoded and joined to their respective census tracts. The census tract level Index of Deprivation (IoD) was calculated using nine 2000 Census variables based on a previously proposed ‘standard’ index. Two-level random intercept regression models were developed using 117,329 live and singleton births at the individual level and 1618 census tracts at the neighbourhood level. After adjustment for individual-level factors, IoD generated an odds ratio of 1.006 (95% CI 1.00–1.01), showing a modest but significant effect on PTB. Intra-class correlation (ICC) was 0.83% after adjusting for individual-level factors and the census tract level IoD. A wide IOR-80% interval (0.74–1.36) suggests large unexplained residual in between census tract variation remained. The median odds ratio (MOR) value of 1.17 revealed that the unmodelled neighbourhood effect was stronger than the fixed effect of census tract-level predicting variable, IoD, but weaker than the effects of several individual-level predictor variables, including race, tobacco use, prenatal care, foetal death history and marital status. Overall, better census tract-level SES would have a modest protective effect for PTB risk. The full strength of multilevel models should be exploited further to help our understanding of PTB aetiology.

Estimated risk of death among employees in agriculture and agriculture-related industries in Georgia, 1985-1994.

ABSTRACT Farming has an enormous impact on the economy of Georgia, with as many as one in six Georgians working in agriculture. The purpose of this study was to compare the risk of death of white and black farmers to non-farmers in Georgia. Mortality data stratified by age and aggregated by race were retrieved from the Georgia Office of Vital Statistics for the years 1985-1994. The classification system used to code occupation on the death certificate was W473-489, which includes farmers and most all other agricultural occupations. For each cause of death, the Breslow-Day Test was used to determine homogeneity of risk across all age strata (a = 0.05). A common odds ratio (OR) and 95% confidence intervals were calculated for all homogenous causes of death using the Mantel-Haenzel procedure. Among white farmers, the risk of death was significantly high for tuberculosis [OR = 1.64 (1.01, 2.65)], fires [OR = 1.60 (1.15, 2.22)], and accidental drowning [OR = 1.52 (1.01, 2.28)]. The leading causes of death among black farmers were accidental drowning [OR = 1.53 (1.03, 2.26)], cerebrovascular disease [OR = 1.27 (1.18, 1.38)], and ischemic heart disease [OR = 1.21 (1.14, 1.29)]. Causes of death reported to be significantly low were also investigated. The findings of this study are varied, but trends related to risk of death appear to be similar to observed national trends.