Mechanical systems versus smoking bans for secondhand smoke control.

INTRODUCTION: Despite international efforts to implement smoking bans, several national legislations still allow smoking and recommend mechanical systems, such as ventilation and air extraction, to eliminate secondhand smoke (SHS) health-related risks. We aimed to quantify the relative contribution of mechanical systems and smoking bans to SHS elimination. METHODS: A cross-sectional study was conducted in randomly selected establishments from 4 Mexican cities (3 with no ban). SHS exposure was assessed using nicotine passive monitors. Establishment characteristics, presence of mechanical systems, and enforcement of smoking policies were obtained through direct observation and self-report. Multilevel models were used to assess relative contributions to SHS reduction. RESULTS: Compared with Mexico City, nicotine concentrations were 3.8 times higher in Colima, 5.4 in Cuernavaca, and 6.4 in Toluca. Mechanical systems were not associated with reduced nicotine concentrations. Concentration differences between cities were largely explained by the presence of smoking bans (69.1% difference reduction) but not by mechanical systems (-5.7% difference reduction). CONCLUSIONS: Smoking bans represent the only effective approach to reduce SHS. Tobacco control regulations should stop considering mechanical systems as advisable means for SHS reduction and opt for complete smoking bans in public places.

Reductions in cigarette smoking and acute myocardial infarction mortality in Jefferson County, Texas.

After litigation against the tobacco industry ended in a settlement, the Texas legislature funded pilot projects to reduce tobacco use in selected areas of the state. Subsequent telephone surveys showed that well-funded activities were successful in reducing population rates of self-reported cigarette smoking. We present evidence that the reduction in smoking promptly led to lower rates of death from acute myocardial infarctions.

Upper extremity pain and computer use among engineering graduate students: a replication study.

BACKGROUND: Recent literature identified upper extremity musculoskeletal symptoms at a prevalence of >40% in college populations. The study objectives were to determine weekly computer use and the prevalence of upper extremity musculoskeletal symptoms in a graduate student population, and make comparisons with previous graduate and undergraduate cohorts. METHODS: One hundred sixty-six graduate students completed a survey on computing and musculoskeletal health. Associations between individual factors and symptom status, functional limitations, academic impact, medication use, and health services utilization were determined. Logistic regression analyses evaluated the association between symptom status and computing. Cross-study comparisons were made. RESULTS: More symptomatic participants experienced functional limitations than asymptomatic participants (74% vs. 32%, P < 0.001) and reported medication use for computing pain (34% vs. 10%, P < 0.01). More participants who experienced symptoms within an hour of computing used health services compared to those who experienced symptoms after an hour of computer use (60% vs. 12%, P < 0.01). Years of computer use (OR = 1.59, 95% CI 1.05-2.40) and number of years in school where weekly computer use was more than 10 hr (OR = 1.56, 95% CI 1.04-2.35) were associated with pain within an hour of computing. Cross-study comparisons found college populations more similar than different. CONCLUSION: The overall findings reinforced previous literature documenting the prevalence of upper extremity musculoskeletal symptoms in college populations, suggesting an important population for participating in public health interventions designed to support healthy computing practices and identify risk factors important to evaluate in future cohort studies. Am. J. Ind. Med. 52:113-123, 2009. (c) 2008 Wiley-Liss, Inc.

The cultural production of health inequalities: a cross-sectional, multilevel examination of 52 countries.

In a 2001 report, the U.S. National Institutes of Health called for more integration of the social sciences into health-related research, including research guided by theories and methods that take social and cultural systems into consideration. Based on a theoretical framework that integrates Hofstede's cultural dimensions with sociological theory, the authors used multilevel modeling to explore the association of culture with structural inequality and health disparities. Their results support the idea that cultural dimensions and social structure, along with economic development, may account for much of the cross-national variation in the distribution of health inequalities. Sensitivity tests also suggest that an interaction between culture and social structure may confound the relationship between income inequality and health. It is necessary to identify important cultural and social structural characteristics before we can achieve an understanding of the complex, dynamic systems that affect health, and develop culturally sensitive interventions and policies. This study takes a step toward identifying some of the relevant cultural and structural influences. More research is needed to explore the pathways leading from the sociocultural environment to health inequalities.

Social capital, income inequality, and self-rated health in 45 countries.

There has been growing interest in the relationship between the social environment and health. Among the concepts that have emerged over the past decade to examine this relationship are socio-economic inequality and social capital. Using data from the World Values Survey and the World Bank, we tested the hypothesis that self-rated health is affected by social capital and income inequality cross-nationally. The merit of our approach was that we used multilevel methods in a larger and more diverse sample of countries than used previously. Our results indicated that, for a large number of diverse countries, commonly used measures of social capital and income inequality had strong compositional effects on self-rated health, but inconsistent contextual effects, depending on the countries included. Cross-level interactions suggested that contextual measures can moderate the effect of compositional measures on self-rated health. Sensitivity tests indicated that effects varied in different subsets of countries. Future research should examine country-specific characteristics, such as differences in cultural values or norms, which may influence the relationships between social capital, income inequality, and health.

Drinking social norms and drinking behaviours: a multilevel analysis of 137 workgroups in 16 worksites.

BACKGROUND: Previous studies on worksite drinking norms showed individually perceived norms were associated with drinking behaviours. OBJECTIVE: To examine whether restrictive drinking social norms shared by workgroup membership are associated with decreased heavy drinking, frequent drinking and drinking at work at the worker level. METHODS: The sample included 5338 workers with complete data nested in 137 supervisory workgroups from 16 American worksites. Multilevel models were fitted to examine the association between workgroup drinking norms and heavy drinking, frequent drinking and drinking at work. RESULTS: Multivariate adjusted models showed participants working in workgroups in the most discouraging drinking norms quartile were 45% less likely to be heavy drinkers, 54% less likely to be frequent drinkers and 69% less likely to drink at work than their counterparts in the most encouraging quartile. CONCLUSIONS: Strong associations between workgroup level restrictive drinking social norms and drinking outcomes suggest public health efforts at reducing drinking and alcohol-related injuries, illnesses and diseases should target social interventions at worksites.

Effects of a preschool staff intervention on children's sun protection: outcomes of sun protection is fun!

The preschool is an important yet understudied setting for sun-protection interventions. This study evaluates the effects of Sun Protection is Fun! (SPF) on preschool staff behavioral and psychosocial outcomes related to protecting children from sun exposure. Twenty preschools participated in a 2-year, group-randomized trial to evaluate SPF, a behavioral intervention grounded in social cognitive theory and designed to be more extensive than previous preschool sun-protection interventions. The staff intervention included training, a video, newsletters, a curriculum, and sunscreen. Cross-sectional samples of staff completed surveys at baseline (N= 245), a 12 month intervention assessment (N = 192), and a 24-month intervention assessment (N = 225). At the 12-month and 24-month assessments, significant behavioral effects were seen for use of sunscreen, protective clothing, and shade. Knowledge, self-efficacy, and norms were among the psychosocial variables most affected by the intervention. This study demonstrates that the SPF intervention is effective in improving staff outcomes related to children's sun protection.

Cigarette smoking enhances increased urine albumin excretion as a risk factor for glomerular filtration rate decline in primary hypertension.

BACKGROUND: Subjects with severe compared with mild primary hypertension are at greater risk for decline in glomerular filtration rate (GFR), but additional risk factors are poorly defined. METHODS: Seventy-five subjects referred for assistance with blood pressure control ("severe") and 150 not-referred hypertensive subjects ("mild") were prospectively followed for 7 years. The primary outcome was the change in calculated GFR during follow-up as predicted by various clinical parameters, including urine albumin excretion measured as urine albumin (mg)-to-creatinine (g) (alb/cr) ratio. RESULTS: Calculated GFR declined faster (more negative slope) in patients with severe hypertension than in those with mild hypertension (-0.188+/- 0.025 versus -0.120+/- 0.008 mL/min/month; P=0.010), despite similar follow-up systolic blood pressure (133.4+/-1.2 versus 131.9+/-0.8 mm Hg). Severe subjects had higher entry alb/cr (241.3+/- 29.1 versus 11.4+/- 0.5) and a greater proportion of cigarette smokers than mild subjects (56 versus 19%). Regression analysis comparing GFR decline to alb/cr showed that GFR changed minimally for alb/cr up to 200 but declined at a progressively faster rate as alb/cr increased above 200. GFR declined faster (more negative slope) in smokers than in nonsmokers (-0.231+/- 0.023 versus -0.102+/- 0.008 mL/min/month; P<0.001). Cigarette smoking increased the risk for GFR decline in subjects with alb/cr <200 and in those with alb/cr >200, but the effect was much more robust for subjects with alb/cr >200. CONCLUSIONS: Urine alb/cr >200 increases the risk for subsequent GFR decline in primary hypertension, and this risk is enhanced by cigarette smoking.

Cigarette smoking exacerbates and its cessation ameliorates renal injury in type 2 diabetes.

BACKGROUND: Patients with type 2 diabetes and macroalbuminuria generally experience progressive glomerular filtration rate (GFR) decline despite angiotensin-converting enzyme inhibition (ACEI) and blood pressure (BP) control but this therapy generally stabilizes GFR in those without macroalbuminuria. Cigarette smoking exacerbates GFR decline in patients with type 2 diabetes and macroalbuminuria despite ACEI and BP control; whether this therapy prevents nephropathy progression in nonmacroalbuminuric type 2 diabetic smokers is unknown. METHODS: We determined the course of urine excretion of indices of renal injury that distinguished patients with type 2 diabetes with and without macroalbuminuria but with normal plasma creatinine who were prospectively followed 6 months while receiving ACEI and BP control. We compared this course in nonsmokers and smokers with normo-, micro-, and macroalbuminuria (n = 157) and in response to smoking cessation in a separate cohort (n = 80) with microalbuminuria. RESULTS: Urine excretion of transforming growth factor beta-1 (UTGFbetaV) increased in macroalbuminuric but not in nonmacroalbuminuric nonsmokers and UTGFbetaV rate was higher in smokers than nonsmokers within each albuminuria group. In the separate microalbuminuric cohort, the rate of UTGFbetaV change for quitting smokers was not different from nonsmokers (0.093 versus -0.123 ng/g of creatine/week, P = not significant) but that for nonquitting smokers (0.970) was higher than nonsmokers (P = 0.017). CONCLUSIONS: Patients with type 2 diabetes who are at high risk compared with low risk for nephropathy progression have progressive renal injury as measured by increasing UTGFbetaV. Cigarette smoking exacerbates renal injury in type 2 diabetes despite BP control and ACEI, but its cessation in those with microalbuminuria ameliorates the progressive renal injury caused by continued smoking.

Body measurement variability, fatness, and fat-free mass in children 8, 11, and 14 years of age: Project HeartBeat!

Project HeartBeat! is a four year mixed-longitudinal study of the development of cardiovascular risk factors in White and African American children who at baseline comprised three age cohorts 8, 11, and 14 years. This paper focuses on the anthropometric variables which were chosen to reflect body fat and fat-free mass. Selected anthropometric dimensions are compared with those of samples from the combined National Health and Nutrition Examination Surveys I and II to explore the similarities of the samples in terms of central tendencies and variances. The measurements were then explored in terms of their ability to estimate the two compartment model of body composition: fat-free mass (FFM) and body fat (BF) from bioelectrical impedance (BIA). Project HeartBeat! children are slightly larger than NHANES children and have variances that are generally comparable to the national surveys. Over seven percent (7.7%) of children were overweight (BMI) and 25% had 'mild obesity' by %BF. Three different factor analytic methods (incomplete principal components, alpha and maximum likelihood) produced two latent variables from 17 anthropometric dimensions which together accounted for 76-83% of the variation: (1) A body mass factor (F1) which was weighted highly on six circumferences, weight and six skinfolds, and (2) a linear growth factor (F2) which was strongly associated with height, arm length, and sitting height. Triceps, subscapular and midaxillary skinfolds were consistently highly loaded on the body mass factor and their sum was highly correlated to %BF and fat mass (0.90-0.99). This suggests that this sum could be used to estimate fatness in children in studies where the BIA or other body composition techniques are unavailable. FFM and %BF were predicted from the anthropometric factors. Both factors contributed to the estimate of FFM (R(2) = 0.81-0.93), although F2 contributed proportionately more. The 'body mass' factor (F1) was the main predictor of %BF (R(2) = 0.86-0.93), though at some ages the linear factor (F2) was significantly and negatively related to %BF. This set of anthropometric dimensions, taken for the purpose of estimating body composition and summarized as two latent vectors by factor analysis, strongly reflects body fat and FFM in children and adolescents. Am. J. Hum. Biol. 11:69-78, 1999. Copyright 1999 Wiley-Liss, Inc.

Body circumferences as measures of body fat distribution in 10-14-year-old schoolchildren.

In this paper the hypothesis is tested that circumferences are as useful as skinfolds in children aged 10-14 years to detect variation in regional fat distribution. This would be confirmed by the appearance of a significant canonical correlation between a vector of appropriately selected circumferences and an analogous vector of skinfolds, producing a weighted pattern suggestive of centralized obesity (that is a series of mathematical weights of different signs for central versus peripheral regions of the body). The hypothesis is confirmed (P < 0.01) in this sample of 378 children of both sexes. The association occurs in the second canonical correlation after a strong first canonical correlation providing information about fatness level (0.83-0.87). The canonical correlations are low (0.29 in boys, 0.36 in girls), lower than has previously been reported in a similar study of adults. The circumferences most heavily weighted in opposite directions are the waist and thigh. These results are in accord with adult studies. This study did not support the use of the waist-hip circumference combination, the measures currently used in most epidemiologic studies of body fat distribution.

A validation study comparing two self-reported upper extremity symptom surveys with clinical examinations for upper extremity musculoskeletal disorders.

OBJECTIVE: Evaluate the validity of two self-report symptoms surveys with two disorder classification protocols. PARTICIPANTS: 100 graduate students at a private school in the Southwest United States. METHODS: Study participants completed two self-report upper extremity musculoskeletal symptoms surveys: a nine item 10 cm Visual Analogue Scale (VAS) and a nine item Likert categorical scale anchored from "None" to "Very severe". Clinical examinations were administered using two musculoskeletal disorder classification protocols. RESULTS: For the nine body regions, concordance between the two self-report symptoms scales ranged from 0.49-0.75. Overall there was greater than 80% agreement for the two disorder classification protocols. Using either symptom survey with either disorder classification protocol provided high sensitivities and specificities (Youden's J ≥ 0.70). Three of possible six symptom survey/classification protocol pairings provided high sensitivities and specificities across all disorder groups. CONCLUSION: In this graduate student sample, none of the self-report symptom survey-classification protocol pairings was demonstratively more useful than any other pairing for studies of musculoskeletal disorders among computer users.

Associations of BMI and its fat-free and fat components with blood lipids in children: Project HeartBeat!

AIM: This study aimed to distinguish between the roles of the two components of BMI, the fat mass (FM) index and the fat-free mass (FFM) index, in BMI's association with blood lipids in children and adolescents. METHODS: A total of 678 children (49.1% female, 79.9% non-black), initially aged 8, 11 and 14 years, were followed at 4-month intervals for up to 4 years (1991-1995). Total cholesterol (TC), LDL-C, HDL-C and triglycerides were determined in fasting blood samples. FFM index and FM index were calculated as FFM (kg)/height (m)(2) and FM (kg)/height (m)(2), respectively. Using a multilevel linear model, repeated measurements of blood lipids were regressed on concurrent measures of BMI or its components, adjusting for age, sex and race and, in a subsample, also for physical activity, energy intake and sexual maturity. RESULTS: Estimated regression coefficients for the relations of TC with BMI, FFM index and FM index were 1.539, -0.606 (p > 0.05) and 3.649, respectively. When FFM index and FM index were entered into the TC model simultaneously, regression coefficients were -0.855 and 3.743, respectively. An increase in BMI was related to an increase in TC; however, an equivalent increase in FM index was related to a greater increase in TC and, when FFM index was tested alone or with FM index, an increase in FFM index was related to a decrease in TC. Similar results were observed for LDL-C. FFM index and FM index were both inversely related to HDL-C and directly to triglycerides. Compared with FFM index, the equivalent increase in FM index showed a greater decrease in HDL-C. CONCLUSION: Greater BMI was related to adverse levels of blood lipids in children and adolescents, which was mainly attributable to BMI's fat component. It is important to identify weight management strategies to halt the childhood obesity epidemic and subsequently prevent heart disease in adulthood.

Psychosocial outcomes of Lunch is in the Bag, a parent program for packing healthful lunches for preschool children.

OBJECTIVE: This pilot study evaluated effects of Lunch is in the Bag on behavioral constructs and their predictive relationship to lunch-packing behaviors of parents of young children. METHODS: Six child care centers were pair-matched and randomly assigned to intervention (n = 3) and comparison (n = 3) groups. Parent/child dyads participated. Constructs of knowledge, outcome expectations, perceived control, subjective norms, and intentions were measured by a pre/post questionnaire. Hierarchical linear regression was used, and P < .05 was considered significant. RESULTS: There were significant increases in knowledge (P = .01); outcome expectations for whole grains (P < .001); and subjective norms for fruit (P = .002), vegetables (P = .046), and whole grains (P = .02). Perceived control, outcome expectations, and intentions significantly predicted packing vegetables and knowledge predicted whole grains. CONCLUSIONS AND IMPLICATIONS: Lunch is in the Bag is a feasible intervention to improve the lunch-packing behaviors of parents of preschool-aged children.

Lunch is in the bag: increasing fruits, vegetables, and whole grains in sack lunches of preschool-aged children.

Fruits, vegetables, and whole grains are important sources of nutrients for healthy growth and development of young children. Recent evidence suggests that sack lunches packed by parents for children to consume at child-care centers do not regularly meet the goal of one serving of fruit, vegetables, and whole grains. Lunch Is In The Bag is a child-care center-based nutrition education program targeted at parents of preschool-aged children to increase the number of servings of fruits, vegetables, and whole grains in sack lunches sent from home that was pilot tested in fall 2008. In a quasiexperimental design, six child-care centers were paired by size before being randomly assigned to intervention (n=3) and comparison (n=3) groups. The parents of caregivers with primary responsibility for preparing the sack lunches of the 3- to 5-year-old children attending the centers were enrolled as parent-child dyads. The intervention included parent handouts, classroom activities, education stations, and teacher training. The contents of the lunch sacks for both the intervention group and comparison group were recorded for 3 nonconsecutive days before and immediately after the intervention period to measure the number of servings of fruits, vegetables, and whole grains. A total of 132 parent-child dyads completed the study, 81 in the intervention group and 51 in the comparison group. Direct observation of children's lunches from the intervention group showed an increase in predicted mean number of servings of vegetables, from 0.41 to 0.65 (P<0.001) and whole grains, from 0.54 to 1.06 (P<0.001). No significant difference was observed in the mean number of servings of fruit. Lunch Is In The Bag, which is designed to fit in the child-care environment and targets parents of 3- to 5-year-old children, is a feasible intervention for improving the nutritional quality of sack lunches.

Analytic methods in Project HeartBeat!

Project HeartBeat! (1991-1995) was an observational study of the development of cardiovascular disease (CVD) risk factors in childhood and adolescence using an accelerated longitudinal design. The purpose of this paper is to explain the analytic methods used in the study, particularly multilevel statistical models. Measurements of hemodynamic, lipid, anthropometric, and other variables were obtained in 678 children who were enrolled in three cohorts (baseline ages 8, 11, and 14 years) and followed for 4 years, resulting in data for children aged 8-18 years. Patterns of change of blood pressure, serum lipid concentration, and obesity with age, race, and gender were of particular interest. The design specified 12 measurements of each outcome variable per child. Multilevel models were used to account for correlations resulting from repeated measurements on individuals and to allow use of data from incomplete cases. Data quality-control measures are described, and an example of multilevel analysis in Project HeartBeat! is presented. Multilevel models were also used to show that there were no differences attributable to the cohorts, and combining data from the three age cohorts was judged to be reasonable. Anthropometric data were compared with national norms and shown to have similar patterns; thus, the patterns seen in the CVD risk factors may be generalized, with some caveats, to the U.S. population of children.

Effects of body size and body fatness on left ventricular mass in children and adolescents: Project HeartBeat!

BACKGROUND: Left ventricular mass (LVM) is a strong predictor of cardiovascular disease in adults. Available study findings on effects of body fatness on LVM in children are inconsistent. Understanding the impact of body fat on LVM in children may help prevent excessive LVM through measures to reduce overweight and obesity. METHODS: Healthy children (n=678) aged 8, 11, and 14 years at baseline were examined at 4-month intervals for up to 4 years (1991-1995); 4608 valid measurements of LVM were obtained with M-mode echocardiography. A multilevel linear model was used for analysis. The impact of body size was examined by adding separately nine body-size indicators to a basic LVM-gender-age model. The impact of body fatness was tested by introducing four body-fatness indicators into the nine models, yielding 36 models. RESULTS: All body-size indicators showed strong, positive effects on LVM. In models containing weight or body surface area (measuring both fat-free and fat contributions to body size), additional effects of body fatness were negative; in models containing fat-free mass (FFM) or height (both measuring body size independent of body fat), increased body fatness was related to a significant increase in LVM. For example, in models with FFM as a body-size indicator, a 1-SD increase in percent body fat or fat mass was related to a 5.4- or 7.2-g increase in LVM, respectively. CONCLUSIONS: Effects of body size on LVM attributable to fat-free body mass can be distinguished from those attributable to fat body mass; both are independent, positive predictors, but the former is the stronger determinant. When a body-size indicator not independent of body fat is used as a predictor, effects of fat-free body mass and fat body mass are forced to relate to the same indicator; because their magnitudes are estimated to be equal, the effect of fat body mass is overestimated. Thus, when an additional body-fatness indicator is included in the prediction of LVM, the additional estimated effect related to the indicator appears to be negative.

Trajectories of fat mass index, fat free-mass index, and waist circumference in children: Project HeartBeat!

BACKGROUND: Body composition and fat distribution change dramatically during adolescence. Data based on longitudinal studies to describe these changes are limited. The aim of this study was to describe age-related changes in fat free-mass index (FFMI) and fat mass index (FMI), which are components of BMI, and waist circumference (WC) in participants of Project HeartBeat!, a longitudinal study of children. METHODS: Anthropometric measurements and body composition data were obtained in a mixed longitudinal study of 678 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years, every 4 months for 4 years (1991-1995). Trajectories of change from ages 8 to 18 years were measured for FFMI, FMI, and WC. Because of the small number of observations for black participants, trajectories for this group were limited to ages 8.5-15 years. RESULTS: Body mass index, FFMI, and WC increased steadily with age for all race-gender cohorts. However, in nonblack girls, FFMI remained constant after about age 16 years. For black boys and girls, FFMI was similar at age 8.5 years but increased more steeply for black boys by age 15 years. In girls, FMI showed an upward trend until shortly after age 14 years, when it remained constant. In boys, FMI increased between age 8 years and age 10 years, and then decreased. CONCLUSIONS: The extent to which each component of BMI contributes to the changes in BMI depends on the gender, race, and age of the individual. Healthcare providers need to be aware that children who show upward deviation of BMI or BMI percentiles may have increases in their lean body mass rather than in adiposity.

Blood lipids in children: age-related patterns and association with body-fat indices: Project HeartBeat!

BACKGROUND: Longitudinal data on the normal development of blood lipids and its relationships with body fatness in children and adolescents are limited. Objectives of the current analysis were to estimate trajectories related to age for four blood lipid components and to examine the impact of change in body fatness on blood lipid levels, comparing estimated effects among adiposity indices, in children and adolescents. METHODS: Three cohorts, with a total of 678 children (49.1% female, 79.9% nonblack) initially aged 8, 11, and 14 years, were followed at 4-month intervals (1991-1995). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were determined in blood samples taken following fasting. Body fatness was measured by five adiposity indices-BMI; percent body fat (PBF); abdominal circumference; and the sums of six and of two skinfold thicknesses. Trajectories of change in blood lipid levels from ages 8 to 18 years were estimated by gender and race. The impact of change in body fatness on lipid levels was evaluated for each index, adjusting for gender, race, and age. RESULTS: All lipid components varied significantly with age. Total cholesterol decreased by approximately 19 mg/dL from ages 9 to 16 years in girls and more steeply from ages 10 to 17 years in boys. LDL-C decreased monotonically, more steeply in boys than in girls. It was higher among nonblacks than among blacks. HDL-C increased monotonically in girls, mainly from ages 14 to 18 years, but fluctuated sharply among boys. Levels of HDL-C were higher among blacks than among nonblacks. The levels of triglycerides increased from ages 8 to 12 years among girls and, almost linearly, from ages 8 to 18 years among boys. The levels of triglycerides were higher among nonblacks than among blacks. Increase in body fatness was significantly associated with increases in total cholesterol, LDL-C, and triglyceride levels. Significant interactions between the adiposity indices (except for BMI) and gender indicated smaller impacts of change in body fatness on total cholesterol and LDL-C in girls than in boys. The estimated impact on triglycerides was weaker among blacks than among nonblacks, except for PBF. Change in body fatness was negatively associated with HDL-C. The results remained essentially unchanged after adjustments for energy intake, physical activity, and sexual maturation. CONCLUSIONS: Patterns of change with age in blood lipid components vary significantly among gender and racial groups. Increase in body fatness among children is consistently associated with adverse change in blood lipids. Evaluation of blood lipid level should take into account variation by age, gender, and race. Intervention through body-fat control should help prevent adverse lipid levels in children and adolescents.