Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents.

OBJECTIVE: To investigate weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population-based multiethnic sample of early adolescents. DESIGN: Cross-sectional population-based survey. SUBJECTS: In total, 2789 adolescents 11-14 years of age from three highly deprived regional authorities in East London, in 2001. MEASUREMENTS: Data were collected by student-completed questionnaire on weight perception, dieting history, mental and physical health, health behaviours, social capital and sociodemographic factors. Height and weight were measured by trained researchers. Overweight was defined as BMI > or =85th centile and obesity as BMI > or =98th centile. Underweight was defined as BMI< or =15th centile. RESULTS: In all, 73% were from ethnic groups other than white British. Valid BMI were available for 2522 subjects (90.4%) of whom 14% were obese. Only 20% of overweight boys and 51% of overweight girls assessed their weight accurately. Accuracy of weight perception did not vary between ethnic groups. In all, 42% of girls and 26% of boys reported current dieting to lose weight. Compared with white British teenagers, a history of dieting was more common among Bangladeshi, Indian and mixed ethnicity boys and less likely among Pakistani girls. Self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P=0.02). Within ethnic subgroups, self-esteem was significantly lower in overweight white British boys (P=0.03) and obese Bangladeshi boys (P=0.01) and Bangladeshi girls (P=0.04), but significantly higher in obese black African girls (P=0.01) than those of normal weight. Obese young people had a higher prevalence of psychological distress (P=0.04), except among Bangladeshi teenagers, where overweight and obese young people had less psychological distress than those of normal weight (P=0.02). Birth outside the UK was associated with reduced risk of obesity in girls (P=0.02) but not with history of dieting, weight perception or psychological factors in either gender. CONCLUSION: High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, dieting history and the associations of obesity with self-esteem and psychological distress vary between ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress.

Illicit and traditional drug use among ethnic minority adolescents in East London.

OBJECTIVES: To explore ethnic variations in the use of illicit and traditional drugs, and the association of indicators of acculturation with drug use among an ethnically diverse representative sample of early adolescents in East London. STUDY DESIGN: A cross-sectional questionnaire survey. METHODS: Confidential questionnaires were used to assess 2789 male and female pupils in years 7 and 9, aged 11-14 years old, from a representative sample of 28 secondary schools in East London. RESULTS: In total, 10.8% reported having ever tried illicit drugs and 7.3% reported ever using cannabis. Compared with white British adolescents, cannabis use in the previous month was significantly higher amongst black Caribbean adolescents. Lifetime cannabis use was significantly higher amongst black Caribbean and mixed ethnicity young people, but was lower amongst Bangladeshi, Indian and Pakistani adolescents. Living in UK for 5 years or less markedly reduced the risk of lifetime and recent cannabis use when controlled for ethnicity and social class. Glue or solvent use was reported in 3.2% of adolescents, with use significantly higher amongst Bangladeshi young people. Lifetime paan use was reported by 14.1% of the sample, and was almost completely confined to South Asian or mixed ethnicities. CONCLUSIONS: Ethnic differences in illicit drug use were found in the study population, and significant differences were found between ethnic groups often identified as 'black.' Further research is needed in understanding cultural-specific risk and protective factors in different ethnic groups, and the importance of cultural identity in mediating health risk behaviors. The high use of paan and glue/gas/solvents by Bangladeshi young people poses an unappreciated public health problem that may require targeted interventions.

Aircraft and road traffic noise and children's cognition and health: a cross-national study.

BACKGROUND: Exposure to environmental stressors can impair children's health and their cognitive development. The effects of air pollution, lead, and chemicals have been studied, but there has been less emphasis on the effects of noise. Our aim, therefore, was to assess the effect of exposure to aircraft and road traffic noise on cognitive performance and health in children. METHODS: We did a cross-national, cross-sectional study in which we assessed 2844 of 3207 children aged 9-10 years who were attending 89 schools of 77 approached in the Netherlands, 27 in Spain, and 30 in the UK located in local authority areas around three major airports. We selected children by extent of exposure to external aircraft and road traffic noise at school as predicted from noise contour maps, modelling, and on-site measurements, and matched schools within countries for socioeconomic status. We measured cognitive and health outcomes with standardised tests and questionnaires administered in the classroom. We also used a questionnaire to obtain information from parents about socioeconomic status, their education, and ethnic origin. FINDINGS: We identified linear exposure-effect associations between exposure to chronic aircraft noise and impairment of reading comprehension (p=0.0097) and recognition memory (p=0.0141), and a non-linear association with annoyance (p<0.0001) maintained after adjustment for mother's education, socioeconomic status, longstanding illness, and extent of classroom insulation against noise. Exposure to road traffic noise was linearly associated with increases in episodic memory (conceptual recall: p=0.0066; information recall: p=0.0489), but also with annoyance (p=0.0047). Neither aircraft noise nor traffic noise affected sustained attention, self-reported health, or overall mental health. INTERPRETATION: Our findings indicate that a chronic environmental stressor-aircraft noise-could impair cognitive development in children, specifically reading comprehension. Schools exposed to high levels of aircraft noise are not healthy educational environments.

Qualitative responses of children to environmental noise.

Results from recent quantitative research consistently demonstrate that children are a high risk group, vulnerable to the adverse effects of noise exposure, especially effects on cognitive performance, motivation and annoyance. The aims of the two qualitative studies reported in this paper are to explore children's a) perception of noise exposure; b) perceived risk of and attitudes towards noise pollution; c) coping strategies; and d) the annoyance response. The Millennium Conference Study involved focus group interviews with an international sample (n=36) unselected by exposure. The West London Schools Study involved individual interviews, conducted with a purposively selected sample (n=18) exposed to aircraft noise. The children in the focus groups reported being most affected by neighbours' noise and road traffic noise, whereas children exposed to aircraft noise were most affected by aircraft noise. As expected, the impact of noise pollution on everyday activities (e.g. schoolwork, homework and playing) was larger for the children exposed to high levels of aircraft noise compared with the low noise exposed children and focus group samples. The range of coping strategies that children employed to combat noise exposure in their lives was dependent upon the amount of control they had over the noise source. The emotional response of children describing the annoyance reaction to noise was consistent with adult reactions and it would seem that child noise annoyance is the same construct. Future research should employ qualitative methods to supplement quantitative investigations.

The effects of chronic aircraft noise exposure on children's cognition and health: 3 field studies.

This article provides a review of three of the most important field studies to have examined the non-auditory effects of chronic aircraft noise exposure on children's cognition and health. The design of each of the studies is outlined, relevant methodological issues are highlighted and the findings from the studies are reported. Effects are reported on annoyance and quality of life, motivation and helplessness, stress responses as indexed by neuroendocrine tests and blood pressure measurements. In terms of cognitive performance, effects are reported on reading, attention and long-term and working memory.

Multilevel modelling of aircraft noise on performance tests in schools around Heathrow Airport London.

STUDY OBJECTIVE: To examine the effects of chronic exposure to aircraft noise on children's school performance taking into account social class and school characteristics. DESIGN: This is a cross sectional study using the National Standardised Scores (SATs) in mathematics, science, and English (11 000 scores from children aged 11 years). The analyses used multilevel modelling to determine the effects of chronic aircraft noise exposure on childrens' school performance adjusting for demographic, socioeconomic and school factors in 123 primary schools around Heathrow Airport. Schools were assigned aircraft noise exposure level from the 1994 Civil Aviation Authority aircraft noise contour maps. SETTING: Primary schools. PARTICIPANTS: The sample were approximately 11 000 children in year 6 (approximately 11 years old) from 123 schools in the three boroughs surrounding Heathrow Airport. MAIN RESULTS: Chronic exposure to aircraft noise was significantly related to poorer reading and mathematics performance. After adjustment for the average socioeconomic status of the school intake (measured by percentage of pupils eligible for free school meals) these associations were no longer statistically significant. CONCLUSIONS: Chronic exposure to aircraft noise is associated with school performance in reading and mathematics in a dose-response function but this association is confounded by socioeconomic factors.

The West London Schools Study: the effects of chronic aircraft noise exposure on child health.

BACKGROUND: Previous field studies have indicated that children's cognitive performance is impaired by chronic aircraft noise exposure. However, these studies have not been of sufficient size to account adequately for the role of confounding factors. The objective of this study was to test whether cognitive impairments and stress responses (catecholamines, cortisol and perceived stress) are attributable to aircraft noise exposure after adjustment for school and individual level confounding factors and to examine whether children exposed to high levels of social disadvantage are at greater risk of noise effects. METHODS: The cognitive performance and health of 451 children aged 8-11 years, attending 10 schools in high aircraft noise areas (16 h outdoor Leq > 63 dBA) was compared with children attending 10 matched control schools exposed to lower levels of aircraft noise (16 h outdoor Leq < 57 dBA). RESULTS: Noise exposure was associated with impaired reading on difficult items and raised annoyance, after adjustment for age, main language spoken and household deprivation. There was no variation in the size of the noise effects in vulnerable subgroups of children. High levels of noise exposure were not associated with impairments in mean reading score, memory and attention or stress responses. Aircraft noise was weakly associated with hyperactivity and psychological morbidity. CONCLUSIONS: Chronic noise exposure is associated with raised noise annoyance in children. The cognitive results indicate that chronic aircraft noise exposure does not always lead to generalized cognitive effects but, rather, more selective cognitive impairments on difficult cognitive tests in children.

A follow-up study of effects of chronic aircraft noise exposure on child stress responses and cognition.

BACKGROUND: Children are a high-risk group vulnerable to the effects of chronic aircraft noise exposure. This study examines the effects of aircraft noise exposure on children's health and cognition around London Heathrow airport and tests sustained attention as an underlying mechanism of effects of noise on reading and examines the way children adapt to continued exposure to aircraft noise. METHODS: In this repeated measures epidemiological field study, the cognitive performance and health of 275 children aged 8-11 years attending four schools in high aircraft noise areas (16-h outdoor Leq > 66 dBA) was compared with children attending four matched control schools exposed to lower levels of aircraft noise (16-h outdoor Leq < 57 dBA). The children first examined at baseline were examined again after a period of one year at follow-up. Health questionnaires and cognitive tests were group administered to the children in the schools. RESULTS AND CONCLUSIONS: At follow-up chronic aircraft noise exposure was associated with higher levels of annoyance and perceived stress, poorer reading comprehension and sustained attention, measured by standardized scales after adjustment for age, social deprivation and main language spoken. These results do not support the sustained attention hypothesis previously used to account for the effects of noise on cognition in children. The reading and annoyance effects do not habituate over a one-year period and do not provide strong evidence of adaptation.

Chronic aircraft noise exposure, stress responses, mental health and cognitive performance in school children.

BACKGROUND: Previous research suggests that children are a high risk group vulnerable to the effects of chronic noise exposure. However, questions remain about the nature of the noise effects and the underlying causal mechanisms. This study addresses the effects of aircraft noise exposure on children around London Heathrow airport, in terms of stress responses, mental health and cognitive performance. The research also focuses on the underlying causal mechanisms contributing to the cognitive effects and potential confounding factors. METHODS: The cognitive performance and health of 340 children aged 8-11 years attending four schools in high aircraft noise areas (16 h outdoor Leq > 66 dBA) was compared with children attending four matched control schools exposed to lower levels of aircraft noise (16 h outdoor Leq < 57 dBA). Mental health and cognitive tests were group administered to the children in the schools. Salivary cortisol was measured in a subsample of children. RESULTS: Chronic aircraft noise exposure was associated with higher levels of noise annoyance and poorer reading comprehension measured by standardized scales with adjustments for age, deprivation and main language spoken. Chronic aircraft noise was not associated with mental health problems and raised cortisol secretion. The association between aircraft noise exposure and reading comprehension could not be accounted for by the mediating role of annoyance, confounding by social class, deprivation, main language or acute noise exposure. CONCLUSIONS: These results suggest that chronic aircraft noise exposure is associated with impaired reading comprehension and high levels of noise annoyance but not mental health problems in children.

A Review of Environmental Noise and Mental Health.

The question of whether environmental noise exposure causes mental ill-health is still largely unanswered. This paper reviews the studies of environmental and industrial noise and mental ill-health published between 1993 and 1998 and suggests possibilities for future research. Recent community based studies suggest high levels of environmental noise are associated with mental health symptoms such as depression and anxiety but not with impaired psychological functioning. Several studies find that self-reported noise sensitivity does not interact with noise exposure to lead to increased vulnerability to mental ill-health. Chronic aircraft noise exposure in children impairs quality of life but does not lead to depression or anxiety. Further research on environmental noise and mental health should be accompanied by more accurate and detailed measurement of noise exposure and consideration of the impact of other environmental stressors and careful measurement of confounding factors such as social class. Target study populations exposed to noise should be chosen to avoid those where noise exposure is likely to have led to noise sensitive individuals moving away from the area. There should also be greater use of standardised instruments to measure a wider range of mental health outcomes. Also other physiological outcomes such as hormonal measures could with benefit be measured simultaneously.

AANA journal course: update for nurse anesthetists--pulmonary aspiration revisited: changing attitudes toward preoperative fasting.

Pulmonary aspiration during anesthesia, although rare in most patients, remains a very real concern for anesthesia providers. Recently, an extensive collection of data has emerged demonstrating a seemingly benign effect of gastric pH and volume from clear liquids consumed 2 to 3 hours prior to surgery in select patients. This AANA Journal course will evaluate the risk of pulmonary aspiration and relate this to specific identifying characteristics described to influence risk. Gastric physiology will be reviewed and current research will be examined evaluating the impact of clear liquids on specific outcome variables.