Pregnancy loss is related to body mass index and prediabetes in early adulthood: Findings from Add Health.

Pregnancy loss, including miscarriage and stillbirth, affects 15-20% of pregnancies in the United States (US) annually. Accumulating evidence suggests that pregnancy loss is associated with a greater cardiovascular disease (CVD) burden later in life. However, few studies have evaluated the impact of pregnancy loss on CVD risk factors in early adulthood (age <35 years). The aim of this study was to examine associations between pregnancy loss and CVD risk factors (body mass index, blood pressure, hyperlipidemia, diabetes status) in early adulthood. We conducted a cross-sectional analysis using the public-use dataset for Wave IV (2007-2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our sample consisted of women, ages 24-32 years, with a previous pregnancy who completed biological data collection (n = 2,968). Pregnancy loss was assessed as any history of miscarriage or stillbirth; and quantified as none, one, or recurrent (≥2) pregnancy loss. Associations between pregnancy loss and each CVD risk factor were tested using linear and logistic regression adjusting for sociodemographic factors, parity, health behaviors during pregnancy, and depression. We tested for interactions with race/ethnicity. A total of 670 women reported a pregnancy loss, of which 28% reported recurrent pregnancy loss. A prior pregnancy loss was related to a 3.79 (kg/mm2) higher BMI in non-Hispanic Black women, but not white women. Women with recurrent pregnancy loss were more likely to have prediabetes (AOR, 1.93; 95% CI, 1.10-3.37, p<0.05) than women with all live births. Findings suggest that pregnancy loss may be associated with a more adverse CVD risk profile in early adulthood, particularly for women who experience recurrent pregnancy loss. This highlights the need for CVD risk assessment in young women with a prior pregnancy loss. Further research is necessary to identify underlying risk factors of pregnancy loss that may predispose women to CVD.

Race/Ethnicity, Gender, and Trajectories of Depressive Symptoms Across Early- and Mid-Life Among the Add Health Cohort.

While disparities in depressive symptoms by race/ethnicity and gender have been documented, left unclear is how such status characteristics intersect to influence mental health, particularly across early life and among a diverse set of population subgroups. This study investigates how intra- and inter-individual trends in depressive symptoms unfold across a 30-year span (ages 12-42) and are structured by the intersection of race/ethnicity and gender among White, Black, Hispanic, and Asian American young adults (N = 18,566). Analyses use data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents who have been followed through their fourth decade of life. We draw on Waves I-IV and a representative subsample of the brand new Wave V data. Growth curve models indicated depressive symptoms decreased across adolescence and young adulthood before increasing in the early 30s. Racial/ethnic minorities reported more depressive symptoms than Whites. Women reported more depressive symptoms than men and experienced especially steep increases in their late 30s. Racial/ethnic-gender disparities remained stable with age, except for Hispanic-White disparities among women and Asian American-White disparities among men, which narrowed with age. Overall, findings demonstrate dynamic inequalities across a longer period of the life span than was previously known, as well as heterogeneity in trajectories of poor mental health within and between racial/ethnic-gender groups. Results also suggest that Black and Asian American women experience the highest mental health risks and that interventions for reducing disparities in depressive symptoms should focus on adults in their late 20s/early 30s, particularly women of color.

The Depths of Despair Among US Adults Entering Midlife.

OBJECTIVES: To test whether indicators of despair are rising among US adults as they age toward midlife and whether this rise is concentrated among low-educated Whites and in rural areas. METHODS: We used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of US adolescents in 1994. Our sample was restricted to individuals who participated in 1 or more of 5 waves (1994-2017) and self-identified as non-Hispanic White, non-Hispanic Black, or Hispanic (n = 18 446). We examined change in indicators of despair from adolescence to adulthood using multilevel regression analysis, testing for differences by race/ethnicity, education, and rurality. RESULTS: We found evidence of rising despair among this cohort over the past decade. This increase was not restricted to low-educated Whites or to rural areas. CONCLUSIONS: Results suggest that generally rising despair among the young adult cohort now reaching midlife that cuts across racial/ethnic, educational, and geographic groups may presage rising midlife mortality for these subgroups in the next decade.

Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample.

INTRODUCTION: Although elevated blood glucose is associated with adverse maternal and fetal health outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive health care, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes. METHODS: This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007 to 2009. Women were aged 24 to 32 years, sexually active with men, and not pregnant. Hemoglobin A1C identified prediabetes and diabetes from blood specimens. The primary outcome was most effective contraception used in the past year: more effective (sterilization, intrauterine device, implant, combined hormonal methods, or injectable), less effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for race and ethnicity, education, insurance, health care access, and body mass index. RESULTS: Of the women with diabetes, 37.6% used more effective contraception, 33.6% less effective contraception, and 28.8% none. Women with diabetes had higher odds of using no contraception, rather than more effective contraception, than women with normoglycemia (adjusted odds ratio [aOR], 1.90; 95% CI, 1.25-2.87). Women with diabetes who were undiagnosed had greater odds of using less effective contraception, rather than more effective contraception, compared with those who were diagnosed (aOR 3.39; 95% CI, 1.44-7.96). Contraceptive use did not differ between women with prediabetes and normoglycemia. DISCUSSION: Less effective contraceptive methods were commonly used by women with diabetes. Midwives and other women's health care providers can support women with diabetes to reach their pregnancy goals by providing preconception care and family planning.

Comorbid hypertension and diabetes among U.S. women of reproductive age: Prevalence and disparities.

AIMS: Diabetes is associated with significant pregnancy complications, which can be further exacerbated by comorbid hypertension. Racial/ethnic differentials in the burden of comorbid hypertension and diabetes among women of reproductive age have not been described. METHODS: Using Wave IV of the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health), we analyzed survey and biological data from 6576 non-pregnant women who were aged 24-32 in 2007-2008. Hypertension and diabetes were identified by self-report of diagnosis and biological measurements taken during in-home interviews. We used logistic regression models to predict the presence of comorbid hypertension and diabetes and whether each was diagnosed. RESULTS: Over a third (36.0%) of women with diabetes had comorbid hypertension. Compared to non-Hispanic white women, more non-Hispanic black women had comorbid hypertension and diabetes (adjusted odds ratio (aOR) 5.93, 95% CI 3.84-9.16), and, if comorbid, were less likely to have a diabetes diagnosis (aOR 0.03, 95% CI 0.007-0.1) or hypertension diagnosis (aOR 0.22, 95% CI 0.08-0.65). CONCLUSION: Comorbid hypertension and diabetes are more common among non-Hispanic black women and less likely to be diagnosed, signaling disparities threatening maternal and child health among women with diabetes.

Racial/Ethnic Disparities in Diabetes Diagnosis and Glycemic Control Among Women of Reproductive Age.

BACKGROUND: Types 1 and 2 diabetes mellitus complicate pregnancies and threaten the health of women of reproductive age and their children. Among older adults, diabetes morbidity disproportionately burdens racial/ethnic minorities, but diabetes emergence among younger adults has not been as well characterized. The objective of this study was to describe the distribution of diagnosed diabetes, undiagnosed diabetes, suboptimal preconception glycemic control, and prediabetes among women of reproductive age across racial/ethnic backgrounds. MATERIALS AND METHODS: We analyzed data collected in 2007-2008 from 6774 nonpregnant women, ages 24-32, in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Prediabetes and undiagnosed diabetes were identified by fasting glucose and glycosylated hemoglobin (A1C) and diagnosed diabetes by self-report or antihyperglycemic medication use. We used multinomial regression models to predict prediabetes or diabetes versus normoglycemia. Within women with diabetes, we used logistic regression to predict those being undiagnosed and having suboptimal preconception glycemic control based on A1C. RESULTS: The estimated prevalence of diabetes was 6.8%, of which 45.3% was undiagnosed. Diabetes prevalence varied by race/ethnicity (p < 0.001): 15.0% of non-Hispanic black women (75.6% undiagnosed), 7.5% of Hispanic women (48.1% undiagnosed), 4.8% of non-Hispanic white women (22.8% undiagnosed), and 4.5% of Asian women (11.4% undiagnosed). The prevalence of prediabetes was highest in non-Hispanic black (38.5%), followed by Hispanic (27.8%), Asian (25.1%), Native American (20.3%), and non-Hispanic white (16.6%) women. CONCLUSIONS: Racial/ethnic disparities exist among women of reproductive age with prediabetes and diabetes. Meeting their healthcare needs requires addressing health inequities and coordination of diabetes management with reproductive health.

Depression and Antidepressant Use Among Asian and Hispanic Adults: Association with Immigrant Generation and Language Use.

This research investigates the psychological well-being and usage of medical treatments by Asian and Hispanic immigrant descendants. Using data from all four waves of Add Health study, this paper focuses on two outcomes: (1) depression and (2) levels of antidepressant use by race/ethnicity, immigrant generation, and linguistic acculturation levels during adulthood. Findings reveal that depression is prevalent among Mexican Americans, other Hispanics, and Asian Americans. Furthermore, Mexican Americans and Asian Americans have reported a lower level of antidepressant use than whites, with Asian Americans attaining the lowest level when immigrant generation, language acculturation levels, and other socioeconomic factors are held constant. We also find that those who are linguistically less acculturated have much lower levels of antidepressant use than their monolingual English-speaking counterparts.

Testing Longitudinal Relationships Between Binge Drinking, Marijuana Use, and Depressive Symptoms and Moderation by Sex.

PURPOSE: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship, and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms from adolescence into young adulthood and whether the associations were moderated by sex. METHODS: With data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 9,816), we used growth curve models to test if depressive symptoms predicted marijuana use or binge drinking frequency (Self-Medication Model) or if substance use frequency predicted depressive symptoms (Stress Model). Moderation by sex and age was tested for both potential pathways. RESULTS: Increases in adolescent depressive symptoms, compared to no symptoms, were associated with a steeper predicted increase in marijuana use frequency from adolescence to young adulthood. Increases in persistent binge drinking or marijuana use frequency had concurrent positive associations with depressive symptoms from adolescence to young adulthood, and these associations were significantly stronger for females compared to males. CONCLUSIONS: The results not only support the Self-Medication Model for marijuana use but also provide modest support for the Stress Model, that substance use is associated with depressive symptoms, especially for females.

The reliability of in-home measures of height and weight in large cohort studies: Evidence from Add Health.

BACKGROUND: With the emergence of obesity as a global health issue an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. OBJECTIVES: We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES) and, using both sources, provide a detailed anthropometric description of young adults in the United States. METHODS: The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. RESULTS: Short-term reliabilities of in-home measures of height, weight, waist and arm circumference-as well as derived body mass index (BMI, kg/m2)-were excellent. Prevalence of obesity (37% vs. 29%) and central obesity (47% vs. 38%) was higher in Add Health than in NHANES while socio-demographic patterns of obesity and central obesity were comparable in the two studies. CONCLUSIONS: Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality.

Developmental transitions in presentations of externalizing problems among boys and girls at risk for child maltreatment.

The present study examined the impact of children's maltreatment experiences on the emergence of externalizing problem presentations among children during different developmental periods. The sample included 788 youth and their caregivers who participated in a multisite, prospective study of youth at-risk for maltreatment. Externalizing problems were assessed at ages 4, 8, and 12, and symptoms and diagnoses of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder were assessed at age 14, during interviews with youth and caregivers. Information about maltreatment allegations was coded from official records. Latent transition analysis identified three groups of youth with similar presentations of externalizing problems ("well adjusted," "hyperactive/oppositional," and "aggressive/rule-breaking") and transitions between groups from ages 4, 8, and 12. A "defiant/deceitful" group also emerged at age 12. Girls were generally more likely to present as well adjusted than boys. Children with recent physical abuse allegations had an increased risk for aggressive/rule-breaking presentations during the preschool and preadolescent years, while children with sexual abuse or neglect allegations had lower probabilities of having well-adjusted presentations during middle childhood. These findings indicate that persistently severe aggressive conduct problems, which are related to the most concerning outcomes, can be identified early, particularly among neglected and physically and sexually abused children.

Blood spot-based measures of glucose homeostasis and diabetes prevalence in a nationally representative population of young US adults.

PURPOSE: We investigated understudied biomarker-based diabetes among young US adults, traditionally characterized by low cardiovascular disease risk. METHODS: We examined 15,701 participants aged 24 to 32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health, 2008). The study used innovative and relatively noninvasive methods to collect capillary whole blood via finger prick at in-home examinations in all 50 states. RESULTS: Assays of dried blood spots produced reliable and accurate values of HbA1c. Reliability was lower for fasting glucose and lowest for random glucose. Mean (SD) HbA1c was 5.6% (0.8%). More than a quarter (27.4%) had HbA1c-defined prediabetes. HbA1c was highest in the black, non-Hispanic race/ethnic group, inversely associated with education, and more common among the overweight/obese and physically inactive. The prevalence of diabetes defined by previous diagnosis or use of antidiabetic medication was 2.9%. Further incorporating HbA1c and glucose values, the prevalence increased to 6.8%, and among these participants, 38.9% had a previous diagnosis of diabetes (i.e., aware). Among those aware, 37.6% were treated and 64.0% were controlled (i.e., HbA1c < 7%). CONCLUSIONS: A contemporary cohort of young adults faces a historically high risk of diabetes but there is ample opportunity for early detection and intervention.

Preconception stress, birth weight, and birth weight disparities among US women.

OBJECTIVES: We examined the impact of preconception acute and chronic stressors on offspring birth weight and racial/ethnic birth weight disparities. METHODS: We included birth weights for singleton live first (n = 3512) and second (n = 1901) births to White, Mexican-origin Latina, other-origin Latina, and Black women reported at wave IV of the National Longitudinal Study of Adolescent Health (2007-2008; ages 24-32 years). We generated factor scores for preconception acute and chronic stressors from wave I (1994-1995; ages 11-19 years) or wave III (2001-2002; ages 18-26 years) for the same cohort of women. RESULTS: Linear regression models indicated that chronic stressors, but not acute stressors, were inversely associated with birth weight for both first and second births (b = -192; 95% confidence interval = -270, -113; and b = -180; 95% confidence interval = -315, -45, respectively), and partially explained the disparities in birth weight between the minority racial/ethnic groups and Whites. CONCLUSIONS: Preconception chronic stressors contribute to restricted birth weight and to racial/ethnic birth weight disparities.

Selected preconception health indicators and birth weight disparities in a national study.

BACKGROUND: This analysis explored the effect of timing, sequencing, and change in preconception health across adolescence and young adulthood on racial/ethnic disparities in birth weight in a diverse national cohort of young adult women. METHODS: Data came from Waves I (1994-1995), III (2001-2002), and IV (2007-2008) of the National Longitudinal Study of Adolescent Health. Eligibility was restricted to all singleton live births to female non-Hispanic White, non-Hispanic Black, Mexican-origin Latina, or Asian/Pacific Islander participants (n = 3,014) occurring between the Wave III (ages 18-26 years) and IV (ages 24-32 years) interviews. Birth weight was categorized into low (<2,500 g), normal (2,500-4,000 g), and macrosomic (>4,000 g). Preconception health indicators were cigarette smoking, heavy alcohol consumption, overweight or obesity, and inadequate physical activity, measured in adolescence (Wave I, ages 11-19 years) and early adulthood (Wave III) and combined into four-category variables to capture the timing and sequencing of exposure. FINDINGS: Measures of preconception health did not explain the Black-White disparity in low birth weight, which increased after adjustment for confounders (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.33-3.53) and effect modification by overweight/obesity (OR, 3.58; 95% CI, 1.65-7.78). A positive association between adult-onset overweight/obesity and macrosomia was modified by race (OR, 3.83; 95% CI, 1.02-14.36 for Black women). CONCLUSIONS: This longitudinal analysis provides new evidence on preconception health and racial/ethnic disparities in birth weight. Specifically, it indicates that interventions focused on prevention of overweight/obesity and maintenance of healthy weight during the transition to adulthood, especially among Black females, may be warranted.

Preconception health trajectories and birth weight in a national prospective cohort.

PURPOSE: This study was designed to assess the relationship between birth weight and prospectively measured trajectories of preconception health across adolescence and young adulthood in a diverse national cohort of young adult women. METHODS: Data came from Waves I (1994-1995), III (2001-2002), and IV (2007-2008) of the National Longitudinal Study of Adolescent Health. Eligibility was restricted to all the singleton live births (n = 3,436) to female participants occurring between the Wave III (ages 18-26 years) and Wave IV (ages 24-32 years) interviews. Preconception cigarette smoking, overweight/obesity, adequate physical activity, heavy alcohol consumption, and fair/poor self-rated health were measured in adolescence (Wave I) and early adulthood (Wave III) and combined into four-category variables to capture the timing and sequencing of exposure. The outcome measure, birth weight, was classified as low (<2,500 g), normal (2,500-4,000 g), and macrosomic (>4,000 g). RESULTS: Multinomial logistic regression results indicated that adult-onset overweight significantly increased the odds of having a macrosomic birth (odds ratio = 1.56; 95% confidence interval = 1.02-2.38). CONCLUSIONS: This study provides new evidence about the influence of maternal body mass index trajectories on offspring birth weight. Adult-onset overweight/obesity during the transition to adulthood was common in the sample and increased the odds of subsequently delivering a macrosomic infant by 56%. This finding suggests that healthy weight promotion before this transition would confer intergenerational benefits, and supports recommendations for preconception care to address overweight/obesity.

Adolescent expectations of early death predict adult risk behaviors.

Only a handful of public health studies have investigated expectations of early death among adolescents. Associations have been found between these expectations and risk behaviors in adolescence. However, these beliefs may not only predict worse adolescent outcomes, but worse trajectories in health with ties to negative outcomes that endure into young adulthood. The objectives of this study were to investigate perceived chances of living to age 35 (Perceived Survival Expectations, PSE) as a predictor of suicidal ideation, suicide attempt and substance use in young adulthood. We examined the predictive capacity of PSE on future suicidal ideation/attempt after accounting for sociodemographics, depressive symptoms, and history of suicide among family and friends to more fully assess its unique contribution to suicide risk. We investigated the influence of PSE on legal and illegal substance use and varying levels of substance use. We utilized the National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994-95 among 20,745 adolescents in grades 7-12 with follow-up interviews in 1996 (Wave II), 2001-02 (Wave III) and 2008 (Wave IV; ages 24-32). Compared to those who were almost certain of living to age 35, perceiving a 50-50 or less chance of living to age 35 at Waves I or III predicted suicide attempt and ideation as well as regular substance use (i.e., exceeding daily limits for moderate drinking; smoking ≥ a pack/day; and using illicit substances other than marijuana at least weekly) at Wave IV. Associations between PSE and detrimental adult outcomes were particularly strong for those reporting persistently low PSE at both Waves I and III. Low PSE at Wave I or Wave III was also related to a doubling and tripling, respectively, of death rates in young adulthood. Long-term and wide-ranging ties between PSE and detrimental outcomes suggest these expectations may contribute to identifying at-risk youth.

Trajectories of maltreatment re-reports from ages 4 to 12:: evidence for persistent risk after early exposure.

This study identified trajectories of maltreatment re-reports between ages 4 and 12 for children first referred to Child Protective Services (CPS) for maltreatment prior to age 4 and either removed from the home or assessed by a CPS intake worker as moderately or highly likely to be abused/neglected in the future, absent intervention. Participants (n = 501) were children from the Southwest and Northwest sites of the Consortium for Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). During the 8-year follow-up period, 67% of children were re-reported. Growth mixture modeling identified four trajectory classes: No re-report (33%), Continuous re-reports (10%), Intermittent re-reports (37%), and Early re-reports (20%). Membership in classes with relatively more re-reports was predicted by several factors assessed at age 4, including physical abuse; living with a biological/stepparent; caregiver alcohol abuse, depression, and lack of social support; receipt of Aid to Families with Dependent Children (AFDC); and number of children in the home. For a subpopulation of high-risk children first reported in early childhood, risk for maltreatment re-reporting may persist longer than previously documented, continuing 8 to 12 years after the first report.

Adolescent expectations of early death predict young adult socioeconomic status.

Among adolescents, expectations of early death have been linked to future risk behaviors. These expectations may also reduce personal investment in education and training, thereby lowering adult socioeconomic status attainment. The importance of socioeconomic status is highlighted by pervasive health inequities and dramatic differences in life expectancy among education and income groups. The objectives of this study were to investigate patterns of change in perceived chances of living to age 35 (Perceived Survival Expectations; PSE), predictors of PSE, and associations between PSE and future socioeconomic status attainment. We utilized the U.S. National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994-1995 among 20,745 adolescents in grades 7-12 with follow-up interviews in 1996 (Wave II), 2001-2002 (Wave III) and 2008 (Wave IV; ages 24-32). At Wave I, 14% reported ≤50% chance of living to age 35 and older adolescents reported lower PSE than younger adolescents. At Wave III, PSE were similar across age. Changes in PSE from Wave I to III were moderate, with 89% of respondents reporting no change (56%), one level higher (22%) or one level lower (10%) in a 5-level PSE variable. Higher block group poverty rate, perceptions that the neighborhood is unsafe, and less time in the U.S. (among the foreign-born) were related to low PSE at Waves I and III. Low PSE at Waves I and III predicted lower education attainment and personal earnings at Wave IV in multinomial logistic regression models controlling for confounding factors such as previous family socioeconomic status, individual demographic characteristics, and depressive symptoms. Anticipation of an early death is prevalent among adolescents and predictive of lower future socioeconomic status. Low PSE reported early in life may be a marker for worse health trajectories.

Psychometric properties of a youth self-report measure of neglectful behavior by parents.

OBJECTIVE: This study aimed to empirically assess psychometric properties of a multi-dimensional youth self-report measure of neglectful behavior by parents. METHOD: Data were gathered from 593 12-year-old youth participating in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium; 272 also had data at age 14. Youth responded to a 25-item measure of their experiences of neglect. Expert raters classified items into 4 factors, followed by confirmatory factor analyses. We evaluated cross group measurement equivalence by gender and longitudinal measurement equivalence from age 12 to age 14. Validity was assessed by the relationships between factor scores and (1) neglect reports to child protective services (CPS), (2) quality of parent-child interactions, and (3) parental monitoring. RESULTS: A 3-factor model (Physical Needs, Emotional Support, and Parental Monitoring) of neglect was obtained, with equivalence across gender and longitudinally (age 12-14). The pattern of correlations between the factor scores, CPS reports, and measures of the parent-child relationship offered modest to moderate support for convergent validity. CONCLUSIONS: The findings suggest a promising and relatively brief youth self-report measure of neglect to help advance research in this area.

Discordance in national estimates of hypertension among young adults.

BACKGROUND: In the United States, where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential. METHODS: Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)-a nationally representative field study of 15,701 participants aged 24-32-was referenced against NHANES (2007-2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study. RESULTS: Hypertension rates (BP: ≥ 140/90 mm Hg) were higher in Add Health compared with NHANES (19% vs. 4%), but self-reported history was similar (11% vs. 9%) among adults aged 24-32. Survey weights and adjustments for differences in participant characteristics, examination time, use of antihypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic examinations conducted by NHANES III (1988-1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intraclass correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively. CONCLUSIONS: The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV participants suggests an unexpectedly high risk of cardiovascular disease among US young adults and warrants further scrutiny.