Sexual Partner Accumulation From Adolescence to Early Adulthood in Populations With Physical Disabilities in the U.S.

PURPOSE: This study aimed to examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation. METHODS: Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Poisson regression models were used to assess differences in pre-18 and lifetime sexual partner counts among populations with physical disabilities compared with those without disabilities. Moderation analyses by biological sex, race/ethnicity, and sexual orientation were used to consider further differences among minority subgroups. RESULTS: The results indicated more similarities than differences in sexual partnering patterns across disability severity groups. Specifically, populations with disabilities had just as many pre-18 and lifetime sexual partners as peers without disabilities. There was variation by biological sex, race/ethnicity, and sexual orientation, although this was not tied to disability status. CONCLUSIONS: These results fill an important gap in the literature by considering the sexual partnering behaviors of populations with physical disabilities in the U.S. over the life course. Future research should continue to include populations with disabilities and other minority groups to ensure that their experiences are represented in sexual health policies and programs.

Preterm Birth and Receipt of Postpartum Contraception Among Women with Medicaid in North Carolina.

OBJECTIVES: To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB). METHODS: We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24-36 weeks compared to 37-42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression. RESULTS: Less than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74-0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77-0.88) compared to women with a term birth. CONCLUSIONS FOR PRACTICE: Contraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed. SIGNIFICANCE: Access to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011-2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period.

Variations in the timing of first sexual experiences among populations with physical disabilities in the United States.

BACKGROUND: Timing of first sex has important implications for later sexual health, but little research has considered this in populations with physical disabilities. OBJECTIVE: The purpose of this paper was to examine timing of sexual experiences among populations with physical disabilities in the United States from adolescence to early adulthood, and how timing varies by biological sex, race/ethnicity, and sexual orientation. We hypothesized that those with physical disabilities would exhibit earlier initiation of each type of sexual activity compared to those without disabilities, but the degree of differences would depend on disability severity. We further hypothesized that these associations would be moderated by biological sex, race/ethnicity, and sexual orientation. METHODS: Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Cox proportional hazards models assessed differences in timing of vaginal, oral, anal, and first sex by disability severity. RESULTS: Populations with the most severe physical disabilities had a significantly slower progression to first vaginal sex, oral sex, and their first sexual experience compared to those without disabilities (aHR: 0.74-0.77). Timing also differed by biological sex, race/ethnicity, and sexual orientation, though the direction and degree of these differences varied by disability severity. CONCLUSIONS: Results fill an important gap in the literature by considering variations in sexual timing among populations with physical disabilities using a longitudinal, nationally representative sample. Future research should continue to promote inclusion of populations with disabilities to inform future policies and programs for healthy sexual development.

Effects of Two Educational Posters on Contraceptive Knowledge and Intentions: A Randomized Controlled Trial.

OBJECTIVE: To compare the Centers for Disease Control and Prevention's (CDC) contraceptive effectiveness poster with a more patient-centered poster on factors affecting the likelihood of using effective contraceptives. METHODS: The posters were tested in a randomized controlled trial. Women were eligible if they were aged 18-44 years, could speak and read English, were not pregnant or trying to conceive, and had engaged in vaginal intercourse in the past 3 months. An online survey administered through Amazon Mechanical Turk was used to collect baseline and immediate follow-up data on three primary outcomes: contraceptive knowledge (measured using the Contraceptive Knowledge Assessment), perceived pregnancy risk, and the effectiveness of the contraceptive the woman intended to use in the next year. Subgroup analyses were conducted in women with prior pregnancy scares, low numeracy, and no current contraceptive. Within- and between-group differences were compared for the two randomized groups. RESULTS: From January 26 to February 13, 2018, 2,930 people were screened and 990 randomized. For the primary outcomes, the only significant result was that the patient-centered poster produced a greater improvement in contraceptive knowledge than the CDC poster (P<.001). Relative to baseline, both posters significantly improved contraceptive knowledge (CDC +3.6, patient-centered +6.4 percentage points, P<.001) and a constructed score measuring the effectiveness of the contraceptive that women intended to use in the next year (CDC and patient-centered +3 percentage points, P<.01). This is equivalent to 1-17 of every 100 women who viewed a poster changing their intentions in favor of a more effective contraceptive. CONCLUSION: This study suggests that both posters educate women about contraception and may reduce unplanned pregnancy risk by improving contraceptive intentions. Of the three primary outcomes, the patient-centered poster performs significantly better than the CDC poster at increasing contraceptive knowledge. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03372369.

Cognitive interviews to improve a patient-centered contraceptive effectiveness poster.

OBJECTIVES: To refine the Centers for Disease Control and Prevention (CDC)'s contraceptive education poster using patient-centered design. STUDY DESIGN: We conducted cognitive interviews with 26 women aged 18-44 living in North Carolina who spoke and read English and had ever had sex. We interviewed women about both a CDC and a patient-centered poster in alternating order. Participants were contraceptive users and non-users that we selected purposively to have a range of characteristics that might influence their perspective: age, race/ethnicity, previous births and pregnancies, contraceptive method(s) used in the past three months, pregnancy intentions, and numeracy. The initial response rate for participants was 55%. We used cognitive theory to code interviews for comprehension, relevance, and acceptability, as well as design and overall preference. We structured the 26 interviews into four rounds and revised the patient-centered poster after each round to improve these measures. RESULTS: By the final round, 83% of women preferred the patient-centered poster. The majority of women favored this poster's relevance (86%), and design (100%) and ease of comprehension (86%). Women raised few concerns about the acceptability of the final version of the patient-centered poster. Women identified many issues with both posters that the researchers did not anticipate, highlighting the value of patient-centered design approaches to educational materials. CONCLUSIONS: This study refined a patient-centered poster so that its language is clear and it addresses the informational needs of its target audience. IMPLICATIONS: The Centers for Disease Control and Prevention and the Office of Population Affairs recommend that clinicians educate women about contraception. This study developed a poster that could help clinicians follow this recommendation. Before widespread implementation, more research is needed to evaluate the poster's impact on contraceptive knowledge and behaviors.

Adherence to gender-typical behavior and high frequency substance use from adolescence into young adulthood.

Substance use is prevalent among adolescents in the U.S., especially males. Understanding the cross-sectional and longitudinal associations between gender norms and substance use is necessary to tailor substance use prevention messages and efforts appropriately. This study investigates the relationship between adherence to gender-typical behavior (AGB) and substance use from adolescence into young adulthood. Participants in the National Longitudinal Study of Adolescent to Adult Health completed self-report measures on the frequency of binge drinking, cigarette smoking and marijuana use as well as various behaviors and emotional states that captured the latent construct of AGB. Sex-stratified logistic regression models revealed cross-sectional and longitudinal relationships between AGB and high frequency substance use. For example, an adolescent male who is more gender-adherent, compared to less adherent males, has 75% higher odds of high frequency binge drinking in adolescence and 22% higher odds of high frequency binge drinking in young adulthood. Sex-stratified multinomial logistic regression models also revealed cross-sectional and longitudinal relationships between AGB and patterns of use. For example, a more gender-adherent adolescent male, compared to one who is less adherent, is 256% more likely to use all three substances in adolescence and 66% more likely to use all three in young adulthood. Cross-sectional and longitudinal results for females indicate greater gender-adherence is associated with lower odds of high frequency substance use. These findings indicate adherence to gender norms may influence substance use behaviors across the developmental trajectory, and inform strategies for prevention efforts.

Experiences of Vaginal, Oral, and Anal Sex From Adolescence to Early Adulthood in Populations With Physical Disabilities.

PURPOSE: Few studies have sought to understand the typical sexual development of populations with physical disabilities in the United States, and those that do are often based on convenience samples or cross-sectional data. The purpose of this paper is to examine relationships between physical disability and experiences of vaginal, oral, and anal sex in a nationally representative sample of individuals in the United States who have been followed from adolescence through early adulthood. METHODS: We used data from 13,456 respondents who completed Waves I (1994-1995) and IV (2008-2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Physical disabilities were identified and grouped by severity using information regarding limb difficulties, blindness, and deafness during adolescence. Analyses included bivariate statistics and adjusted logistic regression models relating physical disability and experiences of each type of sex. RESULTS: Respondents with the most severe physical disabilities had significantly lower odds of experiencing vaginal sex, oral sex, and having any sexual experience compared with the odds of those without disabilities. After stratifying by biological sex, we found that males with the most severe physical disabilities had significantly lower odds of experiencing any type of sex compared with the odds of males without disabilities, whereas females with moderate and severe physical disabilities had significantly lower odds of experiencing vaginal sex compared with the odds of females without disabilities. CONCLUSIONS: Our findings build on past research often conducted with convenience samples or cross-sectional data, indicating variation in sexual experiences among populations with disabilities.

The Relationship Between Cognitive Ability and Experiences of Vaginal, Oral, and Anal Sex in the United States.

Few studies have investigated the sexual development of populations with low cognitive abilities in the United States. This article examines the relationship between cognitive ability and various sexual experiences from adolescence (ages 12 to 18) to early adulthood (ages 28 to 34). Data were from 13,845 respondents interviewed at Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a probability sample of adolescents in the United States followed from adolescence to adulthood. Adjusted logistic regression models were used to study relationships between cognitive ability, approximated by the Add Health Picture Vocabulary Test (AHPVT), and experiences of vaginal, oral, and anal sex. After controlling for biological sex, age, race/ethnicity, and socioeconomic status (SES), individuals in the lowest cognitive ability group had significantly lower odds of experiencing each type of sex than those in the average ability group. Although individuals in the highest cognitive ability group had significantly lower odds of experiencing vaginal intercourse than those in the average ability group, this association did not remain significant when analyses were stratified by biological sex. These differences in experiences have implications for future health and warrant further study to understand policy implications for sexual health services and education.

Process Evaluation of a Clinical Trial to Test School Support as HIV Prevention Among Orphaned Adolescents in Western Kenya.

Orphaned adolescents are a large and vulnerable population in sub-Saharan Africa, at higher risk for HIV than non-orphans. Yet prevention of new infection is critical for adolescents since they are less likely than adults to enter and remain in treatment and are the only age group with rising AIDS death rates. We report process evaluation for a randomized controlled trial (RCT) testing support to stay in school (tuition, uniform, nurse visits) as an HIV prevention strategy for orphaned Kenyan adolescents. The RCT found no intervention effect on HIV/HSV-2 biomarker outcomes. With process evaluation, we examined the extent to which intervention elements were implemented as intended among the intervention group (N = 412) over the 3-year study period (2012-2014), the implementation effects on school enrollment (0-9 terms), and whether more time in school impacted HIV/HSV-2. All analyses examined differences as a whole, and by gender. Findings indicate that school fees and uniforms were fully implemented in 94 and 96% of cases, respectively. On average, participants received 79% of the required nurse visits. Although better implementation of nurse visits predicted more terms in school, a number of terms did not predict the likelihood of HIV/HSV-2 infection. Attending boarding school also increased number of school terms, but reduced the odds of infection for boys only. Four previous RCTs have been conducted in sub-Saharan Africa, and only one found limited evidence of school impact on adolescent HIV/HSV-2 infection. Our findings add further indication that the association between school support and HIV/HSV-2 prevention appears to be weak or under-specified.

Description and Evaluation of a Measurement Technique for Assessment of Performing Gender.

The influence of masculinity and femininity on behaviors and outcomes has been extensively studied in social science research using various measurement strategies. In the present paper, we describe and evaluate a measurement technique that uses existing survey items to capture the extent to which an individual behaves similarly to their same-gender peers. We use data from the first four waves of The National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of adolescents (age 12-18) in the United States who were re-interviewed at ages 13-19, 18-26, and 24-32. We estimate split-half reliability and provide evidence that supports the validity of this measurement technique. We demonstrate that the resulting measure does not perform as a trait measure and is associated with involvement in violent fights, a pattern consistent with theory and empirical findings. This measurement technique represents a novel approach for gender researchers with the potential for expanding our current knowledge base.

Population differences in associations of serotonin transporter promoter polymorphism (5HTTLPR) di- and triallelic genotypes with blood pressure and hypertension prevalence.

Based on prior research finding the 5HTTLPR L allele associated with increased cardiovascular reactivity to laboratory stressors and increased risk of myocardial infarction, we hypothesized that the 5HTTLPR L allele will be associated with increased blood pressure (BP) and increased hypertension prevalence in 2 large nationally representative samples in the United States and Singapore. METHODS: Logistic regression and linear models tested associations between triallelic (L'S', based on rs25531) 5HTTLPR genotypes and hypertension severity and mean systolic and diastolic blood pressure (SBP and DBP) collected during the Wave IV survey of the National Longitudinal Study of Adolescent to Adult Health (Add Health, N=11,815) in 2008-09 and during 2004-07 in 4196 Singaporeans. RESULTS: In US Whites, L' allele carriers had higher SBP (0.9 mm Hg, 95% CI=0.26-1.56) and greater odds (OR=1.23, 95% CI=1.10-1.38) of more severe hypertension than those with S'S' genotypes. In African Americans, L' carriers had lower mean SBP (-1.27mm Hg, 95% CI=-2.53 to -0.01) and lower odds (OR = 0.78, 95% CI=0.65-0.94) of more severe hypertension than those with the S'S' genotype. In African Americans, those with L'L' genotypes had lower DBP (-1.13mm Hg, 95% CI=-2.09 to -0.16) than S' carriers. In Native Americans, L' carriers had lower SBP (-6.05mm Hg, 95% CI=-9.59 to -2.51) and lower odds of hypertension (OR = 0.34, 95% CI=0.13-0.89) than those with the S'S' genotype. In Asian/Pacific Islanders those carrying the L' allele had lower DBP (-1.77mm Hg, 95% CI=-3.16 to -0.38) and lower odds of hypertension (OR = 0.68, 95% CI=0.48-0.96) than those with S'S'. In the Singapore sample S' carriers had higher SBP (3.02mm Hg, 95% CI=0.54-5.51) and DBP (1.90mm Hg, 95% CI=0.49-3.31) than those with the L'L' genotype. CONCLUSIONS: These findings suggest that Whites carrying the L' allele, African Americans and Native Americans with the S'S' genotype, and Asians carrying the S' allele will be found to be at higher risk of developing cardiovascular disease and may benefit from preventive measures.

How does a national poverty programme influence sexual debut among Kenyan adolescents?

Cash transfer programmes have recently emerged as promising interventions for HIV prevention among adolescents in Africa. However, the pathways through which risk reduction occurs are not well understood. We examine data on 1429 adolescents and youth from the Kenya Cash Transfer for Orphans and Vulnerable Children, which has been shown to result in delayed sexual debut among adolescents. We explored three potential mediating pathways: schooling, socio-economic status and psycho-social status. None of these hypothesised mediators greatly altered the main effect. However, school attendance had a larger protective effect on sexual debut among females but was only increased by the programme among males. This gendered pattern of effects may explain why we did not see a mediating effect of the cash transfer through schooling, despite schooling's protective effects against early sexual debut. Results also suggest that cash transfer programmes in Africa can contribute to the reduction of HIV related risk behaviours.

Testing Longitudinal Relationships Between Binge Drinking, Marijuana Use, and Depressive Symptoms and Moderation by Sex.

PURPOSE: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship, and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms from adolescence into young adulthood and whether the associations were moderated by sex. METHODS: With data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 9,816), we used growth curve models to test if depressive symptoms predicted marijuana use or binge drinking frequency (Self-Medication Model) or if substance use frequency predicted depressive symptoms (Stress Model). Moderation by sex and age was tested for both potential pathways. RESULTS: Increases in adolescent depressive symptoms, compared to no symptoms, were associated with a steeper predicted increase in marijuana use frequency from adolescence to young adulthood. Increases in persistent binge drinking or marijuana use frequency had concurrent positive associations with depressive symptoms from adolescence to young adulthood, and these associations were significantly stronger for females compared to males. CONCLUSIONS: The results not only support the Self-Medication Model for marijuana use but also provide modest support for the Stress Model, that substance use is associated with depressive symptoms, especially for females.

Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood.

PURPOSE: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females. METHODS: Using data from the National Longitudinal Study of Adolescent to Adult Health we investigated longitudinal associations between high frequency substance use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear mixed effects models were stratified by sex and used a lagged measure of the dependent variable to test temporal relationships. A random intercept was used for respondent ID. RESULTS: Increases in depressive symptoms were significantly associated with a later increase of about a half day in marijuana use frequency for males and nearly a two day increase in smoking frequency for females. Conversely, increases in smoking frequency were significantly associated with approximately a 0.6-point increase for females and 0.4-point increase for males in depressive symptoms at a later wave. CONCLUSIONS: Results indicate a bidirectional relationship between smoking and depressive symptoms for females. For males, there was evidence supporting self-medication with marijuana and for smoking being associated with later increases in depressive symptoms. Results inform how substance use and depression screening, prevention and treatment efforts should be paired and targeted for males and females.

The Enduring Significance of Skin Tone: Linking Skin Tone, Attitudes Toward Marriage and Cohabitation, and Sexual Behavior.

Past evidence has documented that attitudes toward marriage and cohabitation are related to sexual behavior in adolescence and young adulthood. This study extends prior research by longitudinally testing these associations across racial/ethnic groups and investigating whether culturally relevant variations within racial/ethnic minority groups, such as skin tone (i.e., lightness/darkness of skin color), are linked to attitudes toward marriage and cohabitation and sex. Drawing on family and public health literatures and theories, as well as burgeoning skin tone literature, it was hypothesized that more positive attitudes toward marriage and negative attitudes toward cohabitation would be associated with less risky sex, and that links differed for lighter and darker skin individuals. The sample included 6872 respondents (49.6 % female; 70.0 % White; 15.8 % African American; 3.3 % Asian; 10.9 % Hispanic) from the National Longitudinal Study of Adolescent to Adult Health. The results revealed that marital attitudes had a significantly stronger dampening effect on risky sexual behavior of lighter skin African Americans and Asians compared with their darker skin counterparts. Skin tone also directly predicted number of partners and concurrent partners among African American males and Asian females. We discuss theoretical and practical implications of these findings for adolescence and young adulthood.

Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya.

PURPOSE: This study investigates the causal effect of Kenya's unconditional cash transfer program on mental health outcomes of young people. METHODS: Selected locations in Kenya were randomly assigned to receive unconditional cash transfers in the first phase of Kenya's Cash Transfer Program for orphans and Vulnerable Children. In intervention locations, low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $20 in 2007. In 2011, 4 years after program onset, data were collected on the psychosocial status for youth aged 15-24 years from households in intervention and control locations (N = 1960). The primary outcome variable was an indicator of depressive symptoms using the 10-question Center for Epidemiologic Studies Depression Scale. Secondary outcomes include an indicator for hopefulness and physical health measures. Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program. RESULTS: The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers. Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20-24 years and orphans. CONCLUSIONS: This study provides evidence that poverty-targeted unconditional cash transfer programs, can improve the mental health of young people in low-income countries.

Prevalence of High-Risk Sexual Behaviors Among Monoracial and Multiracial Groups from a National Sample: Are Multiracial Young Adults at Greater Risk?

The present study compared the prevalence and variation in high-risk sexual behaviors among four monoracial (i.e., White, African American, Asian, Native American) and four multiracial (i.e., White/African American, White/Asian, White/Native American, African American/Native American) young adults using Wave IV data (2008-2009) from the National Longitudinal Study of Adolescent to Adult Health (N = 9724). Findings indicated differences in the sexual behavior of monoracial and multiracial young adults, but directions of differences varied depending on the monoracial group used as the referent and gender. Among males, White/African Americans had higher risk than Whites; White/Native Americans had higher risk than Native Americans. Otherwise, multiracial groups had lower risk or did not differ from the single-race groups. Among females, White/Native Americans had higher risk than Whites; White/African Americans had higher risk than African Americans. Other comparisons showed no differences or had lower risk among multiracial groups. Variations in high-risk sexual behaviors underscore the need for health research to disaggregate multiracial groups to better understand health behaviors and outcomes in the context of experiences associated with a multiracial background, and to improve prevention strategies.

The reliability of in-home measures of height and weight in large cohort studies: Evidence from Add Health.

BACKGROUND: With the emergence of obesity as a global health issue an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. OBJECTIVES: We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES) and, using both sources, provide a detailed anthropometric description of young adults in the United States. METHODS: The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. RESULTS: Short-term reliabilities of in-home measures of height, weight, waist and arm circumference-as well as derived body mass index (BMI, kg/m2)-were excellent. Prevalence of obesity (37% vs. 29%) and central obesity (47% vs. 38%) was higher in Add Health than in NHANES while socio-demographic patterns of obesity and central obesity were comparable in the two studies. CONCLUSIONS: Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality.