Moderate-intensity physical activity and fasting insulin levels in women: the Cross-Cultural Activity Participation Study.

OBJECTIVE: The purpose of this study was to determine the association between moderate-intensity physical activity (PA) and fasting insulin levels among African-American (n = 47), Native American (n = 46), and Caucasian women (n = 49), aged 40-83 years, enrolled in the Cross-Cultural Activity Participation Study. Associations by race/ethnicity, levels of central obesity, and cardiorespiratory fitness were also examined. RESEARCH DESIGN AND METHODS: Physical activity scores were obtained from detailed PA records that included all PA performed during two consecutive 4-day periods scheduled 1 month apart. Using MET intensity (the associated metabolic rate for a specific activity divided by a standard resting metabolic rate), PA was expressed as MET-min (the product of the minutes for each activity times the MET intensity level) per day of energy expended in moderate (3-6 METs) and moderate/vigorous (> or = 3 METs) PA. Fasting insulin levels were determined by radioimmunoassay. Data were analyzed by multiple linear regression analysis. RESULTS: After adjusting for race/ethnicity, age, educational attainment, and site, an increase of 30 min of moderate-intensity PA was associated with a 6.6% lower fasting insulin level (P < 0.05). The association was similar among races/ethnicities, centrally lean and centrally obese women, and women with low and high cardiorespiratory fitness levels. CONCLUSIONS: These findings lend support to the 1995 Centers for Disease Control and Prevention and American College of Sports Medicine recommendations for an accumulation of 30 min/day in moderate-intensity PA. They also contribute to the growing literature suggesting that moderate amounts of PA have a significant role in reducing the burden of hyperinsulinemia and diabetes among ethnic populations at highest risk for these conditions.

Dengue epidemics on the Pacific Coast of Mexico.

Dengue epidemics in three Mexican cities were investigated with retrospective surveys and virus isolations from acute cases. These epidemics were part of the continuing extension of dengue in Mexico since 1978 after 15 years without transmission. Serotype 1 dengue infection predominated in all epidemics, but in one city, type 2 strains were also isolated. The following findings were consistent in all three cities: 1) illness history provided evidence of presence of infection months before the epidemic became evident, 2) there was a very sharp and progressive increase of dengue illness attack rates by age, 3) there were no interpretable relationships between illness and the presence of different types of breeding sights in the home, 4) socioeconomic status was strongly negatively related to illness, and 5) geographical factors not related to the other measured variables had a strong effect on illness rates reflecting the focality of transmission. In addition, there was evidence of a strong protective effect against illness by the use of mosquito netting or the presence of screens on houses, but these relationships were not universal to all three cities.

Environmental influences, physical activity, and weight status in 8- to 16-year-olds.

OBJECTIVE: To assess the association between vigorous physical activity, participation on sport teams and in exercise programs, television watching, family environment, and weight status in youth. DESIGN: Cross-sectional data from the Third National Health and Nutrition Examination Survey. PARTICIPANTS: A group of 2791 youth between the ages of 8 and 16 years who were enrolled in the Third National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES: Overweight was defined using age- and sex-specific 85th percentile of body mass index using Center for Disease Control and Prevention growth charts. RESULTS: Both males and females who had an overweight mother and or father were more likely to be overweight compared with youth who did not have an overweight parent. Females who watched 4 or more hours of television were more likely to be overweight than those who watched less than 4 hours. Males and 14- to 16-year-old females who participated in sport team and exercise programs were less likely to be overweight than their counterparts who did not participate. Also, females with larger families and males from families with higher family incomes were less likely to be overweight. CONCLUSIONS: These results suggest that family environment is associated with overweight in youth and that sport and exercise program participants are less like to be overweight and that, for females, increased television watching is related to overweight.

Mother-adolescent agreement on the symptoms and diagnoses of adolescent depression and conduct disorders.

OBJECTIVE: To determine rates and correlates of mother-adolescent agreement on the symptoms and diagnoses of depression and conduct disorders. METHOD: The Schedule for Affective Disorders and Schizophrenia in School Age Children was administered to a community sample of 460 adolescents and their mothers. Race, gender, family adaptability and cohesion, and living arrangement were evaluated as predictors of agreement. RESULTS: Mother-adolescent agreement was low (kappa < 0.40) for all diagnoses and symptoms with these exceptions: feeling tired (kappa = 0.40), inattention (kappa = 0.50), vandalism (kappa = 0.50), and chronic violation of rules (kappa = 0.72). Cohesion and adaptability were associated with mother-adolescent agreement on the symptoms and diagnosis of depression. This association was not demonstrated as consistently for agreement on the symptoms and diagnosis of conduct disorders. CONCLUSION: Study findings underscore the necessity of collecting data from both a parent and the adolescent when assessing an adolescent's psychological status.

A longitudinal study of suicidal ideation in young adolescents.

As part of a longitudinal study of depression and suicidal ideation in adolescents, a three-item suicide screen was administered to 1,073 students for 3 consecutive years starting at the beginning of the 7th or 8th grades. Each year over 70% of respondents reported no suicidal thoughts, and less than 5.5% attained high suicide ideation scores. Blacks and females had higher scores, respectively, than did whites and males. The individual students' suicide scores were less stable than the overall distributions with 1- and 2-year correlations reaching 0.35 and 0.28, respectively. Only one student received a high score all 3 years. The best predictors of a given year's suicide score was the previous years' depression scores. Gender, undesirable life events, family adaptability, and family cohesion were significant but less consistent predictors.

The CES-D as a screen for depression and other psychiatric disorders in adolescents.

The performance of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screen for depression was explored in a two-stage epidemiological study of adolescents. The study consisted of a CES-D screening stage completed by a school sample of 2,465 young adolescents and a structured psychiatric interview stage completed by 332 mother-adolescent pairs. Adolescents with interview validated depression had elevated screening scores (mean = 31.10, SD = 11.30) compared with individuals with no disorder (mean = 21.01, SD = 11.77). Using receiver operating characteristic curves, a cut point of 12 for males produced the best overall screening characteristics (sensitivity = 0.85, specificity = 0.49), while for females, a cut point of 22 was optimal (sensitivity = 0.83, specificity = 0.77).

Posttraumatic stress disorder in adolescents after Hurricane Andrew.

OBJECTIVE: To examine rates and correlates of posttraumatic stress disorder (PTSD) in adolescents after Hurricane Andrew. METHOD: A random-digit dialing sample of 158 Hispanic, 116 black, and 104 white adolescent-parent pairs were surveyed in high- and low-impact areas within Dade County, Florida, 6 months after Hurricane Andrew. Subjects completed a structured telephone interview focused on within-disaster experiences and emotional reaction, disaster-related losses, lifetime exposure to violent or traumatic events, recent stressful experiences, and psychiatric symptomatology. RESULTS: Approximately 3% of males (95% confidence interval 0.4 to 5.3) and 9% of females (95% confidence interval 4.6 to 13.7) met the criteria for PTSD. Rates were highest among blacks (8.3%, 95% confidence interval 2.3 to 14.2) and Hispanics (6.1%, 95% confidence interval 2.2 to 9.9) and increased with age (odds ratio of 1.34, 95% confidence interval 1.04 to 1.72) and the number of undesirable events reported (odds ratio of 1.38, 95% confidence interval 1.21 to 1.57). CONCLUSIONS: While only a relatively small percentage of adolescents reported symptoms consistent with a diagnosis of PTSD, most reported some posttraumatic symptoms. Postdisaster planning should recognize that common stressful events occurring after disasters may be more strongly associated with PTSD than magnitude of contact with the actual disaster.

Frequency of phobic disorder in a community sample of young adolescents.

OBJECTIVE: To investigate the frequency and phenomenology of clinical, subsyndromal, and subthreshold phobias in young adolescents. METHODS: A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale were administered to 487 mother-child pairs. RESULTS: Prevalence rates of clinical, subsyndromal, and subthreshold phobia were 2.3%, 14.5%, and 22.2%, respectively. One-year incidence rates were 0.4%, 8.0%, and 16.9%, with 43.0% of phobic subjects categorized at the same or a more severe level after a year. Females, blacks, subjects not living with both biological parents, and older adolescents were more likely to meet the diagnostic criteria for clinical phobia. The majority (77%) of subjects with clinical phobia experienced multiple phobias. Subsyndromal (52%) and subthreshold (74%) phobics were more likely to experience simple phobias only. CONCLUSIONS: Phobic symptoms are relatively common at a moderate level and in the majority of adolescents are somewhat transitory in nature. Characteristic symptomatology and comorbidity may facilitate earlier identification of subjects at risk of persistent symptomatology and in need of treatment.

Frequency of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVE: To investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in young adolescents. METHOD: A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale were administered to 488 mother-child pairs. RESULTS: The prevalences of OCD and subclinical OCD were found to be 3% and 19%, respectively. Prevalences were similar in males and females. Females reported more symptoms of compulsions although males reported more obsessions. About 55% of adolescents with OCD reported both obsessions and compulsions. The most common compulsions were arranging (56%), counting (41%), collecting (38%), and washing (17%). Major depressive disorder (45%), separation anxiety (34%), dysthymia (29%), suicidal ideation (15%), and phobia (8%) were the diagnoses most frequently comorbid with OCD. CONCLUSIONS: Findings suggest that OCD is not infrequent among adolescents and that the characteristic comorbidity and symptomatology of OCD may facilitate earlier identification and treatment by clinicians.

Incidence of major depressive disorder and dysthymia in young adolescents.

OBJECTIVE: An epidemiological study conducted between 1987 and 1989 in a single school district in the southeastern United States investigated the incidence, transition probabilities, and risk factors for major depressive disorder (MDD) and dysthymia in adolescents aged 11 to 16 years. METHOD: Diagnoses were based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, which was administered to 247 mother-adolescent pairs at 12-month intervals. RESULTS: One-year MDD and dysthymia incidences were 3.3% (n = 11) and 3.4% (n = 9), respectively. Transition probabilities demonstrated movement from disorder to no disorder over time. Family cohesion (odds ratio = 0.95) was the only significant predictor of incident MDD. No factors were significant for dysthymia. While baseline MDD was a significant risk factor for depression at follow-up, 80% of subjects with baseline MDD did not meet the criteria for diagnosis at follow-up. CONCLUSION: Findings suggest perceived family support or cohesion may be more important to adolescent mental health than family structure.

Prevalence of attention-deficit/hyperactivity disorder in a community sample of older adolescents.

OBJECTIVE: To study the prevalence and correlates of attention-deficit/hyperactivity disorder (ADHD) in a community sample of older adolescents. METHOD: From 1986 to 1988, 3,419 seventh, eighth, and ninth graders were screened with the Center for Epidemiologic Studies-Depression Scale. The top decile scorers and a random sample of the remainder were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children. These data are from the second wave of interviews (N = 490, mean age = 18.65). RESULTS: The weighted prevalence of DSM-III-R ADHD was 1.51% (males: 2.62%, females: 0.54%). Significant associations (p < .05) were found for gender (male), comorbid affective disorders, baseline undesirable life events, and fewer than two biological parents at baseline. Family cohesion (p = .058) is inversely associated with ADHD. For subjects not meeting the age-at-onset criterion, 1.94% met the eight symptom criteria, and females (3.2%) were more prevalent than males (0.3%). CONCLUSIONS: ADHD remains a problem in this sample of older adolescents and is often comorbid with affective disorders. A significant number report eight ADHD symptoms but do not meet the age-at-onset criterion. This group deserves research attention.

Prevalence of PTSD in a community sample of older adolescents.

OBJECTIVE: To examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years. METHOD: The second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents. RESULTS: Approximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD. CONCLUSIONS: While relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.

Incidence and predictors of suicidal behaviors in a longitudinal sample of young adolescents.

OBJECTIVE: This analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents. METHOD: Adolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors. RESULTS: Among those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans. CONCLUSIONS: While there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.

Incidence of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVE: To investigate the incidence, transition probabilities, and risk factors for obsessive-compulsive disorder (OCD) and subclinical OCD in adolescents. METHOD: A two-stage epidemiological study originally designed to investigate depression was conducted between 1987 and 1989 in the southeastern United States. For the screening, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children was administered to 488 mother-child pairs. Baseline screening and diagnostic data from the first year the subject completed an interview and follow-up diagnostic data from subsequent years were used. RESULTS: The 1-year incidence rates of OCD and subclinical OCD were found to be 0.7% and 8.4%, respectively. Transition probabilities demonstrated a pattern of moving from more severe to less severe categories. Of those with baseline OCD, 17% had the diagnosis of OCD at follow-up; 62% moved to the referent group. Of those with baseline subclinical OCD, 1.5% had OCD at follow-up and 75% moved to the referent group. Black race (odds ratio [OR] = 23.38), age (OR = 4.02), desirable life events (OR = 0.78), undesirable life events (OR = 1.21), and socioeconomic status (OR not estimable) were significant predictors of incident OCD. Age (OR = 2.30), desirable life events (OR = 0.92), and undesirable life events (OR = 1.13) were significantly associated with incident subclinical OCD. CONCLUSION: An initial diagnosis of subclinical OCD was not significantly predictive of a diagnosis of OCD at 1-year follow-up. The overall morbidity remained higher at follow-up in the baseline OCD group than in the baseline subclinical OCD group. The baseline subclinical OCD group was more dysfunctional at follow-up than was the baseline referent group. Further research concerning differences in symptomatology and impairment between OCD and subclinical OCD is warranted.

Primary infertility and oral contraceptive steroid use.

OBJECTIVE: To determine the association between combined monophasic oral contraceptive (OC) use and primary infertility. DESIGN: Case-control. SETTING: Women serving as controls of the Cancer and Steroid Hormone Study. PARTICIPANTS: Women were 19 to 40 years of age at first conception or infertility diagnosis. Based on 24 consecutive months of unprotected intercourse without a recognized conception, 419 nulligravid women had primary infertility; controls were 2,120 fertile women. A calendar of each women's reproductive history was used to determine fertility status and contraceptive use before infertility diagnosis or first conception. MAIN OUTCOME MEASURE: Primary infertility. RESULTS: Combined monophasic OC use was associated with a lower frequency of primary infertility, particularly among younger (age 20 years) compared with older women (age 30 years) after adjusting for barrier method use and education. A similar association was found for duration of OC use. When adjusted for age at first conception or infertility and barrier method, both higher (> 50 micrograms) and lower (< or = 50 micrograms) estrogen dose use were associated with decreased risk of primary infertility. CONCLUSION: Combined monophasic OC use was associated with a lower frequency of primary infertility.

PIP: Researchers compared data on 419 nulligravid US women diagnosed with primary infertility (no conception during 24 consecutive months of unprotected intercourse) with data on 2120 fertile women to examine the relationship between use of combined monophasic oral contraceptives (OCs) and primary infertility. All cases had documented reproductive histories from menarche to menopause for contraceptive methods before infertility. Controls were more likely than infertile women to have used OCs (14.2% vs. 9.07%; unadjusted odds ratio [OR] = 0.6) and to have used OCs longer (33.6 vs. 30.1 months; OR = 0.6). Infertile women were just as likely as fertile women to have used high-estrogen-dose OCs (i.e., 50 mcg) (5.28% vs. 8.52%). Fertile women were more likely than infertile women to have used barrier methods (41.8% vs. 17.2%; OR = 0.29). When the researchers adjusted for education and barrier method use, infertile women were still less likely to have used OCs than fertile women, especially women who were 20 years old at first conception or infertility (adjusted OR [AOR] = 0.27) (AOR = 0.68 for older women). Both high- and low-estrogen-dose OCs were associated with a reduced risk of primary infertility (AOR = 0.48 for or= 50 mcg and 0.4 for 50 mcg). These results suggest that combined OC use reduces the risk of primary infertility, especially among younger women, regardless of duration of use or estrogen dose.

Oral contraceptive use and breast cancer in Indonesia.

A hospital-based case-control study was conducted in Ujungpandang, Indonesia, to determine the association of breast cancer and current and former oral contraceptive (OC) use. This study included 119 newly diagnosed, histologically-confirmed, breast cancer cases who were admitted to the four largest referral hospitals in Ujungpandang from 1990-1991. Controls were 258 women admitted to these same four hospitals with diagnoses unrelated to breast cancer or OC use. Thirty cases (32%) and 55 (19%) controls reported having ever used OCs. The odds ratio for ever using OCs and breast cancer was 1.8 (95% confidence interval 1.2-3.0) after adjustment for age, age at first pregnancy, and family history of breast cancer. Increasing duration of OC use did not increase risk of breast cancer. No latency trend of increasing years since first OC use among cases was observed; however, a younger age at first OC use was associated with increasing breast cancer risk. A significant recency effect was observed; women last using OCs within five years of study enrollment were at greatest risk of breast cancer (OR = 4.9, 95% CI: 2.1-11.4). This first study of breast cancer and OC use in Indonesia does not provide consistent data to indicate an increased risk of breast cancer associated with OC use. Although breast cancer cases were 80% more likely to have ever used OCs, neither duration nor latency of OC use were associated with cancer risk. The significant recency effect suggests that a detection bias might explain the observed relationship between ever OC use and breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Estimating environmental exposures to sulfur dioxide from multiple industrial sources for a case-control study.

This paper first discusses how population exposures to environmental pollutants are estimated from environmental monitoring data and the problems that are encountered in estimating risk from pollutants on the basis of ecologic studies. We then present a technique of estimating individualized exposures to an atmospheric pollutant, sulfur dioxide (SO2), through atmospheric transport modeling for a case-control study. The transport model uses the quantities of SO2 released from 30 geographically identified industrial facilities and meteorological data (wind speed and direction) to predict the downwind ground-level concentrations of SO2 at geographically identified residences, receptors, of 797 study subjects. A distribution of facility SO2 emissions, uncertainties in effective stack height, and model uncertainty are incorporated to examine the uncertainty in the predicted versus ambient monitoring SO2 levels, and to generate an exposure uncertainty distribution for both the cases and controls. The transport model's accuracy is evaluated by comparing recorded ambient measurements of SO2 with the model's predicted SO2 estimates at geographically identified ambient monitoring stations.

Behavioral and demographic correlates of diabetes, hypertension and overweight among the Catawba Indian Nation.

OBJECTIVE: In 1998, the Catawba Diabetes and Health Survey (CDHS) was conducted among adult members of the Catawba Indian Nation living in the Carolinas to determine the prevalence of diabetes and other health conditions, and to assess the population's health-related behaviors. DESIGN: A population-based sample of adult members of the Catawba Indian Nation (N = 633) were surveyed by telephone or in person regarding health status and health-related behaviors. Logistic regression was used to determine demographic and behavioral correlates of diabetes, hypertension, and overweight among the Catawba. RESULTS: Age-adjusted prevalence rates of self-reported diabetes, hypertension and overweight were 12.3%, 29.1%, and 63.8%, respectively. Older age was related to diabetes, hypertension, and overweight (P<.0001 each), and heavier weight status was related to diabetes (P = .026) and hypertension (P<.0001). Nearly 40% of the Catawba are physically inactive (29.5% men, 46.5% women). Physical inactivity was related to diabetes and hypertension among men only, and related to overweight among women only (P<.05 each). Current smoking was inversely related to overweight among men and women (P = .002). Dietary behavior was not associated with the health outcomes. CONCLUSION: Given the high rates of overweight and physical inactivity, reducing the rates of both may be very important for the health of the Catawba, considering their association with diabetes and hypertension.

Body fat distribution and race differences in apolipoprotein A1.

OBJECTIVE: This is the first study to assess the role of waist-to-hip ratio in explaining race differences in levels of serum apolipoprotein A1, a protective risk factor for atherosclerosis. METHODS: Linear regression analyses were used in a community-based survey of 3,043 adults (23.5% African-American) to assess associations of race, age, anthropometric measures, education, diabetes, blood pressure medication use, cigarette smoking, and leisure-time physical activity with apolipoprotein A1 levels. RESULTS: Higher apolipoprotein A1 levels were observed among African-American than among white adults (African-American men: +15.6 mg/dl than white men, African-American women: +3.1 mg/dl more than white women; p < 0.05). Waist-to-hip ratio and other variables did not account for race differences among men. African-American women had +8.6 mg/dl higher levels than white women after adjustment for differing distributions of waist-to-hip ratio, age, body mass index and education. Cigarette smoking, physical activity, and medical history accounted for no further differences among women. CONCLUSIONS: Higher levels of obesity indicators and lower educational attainment among African-American women reduced a potentially greater beneficial race difference in apolipoprotein A1. These findings also suggest that other environmental and biochemical factors may play roles in explaining the higher protective levels of apolipoprotein A1 observed among African-American children and adults.

A longitudinal study of adolescent mental health service use.

This study examines longitudinal mental health service use patterns of a school-based sample of adolescents. Based on the Center for Epidemiologic Studies Depression Scale scores, a stratified sample of middle-school students was interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children: cycle one (n = 579; mean age 12.83) and cycle two (n = 490; mean age 18.65). Service use also was assessed by mailed questionnaire: cycle three (n = 330; mean age 20.60). Service use decreased over time. Whites and males received significantly more treatment in the first cycle. In the second cycle, service use by race and gender was equal; in the third cycle, females received more treatment. Those with a psychiatric diagnosis (first cycle, 54%; second cycle, 33%) received treatment in the prior year. Under-treatment of youth with psychiatric diagnoses is a significant problem, with differences in service use by race and gender over time.