Lifelong physical activity in maintaining bone strength in older men and women of the Age, Gene/Environment Susceptibility-Reykjavik Study.

UNLABELLED: We examined if lifelong physical activity is important for maintaining bone strength in the elderly. Associations of quantitative computerized tomography-acquired bone measures (vertebral and femoral) and self-reported physical activity in mid-life (mean age, 50 years), in old age (≥65 years), and throughout life (recalled during old age) were investigated in 2,110 men and 2,682 women in the AGES-Reykjavik Study. Results conclude lifelong physical activity with continuation into old age (≥65 years) best maintains better bone health later in life. INTRODUCTION: Skeletal loading is thought to modulate the loss of bone in later life, and physical activity is a chief means of affecting bone strength by skeletal loading. Despite much discussion regarding lifelong versus early adulthood physical activity for preventing bone loss later in life, inconsistency still exists regarding how to maintain bone mass later in life (≥65 years). METHODS: We examined if lifelong physical activity is important for maintaining bone strength in the elderly. RESULTS: The associations of quantitative computerized tomography-acquired vertebral and femoral bone measures and self-reported physical activity in mid-life (mean age, 50 years), in old age (≥65 years), and throughout life (recalled during old age) were investigated in 2,110 men and 2,682 women in the AGES-Reykjavik Study. CONCLUSION: Our findings conclude that lifelong physical activity with continuation into old age (≥65 years) best maintains better bone health in the elderly.

The prevalence of neonatal herpes simplex virus infection compared with serious bacterial illness in hospitalized neonates.

OBJECTIVE: To determine the prevalence of herpes simplex virus (HSV) relative to other viral infections and serious bacterial illnesses (SBIs) in hospitalized neonates admitted from a pediatric emergency department over a 5-year period. STUDY DESIGN: Retrospective prevalence study of laboratory-confirmed viral infections and culture-proven SBIs, with electronic databases and medical record review. RESULTS: A total 5817 neonates were included: 8.4% with viral infection, 4.6% with SBIs. Of 960 neonates with documented fever, 17.2% had viral infections (0.3% HSV infection) and 14.2% had SBIs (1.3% bacterial meningitis). Of 204 neonates with fever and cerebrospinal fluid (CSF) pleocytosis, 1.0% had HSV infection and 5.4% had bacterial meningitis. Of 124 neonates with fever and mononuclear CSF pleocytosis, 1.6% had HSV and 0.8% had bacterial meningitis. Of 187 neonates with hypothermia, 1.1% had HSV infection presenting as a sepsis-like syndrome. CONCLUSIONS: In febrile neonates admitted to the hospital from the emergency department, the prevalence of HSV infection was similar to that of bacterial meningitis, suggesting that HSV infection be considered in the differential diagnosis of neonatal fever, especially in the presence of mononuclear CSF pleocytosis. HSV infection should also be considered in neonates with hypothermia and a sepsis-like syndrome.

Adolescent human immunodeficiency virus and sexually transmitted disease prevention programmes: are gender-blind approaches justified?

OBJECTIVE: To present findings that gender might be more predictive of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) knowledge, and sexual behaviour, compared with participation in knowledge-based HIV prevention programmes. STUDY DESIGN: A cross-sectional study comparing students attending public high schools running an HIV and STD prevention programme. It is based on a study that evaluated the City of Houston HIV and STD prevention programme in public high schools. Comparison was initially between groups (intervention vs comparison) and subsequently between gender. The main variables for comparison were level of interest and knowledge of the subject of HIV and STD, and a range of sexual behaviour variables. METHODS: Self-administered questionnaires were used for eliciting both knowledge and behavioural data. A specific question required participants to rate their level of interest in the subject of HIV and STD on a scale of 1-4 (lowest to highest). The knowledge component was marked and scores awarded in percentage form. Descriptive statistical analysis was followed by stratified analysis. Finally, a select number of variables were used in a logistic regression model. STATA version 8 was the main statistical software. RESULTS: A significantly large proportion of girls reported the highest level of interest in the subject of HIV and STD (a score of 4); had higher HIV and STD knowledge scores; and reported less risk-taking sexual behaviour compared with boys. The only variable in which boys faired better was condom use, reporting higher rates of condom use than girls. CONCLUSIONS: Gender-blind HIV and STD prevention programmes seem to have a minimal effect on boys. Although a myriad of other factors influence male response to such programmes, the relatively low level of interest in the subject of HIV and STD among boys might be contributory. HIV and STD prevention programmes need to be re-designed using approaches that are more appealing to boys. Boys will otherwise remain the weak link and therefore the rate-limiting step in the quest for sexual behaviour change among adolescents.

Factors associated with the awareness and practice of evidence-based obstetric care in an African setting.

OBJECTIVE: To identify the factors associated with important (> or =50%) variation in awareness and practice of evidence-based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence-based reproductive interventions. DESIGN: Cross-sectional analysis of data from our Reproductive Health Interventions Study. SETTING: North-west province, Cameroon, Africa. POPULATION: Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care. MAIN OUTCOME MEASURES: Prevalence ratios (PR) of uniform awareness and practice of four key evidence-based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis. METHODS: Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence-based interventions. RESULTS: A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence-based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3-55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3-53.8) as was median work experience of 5-15 years (aPOR = 2.0; 95% CI: 1.0-3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0-11.8). Other potentially important variations were observed, although they did not attain statistical significance. CONCLUSIONS: Several factors including obstetric training and continuous education positively influence evidence-based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador.

BACKGROUND: Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains-aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors-among public secondary school students in central El Salvador. METHODS: We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12-20 years participated in the study. RESULTS: Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%). CONCLUSION: A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.

Vitamin A supplementation and health outcomes for children in Nepal.

PURPOSE: To compare vitamin A supplementation status of children age 6-60 months to the prevalence of vitamin A deficiency disease, malnutrition, diarrhea, and acute respiratory infection. METHODS: The nutritional status of children was estimated using mid-upper-arm circumference measurements. A trained ophthalmology assistant assessed for clinical signs of vitamin A deficiency disease. A trained female community health worker interviewed mothers about child health status using a standardized questionnaire. RESULTS: Compared to children who did not receive supplements, children who received vitamin A supplements regularly had less malnutrition, diarrhea, and acute respiratory infection, regardless of the number of children per household, age, sex, or father's occupation. CONCLUSIONS: Supplementation with vitamin A is necessary twice a year. Children who received a vitamin A capsule only one time were not as protected as were those children who received vitamin A as a regular twice yearly scheduled dose.

Ecuadorian adolescents and cigarette smoking: a cross-sectional survey.

This study investigates adolescents' attitudes and behaviors toward cigarette smoking in Ecuador. Using social cognitive theory as a basis, the cross-sectional survey focuses attention on such social influences as the smoking habits of family members and peers, as well as on the role of cigarette advertisements. Data on prevalence of actual use, access to cigarettes, and knowledge and attitudes about smoking are also obtained. The survey was conducted during the summer of 1994 in both urban and rural areas. Fifty schools in 40 different communities participated, resulting in a sample of 2,625 adolescents aged 9 to 15 years who completed the self-administered questionnaire. This study was conducted in collaboration with Amigos de las Américas (AMIGOS), an international health organization. Staff and volunteers who participated in projects conducted by AMIGOS in Ecuador worked with local health and education officials to implement the survey. Nearly 9% of students identified themselves as current smokers, 24.5% had experimented with smoking, and 61.1% had never smoked. The results varied significantly by age and gender, with older students and boys smoking at the highest rate. The smoking status of family members and peers also significantly predicted student smoking status. The results from this sample replicate findings from North American samples. Although Ecuadorian students smoke somewhat less than their American counterparts, cigarette smoking in Ecuador is a significant public health problem and clearly warrants a coordinated response. The present study points to several strategies for preventing smoking among youth.

Low birth weight and blood pressure at age 7-11 years in a biracial sample.

The hypothesis that birth weight predicts blood pressure inversely at age 7 through 11 years was examined in 1,446 white children and black children in Washington Parish, Louisiana. Two data sets of the Bogalusa Heart Study were merged: 1) newborn cohort participants (n = 233), initially examined at birth, 1973-1974, and reexamined in 1984-1985 at ages 9 through 11 years; and 2) subjects examined at ages 7 through 11 years in 1987-1988 (n = 1,213) whose birth weight was collected from birth certificates in 1991. The prevalence ratios for being in the race-, sex-, and age-specific upper decile of diastolic blood pressure in children born with low birth weight (< 2,500 g) versus those with birth weight > or = 2,500 g were 0.85 (95% confidence interval 0.28-2.56) for white boys, 2.66 (95% confidence interval 1.24-5.70, p < 0.05) for black boys, 1.38 (95% confidence interval 0.63-3.03) for white girls, and 1.05 (95% confidence interval 0.40-2.75) for black girls. For systolic blood pressure, the corresponding prevalence ratio for each race-sex group did not differ from one. When the analyses were restricted to full-term births, prevalence ratios in any race-sex group did not differ from one for systolic and diastolic blood pressure. In multiple linear regression analyses, the concurrently determined Quetelet index (p < 0.001) was a much stronger correlate of systolic and diastolic blood pressure after appropriate adjustment than was birth weight (p > 0.05). From this study, there is some evidence that low birth weight may determine a risk for subsequent high blood pressure in black boys in the age group 7 through 11 years, but the inconsistency of the results for other race-sex groups was unexpected and remains unexplained, if the underlying hypothesis is true.

Low birth weight and serum lipid concentrations at age 7-11 years in a biracial sample.

The relation between birth weight and serum lipid concentrations at age 7 through 11 years was examined in a sample of 1,411 black children and white children in Washington Parish, Louisiana. Two data sets of the Bogalusa Heart Study were merged: 1) newborn cohort participants (n = 225) initially examined at birth, 1973-1974, and reexamined in 1984-1985 at age 9 through 11 years; and 2) subjects examined at ages 7 through 11 years in 1987-1988 (n = 1,186) whose birth weight was collected from birth certificates in 1991. The prevalence ratios for being in the race-, sex-, and age-specific upper decile of serum lipid concentrations in children born with low birth weight (< 2,500 g) versus those with birth weight > or = 2,500 g were calculated per race-sex group. Among white boys with low birth weight, higher than expected percentages of subjects were in the highest decile group of triglyceride concentrations (0.01 < p < 0.05). The prevalence ratio was 2.42 (95% confidence interval 1.19-4.91). When premature infants were excluded, only for white girls was a greater than expected percentage of subjects with low birth weight found to be in the highest decile group of triglyceride concentrations. The corresponding prevalence ratio for white girls was 3.23 (95% confidence interval 1.16-9.00). In analyses that either included or excluded premature infants, prevalence infants, prevalence ratios for triglyceride concentrations in black boys and black girls and for the low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio, total cholesterol concentration, and very low density lipoprotein cholesterol concentration in all race-sex groups were not significantly different from one. To our knowledge, this is the first study finding associations between low birth weight and elevated triglyceride concentrations in later childhood. A follow-up study among adults is recommended.

Initiation of prenatal care by low-income Hispanic women in Houston.

OBJECTIVE: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy. METHODS: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care. RESULTS: A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby was associated with earlier initiation of care, as was having an eligibility card for hospital district services. Several barriers to care were mentioned by women on open-ended questioning, including long waiting times, embarrassment the physical examination, and lack of transportation. CONCLUSIONS: Recommendations for practice included decreasing the number of visits for women at low risk for poor pregnancy outcomes while increasing the time spent with the provider at each visit, decreasing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emphasizing specific messages about benefits to the baby, and increasing general health motivation to seek preventive care through community interventions.

Birth practice patterns in urban slums of Dhaka, Bangladesh.

This study describes the patterns of birth related practices amongst women from an urban slum population in Dhaka city during December 1988 to May 1989. A household census identified all resident women of childbearing age in Rajabazar ward of Dhaka city. Of the 1017 women so identified, 289 women who had given birth to their last child over the previous five years were randomly selected for interview using a structured interview schedule. To observe actual birth practices, sixteen women pregnant for six months or more at the time of the census were followed-up to the immediate post-natal period. Eight local traditional birth attendants (TBAs) were interviewed informally to obtain insights about birthing techniques. A case study for a typical 'normal' delivery is presented and discussed.

PIP: This study is based on interviews among 753 women who lived in the urban slums of Razabazar ward of Dhaka City, Bangladesh, during 1988-89, and who gave birth within 5 years preceding the survey. In-depth interviews were conducted among 50 women. The household census of 1017 women 15-45 years old included 58 pregnant women, of whom 16 who were due within 3 months of the survey date and delivered in the study area were followed up. The 8 local traditional birth attendants (TBAs) were also interviewed. There were 178 live births and 34 infant deaths in the last year before the survey. Infant mortality was an estimated 191/1000 live births. Among the sample of 289 women with a birth within the 5 years preceding the survey, there were 30% who were pregnant 5-8 times, 6% who were pregnant 9-12 times, and few stillbirths. Most women did not know the cause of neonatal death. 46% of the 289 mothers experienced a perinatal or postneonatal death during their entire reproductive life. The strongest predictor of previous infant loss was maternal education. Findings from an analysis of data from the 174 mothers who gave birth within the last 2 years indicate that most women were under 25 years old, had no schooling, lived over 4 years in the slum, and had limited household income. 69% had no prenatal care. 96% delivered outside the hospital, and 57.9% delivered at home. Over 75% had deliveries performed by an untrained attendant. 8% delivered the infant by themselves. 3% had a doctor-assisted delivery. 95% reported that the umbilical cord was cut with a razor blade, and 5% used a strip of bamboo. 13% reported boiling the razor blade for sterilization. 71% applied nothing to the umbilical cord. Breast feeding delays over 24 hours occurred more frequently among traditional birth attendant deliveries. This article includes a case study of a typical normal delivery.

Dietary vitamin C and beta-carotene and risk of death in middle-aged men. The Western Electric Study.

In the Western Electric Company Study, carried out in Chicago, Illinois, data on diet and other factors were obtained in 1958 and 1959 for a cohort of 1,556 employed, middle-aged men. Nutrients included vitamin C and beta-carotene. An index that summarized combined intake of both nutrients was constructed. Mean intakes of vitamin C in the lowest and highest tertiles of the index were 66 and 138 mg/day; corresponding values for beta-carotene were 2.3 and 5.3 mg/day. A total of 522 of 1,556 men died during 32,935 person-years of follow-up, 231 from coronary heart disease and 155 from cancer. After adjustment for potentially confounding factors, relative risks (95% confidence intervals) associated with an increment of 19 points in the index (difference between means of the lowest and highest tertiles) were 0.60 (0.39-0.93) for cancer mortality, 0.70 (0.49-0.98) for coronary disease mortality, and 0.69 (0.55-0.87) for all-cause mortality. These results support the hypothesis that consumption of foods rich in vitamin C and beta-carotene reduces risk of death in middle-aged men.

Evaluación del registro materno doméstico: estudio colaborativo de la OMS / Evaluation of the home-based maternal record: a WHO collaborative study

Trece centros de ocho países (Egipto, Filipinas, india, Pakistán, Senegal, Sri Lanka, Yemen y Zambia) participaron el el estudio colaborativo de la OMS para evaluar el registro materno doméstico (RMD). La evaluación reveló que el empleo del RMD tuvo efectos favorables en la utilización de los servicios de salud y la continuidad de la atención de salud de las mujeres durante su período reproductivo. Cuando se adaptó a las condiciones locales de riesgo, los puntos de corte de esas condiciones y los recursos disponibles, el RMD logró fomentar la autoatención por las madres y sus familias y aumentar la identificación oportuna de las personas en riesgo que debían ser enviadas a otros servicios de atención especial. La introducción del RMD aumentó los diagnósticos de mujeres embarazadas y recién nacidos en riesgo y su envío a otros niveles de atención, mejoró la planificación familiar y la educación sanitaria, condujo a un aumento de la inmunización con toxoide tetánico y proporcionó un instrumento para reunir información de salud en la comunidad. El RMD gustó a las madres, participaban más en el cuidado de su propia salud y la de sus hijos. Además de la adaptación del RMD a las condiciones locales, la capacidad y la participación del personal de salud (incluyendo el de los niveles secundario y terciario) desde el comienzo del programa del RMD influyeron en el éxito del registro en fomentar la atención de salud de la madre y el niño. También mejoro la recopilación de datos basados en la comunidad y la conexión de las redes para la remisión de pacientes

Evaluación del registro materno doméstico: estudio colaborativo de la OMS / Evaluation of the home-based maternal record: a WHO collaborative study

Trece centros de ocho países (Egipto, Filipinas, india, Pakistán, Senegal, Sri Lanka, Yemen y Zambia) participaron el el estudio colaborativo de la OMS para evaluar el registro materno doméstico (RMD). La evaluación reveló que el empleo del RMD tuvo efectos favorables en la utilización de los servicios de salud y la continuidad de la atención de salud de las mujeres durante su período reproductivo. Cuando se adaptó a las condiciones locales de riesgo, los puntos de corte de esas condiciones y los recursos disponibles, el RMD logró fomentar la autoatención por las madres y sus familias y aumentar la identificación oportuna de las personas en riesgo que debían ser enviadas a otros servicios de atención especial. La introducción del RMD aumentó los diagnósticos de mujeres embarazadas y recién nacidos en riesgo y su envío a otros niveles de atención, mejoró la planificación familiar y la educación sanitaria, condujo a un aumento de la inmunización con toxoide tetánico y proporcionó un instrumento para reunir información de salud en la comunidad. El RMD gustó a las madres, participaban más en el cuidado de su propia salud y la de sus hijos. Además de la adaptación del RMD a las condiciones locales, la capacidad y la participación del personal de salud (incluyendo el de los niveles secundario y terciario) desde el comienzo del programa del RMD influyeron en el éxito del registro en fomentar la atención de salud de la madre y el niño. También mejoro la recopilación de datos basados en la comunidad y la conexión de las redes para la remisión de pacientes

Se publica en inglés en el Bull. WHO. Vol. 71(5), 1993

Evaluation of the home-based maternal record: a WHO collaborative study.

Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks.

PIP: An evaluation was made of the home-based maternal record (HBMR) as an impetus to improved continuity of care and to improved education of women about their health status. The study involved Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen, and Zambia. THe HBMR is a system for recording risk factors and early signs of complications, referrals, and treatment of the mother and infant. Data entry comes from a variety of sources, including the mother and other health personnel. Previous experience with home-based recording systems was reviewed. The WHO record was developed in 1982 and a set of guidelines was developed to evaluate the objectives and explore the functions. The evaluation was conducted between 1984 and 1988 in the 13 countries previously indicated with pre- and post-intervention designs and with controls, where possible. HBMRs were given to mothers during the second through the eight month of pregnancy, and those identified at risk were referred for appropriate care. Study populations ranged from 14,000 to 250,000 and female literacy ranged from 15% to 91%. Sample populations ranged from 75 to 819. Evaluation and results were provided for each of 6 objectives: 1) to encourage continuity of care from pregnancy through interpregnancy periods; 2) to encourage early identification of at-risk women and newborns; 3) to promote referral suitable to women and encouraging self-care; 4) to promote initiation of appropriate care suitable to needs; 5) to provide a useful and practical record of care; and 6) to provide a focus for health education about risk and health care during pregnancy and the interpregnancy period, and for the neonatal period. The findings revealed that HBMR was an important asset in increasing the quality and quantity of prenatal, postnatal, and interpregnancy care of mothers. There was also improved neonatal health care. Mother's knowledge about helpful practices was improved. Other improvements were evident in early identification of risk factors both before and after pregnancy, referrals of at-risk persons, initiation of care, registration of mothers and infants at health centers, vaccination with tetanus toxoid, and provision of useful health information. Continuity of care was improved when compared with baseline and control data. The HBMR was found to be suitable for use with all women regardless of childbearing age.

The Blood Pressure Study in Mexican Children (BPSMC): I. Distribution and correlates of blood pressure in adolescent Mexican girls.

Blood pressure rises in adolescence and its increase appears to be more closely related to body size than to age. This cross-sectional study assessed the relationship between selected anthropometric and demographic factors and blood pressure during early adolescence in a sample of 233 females aged 10-12 years enrolled in public and private primary schools in Tlalpan, Mexico. Standardized measurements of blood pressure, arm circumference and length, height, weight, body mass index, and triceps skinfold were obtained. All anthropometric attributes were strong univariate correlates of blood pressure. Multiple regression analyses suggest positive associations between both body mass index and arm length and systolic blood pressure early in adolescence. When cross-cultural comparisons were made of blood pressure levels in the Blood Pressure Study in Mexican Children (BPSMC) with results in other countries, the BPSMC mean blood pressure levels were found to be the lowest. Possible explanations are discussed.