Diabetes and obesity in the Louisiana Coushatta Indians.

OBJECTIVE: In order to assist their community in planning intervention and prevention programs, prevalence rates for diabetes and obesity were examined among the Louisiana Coushatta. RESEARCH DESIGN AND METHODS: Coushatta individuals participated in a health survey (questionnaires and physical examinations). Those without known diabetes underwent oral glucose tolerance testing and were classified as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes mellitus (DM). Those with known DM had the diagnosis confirmed by history and/or elevated hemoglobin A1c. Waist-to-hip ratio (WHR), body mass index (BMI), and percent body fat (%BF) were determined as measures of central adiposity and obesity. Prevalence rates of diabetes and obesity among those examined were calculated. The prevalence of those with more than one anthropometric index positive for obesity was also determined. RESULTS: The prevalence of DM was 30% and IGT was 17% among the first 151 Coushatta participants. For males, the prevalence of obesity was 62%, 57%, and 52%, and for females, 59%, 54%, 45%, as determined by the BMI, %BF, and WHR, respectively. Obesity was more prevalent among those with glucose intolerance (IGT + DM) than those with NGT, and those who were obese had the highest prevalence of glucose intolerance. A greater percentage of those with glucose intolerance had more than one positive obesity measure as compared to those with NGT, and those with more than one index consistent with obesity had a greater prevalence of IGT + DM. CONCLUSIONS: Prevalence rates of DM and obesity are high among the Louisiana Coushatta, and obesity is associated with glucose intolerance. Clustering of the three obesity measures occurs in a high percentage of individuals. Data from the current survey are providing information that is being used by the Coushatta community for health planning and development of intervention and prevention programs.

Factors associated with short-term oral contraceptive discontinuation.

PIP: An investigation was devised to study factors associated with short-term oral contraceptive discontinuation. Of 405 women in New Orleans who accepted oral contraceptives in the clinics of the Orleans Parish Family Planning Program during January 1974, 365 (90.1%) were located and interviewed. 5.2% of the women did not start the method as scheduled, and 6.1% of those who started quit before the second cycle. 53% ofthose who did not start the pill gave as their major reason for not starting their inability to determine when to begin the pill because of menstrual irregularity. The second major reason (26%) was personal reasons such as sexual inactivity, fear that the pill causes cancer, and unrelated health problems. 63% of the women who discontinued the pill during or immediately after the first cycle cited side effects, principally breakthrough bleeding, as the reasons for discontinuing. A multiple regression analysis was computed with short-term continuation/discontinuation as the dependent variable. The independent variables were age, parity, education, presence or absence of a male sexual partner, employment status, postpartum status, severity of spotting or bleeding as a side effect, attitude toward conception, and frequency of sexual intercourse. Only 7.3% of the variance in oral contraceptive continuation/discontinuation was accounted for by the variables included in the model, and bleeding and spotting accounted for 88% of this total. It is recommended that 1) oral contraception begin immediately postabortion or postpartum, 2) medical attention be given to postpartum or postabortal bleeding and spotting problems of amenorrhea, and 3) bleeding and spotting problems be checked carefully after pill initiation to see if another pill or another method might be used or if medical intervention is required.^ieng