Health Characteristics and Birth Outcomes for "Starting Out Right," a Teen Pregnancy Program.

PURPOSE: To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, "Starting Out Right" (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation. DESCRIPTION: The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate. ASSESSMENT: Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began. CONCLUSION: These results suggest that participation in SOR was associated (p ≤ 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p ≤ 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens.

BMI changes in adolescents treated with bupropion SR for smoking cessation.

OBJECTIVE: Adolescent overweight and obesity and smoking continue to be very important health challenges because of their lasting effects on overall health. Weight gain after smoking cessation is a barrier to quitting as well as a negative consequence to health. This study reports changes in the body mass index (BMI) z-scores of adolescent smokers participating in a dose-ranging clinical trial of bupropion SR (150 mg/day and 300 mg/day) for smoking cessation. METHODS: A total of N = 296 adolescent smokers (placebo n = 100, 150 mg/day n = 101, 300 mg/day n = 95) with a BMI z-score of 0.5 (sd: 1.4), 0.5 (sd: 1.3), and 0.5 (sd: 1.2) in the placebo, 150 mg/day, and 300 mg/day groups, respectively, were followed for 6 months. RESULTS: Adolescents in the 300 mg/day group had a significant reduction in BMI z-score 6 weeks after quitting (ß = -0.16, CI = (-0.29, -0.04), P-value = 0.01). This result was not sustained at the 6-month follow-up. CONCLUSIONS: A reduction in BMI z-score during smoking cessation with bupropion has important implications for the future of adolescent smoking cessation. These results are particularly relevant for adolescents who have either overweight or obesity or who have reservations about quitting for fear of gaining weight or BMI.

The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms.

OBJECTIVES: To examine the effects of a challenge with monosodium glutamate (MSG) as compared to placebo on the symptoms of fibromyalgia (FM), in participants who initially experienced >30% remission of symptoms on an excitotoxin elimination diet. METHODS: Fifty-seven FM patients who also had irritable bowel syndrome (IBS) were placed on a 4-week diet that excluded dietary additive excitotoxins including MSG and aspartame. Thirty-seven people completed the diet and 84% of those reported that >30% of their symptoms resolved, thus making them eligible to proceed to challenges. Subjects who improved on the diet were then randomised to a 2-week double-blind placebo-controlled crossover challenge with MSG or placebo for 3 consecutive days each week. The primary outcome measure was total symptom score. Secondary outcome measures included visual analogue pain scales (VAS for FM and IBS), an IBS Quality of Life Questionnaire (IBS QOL) and the Fibromyalgia Impact Questionnaire-Revised (FIQR). Repeated measures ANOVA was used to analyse crossover challenge results. RESULTS: The MSG challenge, as compared to placebo, resulted in a significant return of symptoms (total symptom score, p<0.02); a worsening of fibromyalgia severity as determined by the FIQR (p<0.03); decreased quality of life in regards to IBS symptoms (IBS QOL, p<0.05); and a non-significant trend toward worsening FM pain based on visual analogue scale (VAS, p<0.07). CONCLUSIONS: These findings suggest that dietary glutamate may be contributing to FM symptoms in some patients. Future research on the role of dietary excitotoxins in FM is warranted.

Developing a university-workforce partnership to address rural and frontier MCH training needs: the Rocky Mountain Public Health Education Consortium (RMPHEC).

The objective of the article is to provide the socio-cultural, political, economic, and geographic conditions that justified a regional effort for training maternal and child health (MCH) professionals in the Rocky Mountain region, describe a historical account of factors that led to the development of the Rocky Mountain Public Health Education Consortium (RMPHEC), and present RMPHEC as a replicable model developed to enhance practice/academic partnerships among state, tribal, and public health agencies and universities to enhance public health capacity and MCH outcomes. This article provides a description of the development of the RMPHEC, the impetus that drove the Consortium's development, the process used to create it, and its management and programs. Beginning in 1997, local, regional, and federal efforts encouraged stronger MCH training and continuing education in the Rocky Mountain Region. By 1998, the RMPHEC was established to respond to the growing needs of MCH professionals in the region by enhancing workforce development through various programs, including the MCH Certificate Program, MCH Institutes, and distance learning products as well as establishing a place for professionals and MCH agencies to discuss new ideas and opportunities for the region. Finally over the last decade local, state, regional, and federal efforts have encouraged a synergy of MCH resources, opportunities, and training within the region because of the health disparities among MCH populations in the region. The RMPHEC was founded to provide training and continuing education to MCH professionals in the region and as a venue to bring regional MCH organizations together to discuss current opportunities and challenges. RMPHEC is a consortium model that can be replicated in other underserved regions, looking to strengthen MCH training and continuing education.

Psychosocial and behavioral profile and predictors of self-reported energy underreporting in obese middle-aged women.

Energy underreporting is a concern with dietary intake data; therefore, subject characteristics associated with underreporting energy intake should be elucidated. Baseline self-reported dietary intake and measures of diet and weight history, life status, weight-loss readiness, psychology, eating behavior, physical activity, and self-image of obese middle-aged women (mean body mass index [calculated as kg/m(2)]=31.0) enrolled in a lifestyle weight-loss program were evaluated. Of the 155 participating, 71 women were identified as underreporting energy intake using the Goldberg cutoff values. Comparison of means between psychosocial and behavioral measures from energy underreporters and energy accurate reporters were used to help develop logistic regression models that could predict likelihood to underreport energy intake based on baseline measures. Characteristics most predictive of energy underreporting included fewer years of education (P=0.01), less-realistic weight-loss goals (P=0.02), higher perceived exercise competence (P=0.07), more social support to exercise (P=0.04), more body-shape concern (P=0.01), and higher perception of physical condition (P=0.03). These results highlight distinct psychosocial and behavioral characteristics that, at baseline, can help identify the likelihood an overweight middle-aged woman entering a weight-loss intervention will underreport energy intake. These results can help provide a framework for screening study participants for probability of energy underreporting, based on baseline psychosocial and behavioral measures. This knowledge can help researchers target at-risk subjects and, through education and training, improve the accuracy of self-reported energy intake and, ultimately, the accuracy of energy and nutrient intake relationships with health and disease.

The psychosocial and behavioral characteristics related to energy misreporting.

Energy underreporting occurs in 2% to 85% and overreporting in 1% to 39% of various populations. Efforts are needed to understand the psychosocial and behavioral characteristics associated with misreporting to help improve the accuracy of dietary self-reporting. Past research suggests that higher social desirability and greater eating restraint are key factors influencing misreporting, while a history of dieting and being overweight are more moderately associated. Eating disinhibition, body image, depression, anxiety, and fear of negative evaluation may be related to energy misreporting, but evidence is insufficient. This review will provide a detailed discussion of the published associations among psychosocial and behavioral characteristics and energy misreporting.

The night vision threshold test is a better predictor of low serum vitamin A concentration than self-reported night blindness in pregnant urban Nepalese women.

This study was conducted to validate the night vision threshold test (NVTT) as an indicator of night blindness. A total of 1401 pregnant women from the National Maternity Hospital participated in this study. Women were queried about night blindness and took the NVTT using standardized procedures after 10 min of dark adaptation. Sixteen percent failed the NVTT, but only 6.4% reported having night blindness. Blood samples from women who failed the NVTT (cases) and matched controls indicated the serum vitamin A (SVA) concentration was lower (P < 0.05) in cases (1.19 +/- 0.03 micromol/L) than in controls (1.29 +/- 0.03 micromol/L). The SVA concentrations did not differ between women who reported and did not report night blindness. The SVA concentration was correlated (r = 0.22, P < 0.001) with the NVTT scores. Twenty-five percent of women with an SVA < 0.35 micromol/L reported night blindness while 100% failed the NVTT. Nineteen percent of women with an SVA < 0.70 micromol/L reported night blindness while 73% failed the NVTT. A receiver operating characteristics analysis indicated that the NVTT had greater sensitivity (0.73 vs. 0.19) and less specificity (0.51 vs. 0.87) compared with reported night blindness for women with SVA < 0.70 micromol/L and greater sensitivity (100.0 vs. 0.73) and similar specificity (0.51 vs. 0.50) for women with SVA < 0.35 micromol/L. The NVTT identified women with low SVA and self-reported night blindness was misleading. We provide a preliminary algorithm to predict the population of women with low SVA concentrations.

KAP study of secondary school students towards obesity in Jamaica

A series of focus groups was used to study the knowledge, attitudes and practices of students (ages 11-18 years) towards obesity in Jamaica. Specifically the study sought to: Understand whether obesity is considered a nutritional disorder or disease among secondary school students in Jamaica. Understand whether obseity is accepte, and if so what are the specific cultural influences? Describe any difficulties between urban and rural atitudes towards obesity. Provide information to assist the development of public health messages that may be most beneficial for health programmes to utilize, for secondary school students in combatting the problems of obesity. Fifteen focus groups with a total of 180 students were drawn form a total of one thousand and twenty-two (1,022) students, from two schools: one located in the urban area of Kingston, St. Andrew; and the other located in the rural area of Ewarton, in the parish of St. Catherine. Samples of students from the two schoos were divided into three categories: Young-for-Grade; Average-for-Grade and Old-for-Grade. Students were further grouped into all boys, all girls, and mixed groups of boya and girls. Group interviews were tape recorded, and all recordings were transcribed verbatim. Notes were also made during each session. Following the standard procedures outlined in grounded methods of groupd interviews, open coding of the transcriptions was done. Concepts were identified and developed in terms of their properties and dimensions. Similar questions werelabelled and grouped to form categories relating to each research question. Analysis of the sessions showed that there was no significant difference in the knowledge of causes of obesity among students in diffferent grades. The majority of male students showed a negative attitude or feeling toward being obese. Yet many preferred women who were heavier or had a lower body distribution of adipose tissue which was referred to as a "coca-cola bottle shape" (gynoid obesity), rather than women with an upper-body or abdominal distribution of adipose tissue (android obesity). The majority of female students expressed a positive attitude toward gynoid obesity, but disliked android obesity. In addition, many of the female students expressed their dislike for obese men. Studnts' knowledge about the causes of obesity and prevention measures was not very consistent with their dietary patterns. Most of the students who participated in the focus group sessions did not think of obesity as a nutritional disease, but rather regarded it as a sign of wealth, good living, or access to an abundance of food (AU)

KAP study of secondary school students towards obesity in Jamaica

A series of focus groups was used to study the knowledge, attitudes and practices of students (ages 11-18 years) towards obesity in Jamaica. Fifteen focus groups with a total of 180 students were drawn from a total of one thousand and twenty-two (1.022) students, from two school: one located in the urban area of Kingston, St. Andrew; and the other located in the rural area of Ewarton, in the parish of St. Catherine. Samples of students from the two schools were divided into three categories: 1. young-for-grade 2. average-for-grade 3. old-for-grade. Students were further grouped into all boys, all girls, and mixed groups of both boys and girls. Group interviews were taped recorded, and all recordings were transcribed verbatim. Notes were also made during each session. Following the standard procedure outlined in grounded method of group interviews open coding of the transcriptions was done. Concepts were identified and developed in terms of their properties and dimensions. Similar questions were labelled and grouped to form categories relating to each research question. Analysis of the sessions showed that there was no significant difference in the knowledge of causes of obesity among students in different grades. The majority of male students showed a negative attitude or feeling toward being obese. Yet many prefered women who were heavier or had a lower body distribution of adipose tissue which was refered to as the a "coca-cola bottle shape" (gynoid obesity, rather than women with an upper-body of abdominal distribution of adipose tissue (android obesity). The majority of female students expressed a positive attitude towards gynoid obesity, but disliked android obesity. In addition many of the females student expressed their dislike for obese men. Students' knowledge about the causes of obesity and prevention measures was not very consistent with their dietary patterns. Most of the students who participated in the focus group sessions did not think of obesity as a nutritional disease, but rather regarded it as a sign of wealth, good living, or access to an abundance of food.