Age of Smoking Initiation in Relation to Multiple Health Risk Factors among US Adult Smokers: National Health Interview Survey (NHIS) Data (2006-2018).

The adverse effects of multiple health risk factors have been well-documented; however, still understudied are the effects of early smoking in the context of multiple health risk factors. This study aimed to examine the role of early smoking initiation in relation to several health risk factors, including heavy drinking, physical inactivity, and obesity in later life among ever smokers in the USA. The National Health Interview Survey (NHIS) data from 2006 through 2018 were analyzed. The primary dependent variables were presence of three other risk factors: heavy drinking, physical inactivity, and obesity. The independent variable was the age of smoking initiation. Logit regression models were constructed to evaluate the association between smoking initiation and multiple health risk factors. All analyses were done in 2022. Among US adult smokers, 18.2% started smoking before age 15 (early initiators), 55.9% at ages 15-18 (middle initiators), and 25.9% at age 20 or later (late initiators). Compared to late smoking initiators, the odds of engaging in additional health risk factors increased by 37.3% among early initiators (OR = 1.373, 95% CI = 1.316, 1.432) and 7.7% among middle initiators (OR = 1.077, 95% CI= 1.041, 1.116). Additionally, current smoking was associated with higher odds (OR = 1.369, 95% CI = 1.322, 1.417) of having additional health risk factors compared to former smoking, with one exception: current smokers had lower odds of obesity (OR = 0.566, 95% CI = 0.537, 0.597). Tobacco control programs to prevent adolescents from initiating smoking may have the potential to prevent other health risk factors in adulthood.

The Impact of Smoking and Multiple Health Behaviors on All-Cause Mortality.

Four common health risk behaviors have the greatest impact on all-cause mortality risk, but studies are needed with larger samples and the appropriate age range for cigarette smokers. We examined the impact of smoking in the context of multiple health behaviors on all-cause mortality using a nationally representative sample of adults aged 30 and older in the United States. National Health Interview Survey data from 1997 to 2005 were linked to the National Death Index with a follow-up to December 2015. The primary dependent variable was all-cause mortality, and the primary predictors were smoking, heavy drinking, physical inactivity, and unhealthy weight (underweight or obesity). The sample contained 189,087 individuals (≥ age 30; population estimate = 140.7 million). Our primary statistical analysis tool involved fitting Cox proportional hazards models. Our findings demonstrated that smoking led to the highest mortality risk among the four risk behaviors examined, but more than half of smokers engaged in at least one additional health risk behavior. Smokers who engaged in multiple health behaviors experienced higher increased mortality risks: smoking combined with one other health risk behavior increased mortality risk by 32% and by 82% when combined with two behaviors. Engaging in all four risk behaviors more than doubled the mortality risk of smokers. Smoking cessation interventions that address multiple risk behaviors-physical inactivity, heavy drinking, and unhealthy weight-will likely prevent premature death better than interventions that address only smoking.

Health-Related Quality of Life Among Patients With Inflammatory Bowel Disease: A Case Control Study.

The aim of this study is to compare health-related quality of life between inflammatory bowel disease patients and age-/gender-matched controls while taking into account comorbid conditions (such as diabetes and heart disease). Data from the 2015 and 2016 National Health Interview Survey were used. Patients with inflammatory bowel disease (n = 951) were age- and gender-matched to noninflammatory bowel disease patients (n = 3,804). Patients with inflammatory bowel disease were more likely to be diagnosed with an airway disease (p < .000), heart disease (p < .000), or stomach cancer (p < .001) than age- and gender-matched individuals without inflammatory bowel disease. Even after controlling for these comorbidities, sociodemographic characteristics as well as health-related behaviors, patients with inflammatory bowel disease had significantly lower health-related quality of life than individuals of the same age and gender. Inflammatory bowel disease appears to be associated with particularly low levels of health-related quality of life. Alcohol consumption, smoking, physical activity, and body mass index may be risk factors for a decreased health-related quality of life.

Revisiting the Quality of Reporting Randomized Controlled Trials in Nursing Literature.

PURPOSE: To examine and update the literature on the quality of randomized controlled trials (RCTs) as reported in top nursing journals, based on manuscripts' adherence to the CONsolidated Standards of Reporting Trials (CONSORT) guidelines. DESIGN: Descriptive review of adherence of RCT manuscript to CONSORT guidelines. METHODS: Top 40 International Scientific Indexing (ISI) ranked nursing journals that published 20 or more RCTs between 2010 and 2014, were included in the study. Selected articles were randomly assigned to four reviewers who assessed the quality of the articles using the CONSORT checklist. Data were analyzed using descriptive and inferential statistics. FINDINGS: A total of 119 articles were included in the review. The mean CONSORT score significantly differed by journal but did not differ based on year of publication. The least consistently reported items included random allocation, who randomly assigned participants and whether those administering the interventions were blinded to group assignment. CONCLUSIONS: Although progress has been made, there is still room for improvement in the quality of RCT reporting in nursing journals. Special attention must be paid to how adequately studies adhere to the CONSORT prior to publication in nursing journals. CLINICAL RELEVANCE: Evidence from (RCTs) are thought to provide the best evidence for evaluating the impact of treatments and interventions by the U.S. Preventive Services Task Force. Since the evidence may be used for the development of clinical practice guidelines, it is critical that RCTs be designed, conducted, and reported appropriately and precisely.

Husbands' knowledge and attendance at wives' postpartum care among rural farmers.

We examined husbands' knowledge and attendance at their wives' postpartum visit in a sample of rural husband-and-wife farmer dyads in central Malawi. A cross-sectional matched-pairs survey of 70 husband-and-wife farmer dyads, who lived in rural communities in Ntcheu district, and had a live birth in the past year was conducted. Data were collected using an interviewer-administered, structured postpartum questionnaire adapted from WHO Safe Motherhood Needs Assessment Questionnaires. Many husbands did not know about postpartum assessments and education their wives received from health facilities. Percent agreement between dyads' responses was lower on questions referring to assessments than to education. The odds of reporting that the woman received postpartum assessments were greater among husbands than among wives. Fifty-nine percent of husbands did not go with their wives for 1-week postpartum visits. Top three reasons for not attending visits were: at work, out of town, and did not see the need.

Use and Evaluation of Postpartum Care Services in Rural Malawi.

PURPOSE: The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. DESIGN: Cross-sectional matched-pairs survey design. METHODS: Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi. Data were collected using an interviewer-administered postpartum care questionnaire from the World Health Organization (WHO) Safe Motherhood Needs Assessment Questionnaires. Data analysis included univariate and multivariate statistics. FINDINGS: Women's evaluation of postpartum care assessments received from midwives in rural health facilities prior to discharge included partial assessments of blood pressure (44%), temperature (41%), abdominal examination (50%), vaginal examination/bleeding (46%), breast examination/soreness (34%), and baby examination (77%). Only 16% of the women received all six of these postpartum clinical assessments prior to discharge, while 11% received none. Women also reported that midwives did not: introduce themselves (50%); ask if patients had questions (44%); explain what they were doing (43%); or explain what to expect after delivery (50%). Despite this, 77% of women felt midwives paid close attention to them and 83% gave an overall positive evaluation (3.5-5 on a scale of 1-5). Numbers of postpartum clinical assessments (p = .09) and overall evaluation (p = .71) did not differ between the four health facilities. The top three reasons for husbands' and wives' decisions to return for 1-week postpartum care visits were: being advised to return for care, wanted the mother to be examined, and wanted the baby to be examined. Participants stated prior negative experiences, or not perceiving a need for care (feels fine), may potentially prevent them from returning for postpartum care visits in a health facility. CONCLUSIONS: Most women reported they received only partial postpartum clinical assessments; thus, it is important for health facilities to address the adequacy of postpartum clinical assessments provided to women by midwives before discharge. Women returned for 1-week postpartum care visits because they were advised to return for care, and also to make sure their babies were examined. However, the principal reason why husbands permitted their wives to return for postpartum care was because they wanted their wives to be examined. CLINICAL RELEVANCE: Midwives need to advise all patients to return for postpartum care visits consistent with WHO or country guidelines, and continue to educate husbands and wives regarding the importance of postpartum care even when the wife feels fine. Refresher in-service trainings on postpartum care are recommended for midwives to encourage them to perform the recommended postpartum clinical assessments.

Racial and ethnic differences in breastfeeding, maternal knowledge, and self-efficacy among low-income mothers.

PURPOSE: The purpose of this secondary analysis was to examine racial and ethnic differences in the propensity to engage in breastfeeding, maternal knowledge, and self-efficacy in infant feeding among three groups of low-income mothers: non-Hispanic (NH) White, NH African American, and Hispanic. BACKGROUND: While racial and ethnic differences in infant feeding practices are substantial, these differences have not been broadly examined in relation to breastfeeding, maternal knowledge, and self-efficacy in infant feeding among low-income mothers. METHODS: This secondary analysis used baseline data from a randomized clinical trial with a sample of 540 low-income, mother-infant dyads from Michigan and Colorado. All data were collected when infants were approximately one month old via self-report questionnaires. RESULTS: After adjusting for mothers' age, education, marital and working status, the odds of engaging in any form of breastfeeding among Hispanic mothers remained significantly higher than among NH African-American mothers (OR=2.5, 95% CI:1.59-3.96) and NH White mothers (OR=1.7, 95% CI:1.08-2.81). However, Hispanic mothers had significantly lower maternal knowledge and self-efficacy in infant feeding than the other two groups. No significant correlations were found between maternal knowledge, self-efficacy in infant feeding, and the propensity to breastfeed. CONCLUSIONS: Racial and ethnic variations were evident in the propensity to breastfeed, maternal knowledge, and self-efficacy in infant feeding suggesting the importance of tailoring breastfeeding programs to improve breastfeeding, and associated positive health outcomes. Further investigation is needed to find a better way to address breastfeeding disparity in relation to race and ethnicity, maternal knowledge, and self-efficacy in infant feeding.

Is quality improvement sustainable? Findings of the American College of Cardiology's Guidelines Applied in Practice.

OBJECTIVE: (i) To examine the sustainability of an in-hospital quality improvement (QI) intervention, the American College of Cardiology's Guideline Applied to Practice (GAP) in acute myocardial infarction (AMI). (ii) To determine the predictors of physician adherence to AMI guidelines-recommended medication prescribing. DESIGN: Prospective observational study. SETTING: Five mid-Michigan community hospitals. PARTICIPANTS: 516 AMI patients admitted consecutively 1 year after the GAP intervention. These patients were compared with 499 post-GAP patients. MAIN OUTCOME MEASURES: The main outcome was adherence to medication use guidelines. Predictors of medication use were determined using multivariable logistic regression analysis. RESULTS: 1 year after GAP implementation, adherence to most medications remained high. We found a significant increase in beta-blocker (BB) use in-hospital (87.9 vs. 72.1%, P < 0.001) whereas cholesterol assessment within 24 h (79.5 vs. 83.6%, P > 0.225) did not change significantly. However, discharge aspirin (83 vs. 90%, P < 0.018) and BB prescriptions (84 vs. 92%, P < 0.016) dropped to preintervention rates. Discharge angiotensin-converting enzyme inhibitor and treatment of patients with low-density lipoprotein of ≥ 100 were unchanged. Predictors of receiving appropriate medications were male gender (for aspirin and BBs) and treatment with percutaneous coronary intervention compared with coronary artery bypass graft. Notably, prescription rates for discharge medications differed significantly by hospital. CONCLUSIONS: Early benefits of the Mid-Michigan GAP intervention on guideline use were only partially sustained at 1 year. Differences in guideline adherence by treatment modality and hospital demonstrate challenges for follow-up phases of GAP. Additional strategies to improve sustainability of QI efforts are urgently needed.

Mortality risks associated with average drinking level and episodic heavy drinking.

Data from the 1997 to 2004 National Health Interview Survey Sample Adult questionnaires were linked to the National Death Index (N = 242,397) to examine mortality risks associated with average and episodic heavy drinking. Cox proportional hazard models (Stata 12.0) revealed that (average) heavier drinkers and episodic heavy drinkers (5+ in a day) had increased mortality risks but when examined together, episodic heavy drinking added only modestly to the mortality risks of light and moderate drinkers. Limitations and implications of results for survey measurement of potentially harmful levels of alcohol use are noted. This was a Federal study that received no outside funding.

Bridging the gap: perceived educational needs in the inpatient to home care setting for the person with a new ostomy.

PURPOSE: The purpose of this study was to investigate what specific ostomy self-care educational content is considered the most useful by the new ostomy patient after discharge. DESIGN: A cross-sectional, correlational design was used to address study aims. SUBJECTS AND SETTING: The sample comprised 33 men and 27 women with a mean age of 55.58 ± 15.56 (mean ± SD) years, range 27 to 79 years old. The study setting was a 587-bed teaching hospital, level 1 trauma center in the Midwest, with Magnet designation. METHODS: Demographic data were collected during the patients' hospital stay as part of routine care. This information is used for follow-up with all ostomy patients who have surgery in this hospital. All of the participants in this study completed an interview administered by phone or in person. A semistructured interview guide was used to elicit participant perceptions of the usefulness of 4 categories of ostomy care, including (1) ostomy information (ostomy function), (2) activities of daily living (strategies to manage travel, bathing, intimacy, odor), (3) ostomy care (strategies for managing the ostomy), and (4) other informational needs (social support resources). Participants were asked to rate these 4 areas from most useful to least useful, using a 4-point scale. At the end of the interview, participants were asked, "Has there been anything that has happened or event related to your ostomy that your ostomy teaching did not prepare you for?" The interview took place several weeks after surgery or during their readmission visit for surgical ostomy takedown. RESULTS: Sixty-two patients were enrolled into the study, and 60 participants completed the data collection. The sample included 26 (43%) patients with ileostomies, 18 (30%) with colostomies, and 16 (27%) with urostomies. Ninety percent ranked the education category of ostomy self-care as the most useful content, 55% ranked information on resuming activities of daily living as the second most useful category, and 55% ranked general information as third most useful content area. Fifty respondents (83%) ranked ostomy support as the least useful. Nine (15%) of the participants felt unprepared for their first pouch leak, and 2 (3%) reported difficulty adjusting to the feel of the stool entering the pouch. Two patients would have liked more photos of peristomal skin conditions and how to treat them. CONCLUSIONS: Since the category of ostomy self-care ranked highest, patient teaching for the new ostomy patient should focus on this skill set, including stoma care, how, and when to empty and change the pouch.

Food patterns and mealtime behaviors in low-income mothers and toddlers.

Maternal and/or child-feeding behaviors and food choices may be important contributors to childhood obesity. We aimed to compare food patterns and mealtime behaviors and to determine predictors of frequent intake of nutrient-dense and energy-dense foods of low-income African American (AA; n = 199) and non-Hispanic White (NHW; n = 200) mother-toddlers dyads using a cross-sectional study. Energy-dense foods were consumed frequently by AA than NHW mother-toddler dyads. Mealtime TV watching for AA and being single for NHW mothers predicted toddlers' frequency of nutrient-dense food intake. These findings have implications for culturally relevant interventions aimed at obesigenic food behavior in low-income parents of toddlers.

Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly?

BACKGROUND: The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used. The purpose of this study was to evaluate the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity, quality of life (QOL) health outcomes compared to CCI medical records data. METHOD: An SCQ-score was generated from patient interview, and the CCI score was generated by medical record review for 525 patients hospitalized for Acute Coronary Syndrome (ACS) at baseline, three months and eight months post-discharge. Linear regression models assessed the extent to which there were differences in the ability of comorbidity measures to predict functional capacity (Activity Status Index [ASI] scores) and quality of life (EuroQOL 5D [EQ5D] scores). RESULTS: The CCI (R2 = 0.245; p = 0.132) did not predict quality of life scores while the SCQ self-report method (R2 = 0.265; p < 0.0005) predicted the EQ5D scores. However, the CCI was almost as good as the SCQ for predicting the ASI scores at three and six months and performed slightly better in predicting ASI at eight-month follow up (R2 = 0.370; p < 0.0005 vs. R2 = 0.358; p < 0.0005) respectively. Only age, gender, family income and Center for Epidemiologic Studies-Depression (CESD) scores showed significant association with both measures in predicting QOL and functional capacity. CONCLUSIONS: Although our model R-squares were fairly low, these results show that the self-report SCQ index is a good alternative method to predict QOL health outcomes when compared to a CCI medical record score. Both measures predicted physical functioning similarly. This suggests that patient self-reported comorbidity data can be used for predicting physical functional capacity and QOL and can serve as a reliable risk adjustment measure. Self-report comorbidity data may provide a cost-effective alternative method for risk adjustment in clinical research, health policy and organizational improvement analyses. TRIAL REGISTRATION: Clinical Trials.gov NCT00416026.

Time of pregnancy recognition and prenatal care use: a population-based study in the United States.

BACKGROUND: A woman who does not recognize her pregnancy early may not initiate prenatal care early. This study examined the relationship between the time of pregnancy recognition and the time of initiation of prenatal care, and the number of prenatal visits among women of childbearing age. METHODS: This study analyzed the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. The analysis sample was representative of resident women of childbearing age in 29 U.S. states who had live births within 2 to 6 months before being contacted. The data were weighed to reflect the complex survey design of the PRAMS, and binary and multinomial logistic regressions were used for the analyses. RESULTS: Most (92.5%) of the 136,373 women in the study had recognized their pregnancy by 12 weeks of gestation, and 80 percent initiated prenatal care within the first trimester. Early pregnancy recognition was associated with significantly increased odds of initiating prenatal care early (OR = 6.05, p < 0.01), after controlling for sociodemographic and prior birth outcome data, and was also associated with lower odds of having fewer than the recommended number of prenatal visits and higher odds of having more than the recommended prenatal visits (OR: <11 visits = 0.71 and >15 visits = 1.17, p < 0.01). CONCLUSIONS: Early pregnancy recognition was associated with improved timing and number of prenatal care visits. Promotion of early pregnancy recognition could be a means of improving birth outcomes by encouraging and empowering women to access prenatal care at a critical point in fetal development.

Mealtime television viewing and dietary quality in low-income African American and Caucasian mother-toddler dyads.

To examine maternal demographic characteristics and depressive symptoms as predictors of TV viewing during mealtimes, and to investigate how mealtime TV viewing predicts mothers' and toddlers' food consumption. A prospective, cross-sectional survey design was employed with 199 African American and 200 Caucasian, low-income, mother-toddler dyads enrolled in eight Early Head Start programs in a Midwestern state. Mothers completed the Toddler-Parent Mealtime Behavior Questionnaire to assess toddler mealtime behavior. Data were analyzed using a three-step multiple regression: (a) step one was to determine what characteristics predicted family TV viewing during mealtime; (b) step two was to determine whether TV viewing during mealtime predicted maternal food consumption, and (c) step three was to determine whether TV viewing during mealtime predicted toddler food consumption. Direct and indirect effects of TV watching were explored via path models. Maternal race, education, and depressive symptoms predicted 8% of the variance in TV viewing during mealtime (P < or = 0.001). African American mothers and mothers who had fewer years of schooling and exhibited more depressive symptoms tended to watch more TV during mealtime. More TV viewing during mealtime predicted mothers' intake of 'more' unhealthy foods. Mothers' food consumption was the single best predictor of toddlers' food consumption, while TV viewing during mealtime had an indirect effect through mothers' TV viewing. TV viewing practices affect mothers' food consumption and mealtime behaviors; this, in turn, impacts toddlers' food consumption. Practical interventions are needed to positively influence the nutritional habits of lower-income mothers. Reducing mothers' "unhealthy" food consumption while watching TV may offer one effective strategy.

Low-income African American and non-Hispanic White mothers' self-efficacy, "picky eater" perception, and toddler fruit and vegetable consumption.

OBJECTIVES: To examine whether and how toddlers' vegetable and fruit consumption is associated with maternal vegetable and fruit consumption, mothers' perceptions of toddlers as "picky eaters," maternal efficacy, and sociodemographic characteristics of the family. DESIGN AND SAMPLE: A cross-sectional survey. One hundred and ninety-nine African American and 200 Non-Hispanic White low-income, mother-toddler dyads enrolled in 8 Early Head Start programs in a Midwestern state. MEASURES: Mothers completed the Feeding Self-Efficacy Scale, Toddler-Parent Mealtime Behavior Questionnaire, and Mothers' and Toddlers' Food Frequency Questionnaires. Data were analyzed using linear and logistic regression models. RESULTS: Toddlers were less likely to consume vegetables 4 or more times a week if their mothers: viewed them as "picky eaters" (OR: 2.5), did not consume vegetables 4 or more times a week themselves (OR: 10.1), and were African American (OR: 2.2). Toddlers were less likely to consume fruits 4 or more times a week if their mothers: viewed them as "picky eaters" (OR: 1.6) and did not consume fruit 4 or more times a week (OR: 9.9) themselves. CONCLUSIONS: Health professionals need to consider mothers' own consumption of fruits and vegetables when developing strategies to increase toddler consumption of fruits and vegetables.

Late recognition of pregnancy as a predictor of adverse birth outcomes.

OBJECTIVE: We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality. STUDY DESIGN: A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX). RESULTS: Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21). CONCLUSION: These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.

Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006.

BACKGROUND: The Body Mass Index (BMI) based on self-reported height and weight ("self-reported BMI") in epidemiologic studies is subject to measurement error. However, because of the ease and efficiency in gathering height and weight information through interviews, it remains important to assess the extent of error present in self-reported BMI measures and to explore possible adjustment factors as well as valid uses of such self-reported measures. METHODS: Using the combined 2001-2006 data from the continuous National Health and Nutrition Examination Survey, discrepancies between BMI measures based on self-reported and physical height and weight measures are estimated and socio-demographic predictors of such discrepancies are identified. Employing adjustments derived from the socio-demographic predictors, the self-reported measures of height and weight in the 2001-2006 National Health Interview Survey are used for population estimates of overweight & obesity as well as the prediction of health risks associated with large BMI values. The analysis relies on two-way frequency tables as well as linear and logistic regression models. All point and variance estimates take into account the complex survey design of the studies involved. RESULTS: Self-reported BMI values tend to overestimate measured BMI values at the low end of the BMI scale (< 22) and underestimate BMI values at the high end, particularly at values > 28. The discrepancies also vary systematically with age (younger and older respondents underestimate their BMI more than respondents aged 42-55), gender and the ethnic/racial background of the respondents. BMI scores, adjusted for socio-demographic characteristics of the respondents, tend to narrow, but do not eliminate misclassification of obese people as merely overweight, but health risk estimates associated with variations in BMI values are virtually the same, whether based on self-report or measured BMI values. CONCLUSION: BMI values based on self-reported height and weight, if corrected for biases associated with socio-demographic characteristics of the survey respondents, can be used to estimate health risks associated with variations in BMI, particularly when using parametric prediction models.

Measurement properties of the centers for epidemiological studies depression scale (CES-D) in a sample of African American and non-Hispanic White pregnant women.

This study investigated the appropriateness of using the CES-D scale for comparing depressive symptoms among pregnant women of different races. Black and White women were matched on education, age, Medicaid status, and marital status-living arrangements. The matching procedure yielded a study sample of 375 in each ethnic group. Using a confirmatory factor analysis, the fit of several factor models for the CES-D was evaluated. One CES-D item, "everything was an effort", showed a low item-total correlation (0.04 among blacks, 0.22 among whites) and was excluded from further analysis. After imposing the constraints of equal factor loadings and factor covariance across both groups, a two-factor model with 19 CES-D items provided a good fit. Only the loading for the "was happy" item displayed a small difference between the two groups. Furthermore, the correlations between the original 20-item and the unbiased 18-item scales were r = 0.994 for Whites and r = 0.992 for Blacks. The results suggest that the 20-item CES-D can be used to compare depressive symptoms in White and Black pregnant women without introducing significant ethnic-racial bias in the measurement of these symptoms.

Parental and Self-Weight Perceptions in U.S. Children and Adolescents, NHANES 2005-2014.

This study aimed to describe the parental and child self-weight perceptions and their associated sociodemographic factors. The 2005-2014 National Health and Nutrition Examination Survey (NHANES) sample of 16,869 children aged 2 to 17 years was used. For overweight/obese children aged 2 to 15 years, 61.2% of parents underestimated their child's weight. For overweight/obese children aged 8 to 17 years, 55.2% underestimated their own weight. For children aged 8 to 15 years, 77.8% parents and children agreed on the weight classification. Parents of boys and those with low income were more likely to underestimate their child's weight. Girls, older children, and those living in larger or high-income families were less likely to underestimate their own weight. Hispanic and Black children tended to underestimate their weight. With increasing child age, parents and children were more likely to disagree on the child's weight. Future efforts should focus on low-income families with larger number of children and Hispanic and Black young children who were more likely to underestimate their weight.