Socioeconomic position, resilience, and health behaviour among elderly people.

OBJECTIVES: Healthy psychological functioning, the ability to respond rapidly to environmental changes, has been associated with better health outcomes. Less work has examined the association with health behaviour. This study explores whether resilience (a specific expression of healthy psychological functioning) is positively associated with health behaviour in an elderly population aged ≥65 years and whether this association differs in different socioeconomic groups. METHODS: Resilience was measured in 3,942 elderly participating in a population-based cohort study (KORA-Age study) in Germany through a short version of the Resilience Scale developed by Wagnild and Young. Regression analyses were performed by socioeconomic position (low/high educational level or income) for two outcome variables, i.e. high consumption of fruit and vegetables and high/moderate physical activity. RESULTS: Resilient people were more likely to consume ≥5 servings of fruit and vegetables a day and to perform high/moderate physical activity as compared to non-resilient people (ORs ranging from 1.5 to 2.2), irrespective of socioeconomic position. CONCLUSIONS: Resilience could provide an important starting point for health promotion strategies, addressing resources rather than deficits and risk factors.

Relative weight-related costs of healthcare use by children--results from the two German birth cohorts, GINI-plus and LISA-plus.

Obesity among children and adolescents is a growing public health burden. According to a national reference among German children and adolescents aged 3-17 years, 15% are overweight (including obese) and 6.3% are obese. This study aims to assess the economic burden associated with overweight and obesity in children based on a cross-sectional survey from two birth cohort studies: the GINI-plus - German Infant Nutritional Intervention plus Non-Intervention study (3287 respondents aged 9 to <12 years) and the LISA-plus study - Influence of life-style factors on the development of the immune system and allergies in East and West Germany (1762 respondents aged 9 to <12 years). Using a bottom-up approach, we analyse direct costs induced by the utilisation of healthcare services and indirect costs emerging from parents' productivity losses. To investigate the impact of Body Mass Index (BMI) on costs, we perform various descriptive analyses and estimate a two-part regression model. Average annual total direct medical costs of healthcare use are estimated to be €418 (95% CI [346-511]) per child, split between physician (22%), therapist (29%), hospital (41%) and inpatient rehabilitation costs (8%). Bivariate analysis shows considerable differences between BMI groups: €469 (severely underweight), €468 (underweight), €402 (normal weight), €468 (overweight) and €680 (obese). Indirect costs make up €101 per year on average and tend to be higher for obese children, although this was not statistically significant. Drawing on these results, differences in healthcare costs between BMI groups are already apparent in children.

The transition to post-industrial BMI values among US children.

The trend in the BMI values of US children has not been estimated very convincingly because of the absence of longitudinal data. Our objective is to estimate time series of BMI values by birth cohorts instead of measurement years. We use five regression models to estimate the BMI trends of non-Hispanic US-born black and white children and adolescents ages 2-19 between 1941 and 2004. The increase in BMIZ values during the period considered was 1.3 sigma (95% CI: 1.16 sigma; 1.44 sigma) among black girls, 0.8 sigma for black boys, 0.7 sigma for white boys, and 0.6 sigma for white girls. This translates into an increase in BMI values of some 5.6, 3.3, 2.4, and 1.5 units, respectively. While the increase in BMI values started among the birth cohorts of the 1940s among black girls, the rate of increase tended to accelerate among all four ethnic/gender groups born in the mid-1950s to early-1960s. Some regional evidence leads to the conjecture that the spread of automobiles and radios affected the BMI values of boys already in the interwar period. We suppose that the changes in lifestyle associated with the labor saving technological developments of the 20th century are associated with the weight gains observed. The increased popularity of television viewing was most prominently associated with the contemporaneous acceleration in BMI gain.

Differences in the physical growth of US-born black and white children and adolescents ages 2-19, born 1942-2002.

AIM: The present study estimates differences in the trend and in the age-by-height profiles of US-born non-Hispanic black and white children and adolescents born 1942-2002. SUBJECTS AND METHODS: The combined NHES and NHANES data sets stratified by ethnicity and gender were used. The differences in height-for-age z-scores (HAZ) were decomposed into an age effect and a secular trend effect using a non-linear regression model. RESULTS: The tempo of growth among blacks is faster than among whites. Black girls are more than 0.3sigma taller than white girls between the ages of 3 and 11. At age 9 this amounts to some 2.7 cm. White boys catch up to black boys at age 14 and white girls catch up at age 15 and are taller thereafter. At age 19 whites are only slightly taller: By 0.12sigma (0.8 cm) for boys and 0.03sigma (0.2 cm) among girls. The cumulative effect of the differences in the secular trend is considerable. Between the birth cohorts of the mid-1950s and the beginning of the new century blacks gained some 0.17sigma (girls) and 0.23sigma (boys) relative to white HAZ values. CONCLUSION: Blacks have a faster tempo of linear growth in childhood partly on account of their nutritional habits, as girls in particular tend to have higher BMI values, and partly probably because of genetic differences.

Height of US-born non-Hispanic children and adolescents ages 2-19, born 1942-2002 in the NHANES samples.

We examine the height of non-Hispanic US-born children born 1942-2002 on the basis of all NHES and NHANES data sets available. We use the CDC 2000 reference values to convert height into height-for-age z-scores stratified by gender. We decompose deviations from the reference values into an age-effect and a secular trend effect and find that after an initial increase in the 1940s, heights experienced a downward cycle to reach their early 1950s peak again only c. 2 decades later. After the early 1970s, heights increased almost continuously until the present. Girls born in 2002 are estimated to be 0.35sigma and boys are 0.39sigma above their 1971 values implying an increase of approximately 2.5 cm between birth cohorts 1971 and 2002 as an average of all ages (Table 3). Age effects are also substantial-pointing to faster tempo of growth. Girls are c. 0.23sigma taller at age 11 and boys 0.15sigma taller at age 13 than reference values (Fig. 3). This translates into an age effect of approximately 1.7 and 1.3 cm, respectively. Hence, the combined estimated trend and age-effects are substantially larger than those reported hitherto. The 2-decade stagnation in heights and the upward trend beginning in the early 1970s confirm the upswing in adult heights born c. 1975-1983, and imply that adults are likely to continue to increase in height. We find the expected positive correlation between height and family income, but income does not affect the secular trend or the age effects markedly.

Are Americans shorter (partly) because they are fatter? A comparison of US and Dutch children's height and BMI values.

OBJECTIVE: The study compared the height and BMI values of US children and youth by gender in the most recent NHANES surveys (1999-2004) to those of their Dutch counterparts in 1997 in order to gain insights into the different growth patterns. RESULTS: US children and youth are both shorter and heavier than their Dutch counterparts. US adolescent girls tend to experience an earlier growth spurt than do the Dutch and the velocity of growth of US boys slows down faster after the adolescent growth spurt than does that of their Dutch counterparts. The latter end up being approximately 5.6 cm taller and their median BMI values are 1.9-2.0 less than that of US youth between the ages of 10 and 19. This implies that US boys of the same height at age 19 are 8.8 kg heavier than their Dutch counterparts, and girls of age 13 are 7.2 kg heavier. DISCUSSION: Some studies link high BMI values in childhood to an earlier onset of adolescence, which in turn has been linked to less growth thereafter. CONCLUSION: The fast tempo of growth of the US children may be associated with high energy balance, which leads to higher BMI values and which in turn may be associated with less growth during adolescence.