Racial disparities in African American and white infant mortality United States and Wisconsin, 1980 to 1998.

Infant mortality is a powerful indicator for assessing the health of a population, and the extent to which society invests in its children. This paper examines infant mortality trends in the United States and Wisconsin among the African American and white populations from 1980 to 1998. Data from the National Center for Health Statistics and Wisconsin Birth and Infant Death Reports were used to examine overall infant mortality trends from 1980 to 1998 for African American and white infants. The overall infant mortality rate in Wisconsin decreased steadily from 10.3 infant deaths per 1000 live births in 1980 to 7.2 in 1998. White infant mortality followed this trend, declining from 9.6 in 1980 to 5.6 in 1998. African American infant mortality has remained about the same since 1980 at 18 infant deaths per 1000 live births, even though the overall percentage of African American live births in Wisconsin increased from 6% in 1980 to 10% in 1998. The ratio of African American to white infant mortality rates in Wisconsin increased from 2 to 1 in 1980 to 3.2 to 1 in 1998. While the Wisconsin African American infant mortality rate remained even since 1980, the US rate declined from 22.2 in 1980 to 14.1 in 1998. The Wisconsin African American rate in 1998, 17.9, surpassed the national rate. The use of 5-year running averages to smooth out year-to-year fluctuations showed statistically significant declines in Wisconsin white infant mortality rates and no change in Wisconsin African American infant mortality rates. These trends show the importance for Wisconsin to sustain its current efforts to reduce black infant mortality. At the same time, Wisconsin-based research efforts to determine strategies and factors that work should continue and influence the future design of systems, programs, and policies to eliminate the disparity.

Alcohol, tobacco, and other drug use among rural/small town and urban youth: a secondary analysis of the monitoring the future data set.

OBJECTIVES: This study compared prevalence of substance use among high school seniors in rural and urban areas from 1976 through 1992. METHODS: We used data collected for these years from urban (n = 75,916) and rural (n = 51,182) high school seniors. Thirty-day prevalence for alcohol, cigarettes, marijuana, cocaine, LSD, and inhalant use, binge drinking, smoking a pack or more of cigarettes a day, and daily alcohol and marijuana use were evaluated. RESULTS: Substance use declined from 1976 through 1992. In 1976, urban students had greater prevalence for most substances, but by 1992, rural and urban students were similar, with rural students having higher prevalence for alcohol and cigarette use (particularly excessive use). Trends were similar for both sexes, though rural girls showed a later catch-up to use levels of urban girls. CONCLUSIONS: Rural students are currently at risk approximately equal to that of urban students. Other studies have demonstrated the association of substance use with increased morbidity and mortality. Policy alterations and health education programs should address this pattern in the nation's rural areas.

A secondary analysis of smoking among rural and urban youth using the MTF data set.

This paper compares rural and urban youth cigarette-smoking behavior using the Monitoring the Future data set, a national, probability-based, multi-stage sample design. Cigarette smoking was examined by region, race, and gender over time. Results indicated that rural White males smoked more often (30-day prevalence of 34%) than any other group. Urban Black males smoked the least (10%). Urban White females smoked more (30-day prevalence of 33%) than urban Black females (7%). In general, rural and urban Whites reported smoking at significantly higher rates than rural and urban Blacks. Smoking rates declined steadily for both rural and urban Black females and urban Black males over the study period. These data document distinctive patterns of tobacco use among the nation's youth, which can be used by program planners for specific targeted interventions.

Energy expenditure of children and adolescents with severe disabilities: a cerebral palsy model.

Spastic quadriplegic cerebral palsy (SQCP) is a severe disability that is associated with abnormal physical activity, body composition, and food intake and with frequent malnutrition. This study examined the pattern of dietary intake, anthropometry, and energy expenditure in a group of subjects with SQCP aged 2-18 y and a normal control group. The energy expenditure pattern was determined from resting energy expenditure (REE, n = 61 SQCP; n = 37 control group) by using indirect calorimetry and from total energy expenditure (TEE, n = 32 SQCP; n = 32 control group) by using the doubly labeled water method. Physical activity, including the chronic spasticity of SQCP, was estimated from the ratio of TEE to REE. Abnormal growth and body composition were common and dietary intake was markedly overreported in the children with SQCP. Children with SQCP were divided according to body fat stores determined by triceps-skinfold-thickness measurements. The children with low fat stores had a lower REE adjusted for fat-free mass compared with the SQCP and control groups with adequate fat stores. TEE was significantly lower for the SQCP group than for the control group. The ratio of TEE to REE, indicating energy for nonbasal needs, was significantly lower in the SQCP children than in the control group, with the adequately nourished SQCP children having lower ratios than the more poorly nourished SQCP group. The nonbasal energy expenditure, such as for physical activity and spasticity, of children with SQCP was low. The nutrition-related growth failure and abnormal pattern of REE are likely related to inadequate energy intake.

One-year changes in weight and fatness in girls during late adolescence.

OBJECTIVE: To document postmenarcheal growth and changes in weight and fatness in girls. DESIGN: Mixed longitudinal study to determine yearly growth increments. PARTICIPANTS: Six hundred sixty-eight postmenarcheal girls, initially ages 13 to 17 years, from two Philadelphia high schools. Overall, 61.4% of the girls were white, 15.7% black, 16.8% Puerto Rican Hispanic, and 6.1% of other ethnicities (non-Puerto Rican Hispanic or Asian). OUTCOME MEASURES: Height (in centimeters), weight (in kilograms), and triceps and subscapular skinfold thicknesses (in millimeters) were measured initially and after 1 year. The anthropometric measures were analyzed both cross-sectionally by age cohort and longitudinally. RESULTS: Viewed cross-sectionally by chronologic age groups and adjusted for ethnicity, gynecologic age, cigarette smoking, and late maturation (menarche > or = 14 years), there were no statistically significant trends with age in height, weight, body mass index (kilograms per m2), triceps, or subscapular skinfold thicknesses. Nevertheless, there were significant trends in velocity with increasing chronologic age. On the average, postmenarcheal girls gained about 6.5 kg (14.3 lb) during late adolescence from about 1.5 years after menarche to age 18 years. Height and triceps skinfolds showed significantly decreasing velocities, whereas there was a significant monotonic increase in velocity with age for skinfolds at the subscapular site. CONCLUSIONS: Even with normal weight gain during late adolescence in girls, there seems to be greater potential for fat deposition centrally. Thus, excessive weight gain during late adolescence may exacerbate the normal processes of fat deposition, leading to large gains in central fat, and thereby increasing the long-term risk for metabolic and cardiovascular diseases later in life.

A longitudinal study of infant vocalizations during mother-infant games.

This study explored the development of verbal behaviours of infants during two mother-infant games. Twenty-five infants were videotaped as they played peek-a-boo and ball with their mothers at 0;6, 0;9, 1;0, 1;3, 1;6, and 2;0. The frequencies of eight categories of vocal/verbal behaviours were analysed as they evolved over time in both games. Despite differences in the structure and level of difficulty of peek-a-boo and ball, the development of these behaviours proved to be similar in the two games. One category, PRIMITIVE VOCALIZATIONS, which did not change in frequency over time, was seen to have a pragmatic rather than a linguistic function. Another category, PRELEXICAL COMMENT, demonstrated an early capacity for conveying topic and comment together in the form of speech sounds combined with an attention-getting gesture well before the emergence of multiple-word utterances. The vocal behaviours produced during games were compared with the results of language tests administered during the experimental sessions. Strong correlations were found between the results of these two measures of language. The predictive nature of vocal behaviours during games is discussed.

Body composition in children with spastic quadriplegic cerebral palsy.

OBJECTIVE: To determine the pattern of body composition and nutritional status in a group of prepubertal children with spastic quadriplegic cerebral palsy (SQCP) compared with healthy control children. STUDY DESIGN: Subjects were enrolled for this cross-sectional study from two tertiary care settings. One hundred thirty-six subjects with SQCP, 2 to 12 years of age, were evaluated by anthropometric measures, or by anthropometric and total body water (TBW) measures (n = 28), with 39 control subjects. RESULTS: Body composition and nutritional status indicators were significantly reduced in children with SQCP. Accretion of fat-free mass with age was smaller for children with SQCP. Calculation of body fat from two skin folds correlated best with measures of fat mass from TBW. CONCLUSION: Malnutrition is common in children with SQCP. Clinically available, serial anthropometric measures enable the clinician to identify malnourished children with SQCP.

Nutritional status and growth of children with diplegic or hemiplegic cerebral palsy.

The growth failure and nutritional status were assessed of 154 children with diplegic or hemiplegic cerebral palsy, aged between two and 17.4 years. Linear growth was significantly reduced compared with norms for healthy children. About 30 per cent of the sample were undernourished, indicated by bodyweight or depleted subcutaneous fat stores at the triceps skinfold site. 8 per cent were overly fat by triceps skinfold and 14 per cent overweight by bodyweight. 23 per cent of the children had stunted growth. Children in the youngest age-group were most at risk for poor nutritional status and delayed growth. These findings suggest that children with diplegic or hemiplegic cerebral palsy are at risk for a variety of abnormalities of growth and nutritional status, and that a growth and nutritional assessment should be conducted periodically so that under- or overnutrition can be corrected when identified.

Nutrition-related growth failure of children with quadriplegic cerebral palsy.

Growth failure and nutritional status were evaluated in 142 children with quadriplegic cerebral palsy, aged between two and 18 years. Linear growth was assessed by upper-arm and lower-leg lengths: both means were significantly reduced. Mean bodyweight and triceps skinfold thickness fat stores were reduced to 65 per cent medians and subcapsular skinfold fat stores to 81 per cent median. Muscle stores were the most preserved and reduced to 88 per cent median. Examination of the sample by age-group showed significant reductions in growth and nutrition status indicators, even at two to four years, except for muscle area. To determine the degree to which nutritional status affected linear growth, a set of two-step regression analyses was conducted. The linear growth measures were significantly correlated with the measures of nutritional status.

Maternal growth during pregnancy and lactation.

Until recently, it was widely accepted that the small amount of statural growth observed in young gravidas was unlikely to be clinically significant, to alter maternal nutritional status, or to threaten fetal growth. We show that this belief reflects incomplete information about growth and the use of inappropriate measuring techniques by investigators. We have done this using illustrations drawn primarily from the Camden Study, a controlled, prospective study of nutrition and growth during adolescent pregnancy. Maternal growth during pregnancy is prevalent and associated with increased gestational weight gain. In the postpartum period it is associated with increased triceps skinfolds, arm fat area and weight retention, all of which occur at caloric intakes comparable with those of pregnant, non-growing adolescents and mature women. Unlike pregnancy where research is continuing, the sequelae of maternal growth during lactation are virtually unstudied.

PIP: Inaccurate inferences about maternal growth based on measurements in medical records and the inability of traditional measuring techniques (e.g. serial measurements of stature) to detect maternal growth led many clinicians to erroneously believe that the limited statural growth in young pregnant women probably does not change maternal nutritional status or jeopardize fetal growth. In Camden, New Jersey, clinicians used the knee high measuring device during pregnancy and the postpartum period to measure the lower leg of pregnant adolescents and mature controls so they could monitor maternal growth during pregnancy. They measured the lower leg because it is less susceptible to the effects of gestational weight gain and forward curvature of the spine during pregnancy. Pregnant adolescents exhibited considerable positive increments in knee height growth while mature controls exhibited small decrements. So pregnant teens are growing in knee height but shrinking in stature as a result of weight gain and lordosis, suggesting that limited or no maternal growth occurs. Caloric intakes of the growing and nongrowing adolescents and the mature controls are essentially the same. Six weeks after delivery, adolescents who grow in knee height during pregnancy retain significantly more weight (3 kg more) than those who do not grow in knee height (p 0.01), indicating that greater weight retention is linked to maternal growth. The triceps of postpartum adolescents arm much larger and the arm fat area much greater in those who grow during pregnancy (p 0.05). Maternal growth in knee height during pregnancy is related to reduced infant birth weight, indicating that fat reserves in growing pregnant teens do not support fetal growth but support the mother's continued development. Few studies have examined growth and health status of breast feeding adolescents. This is an area that needs to be studied.

Dermatoglyphics in sudden infant death syndrome.

An analysis of digital and palmar dermatoglyphic patterns was conducted in 173 victims of the sudden infant death syndrome (SIDS). The results expose four dermatoglyphic regions with pattern frequencies differing from those in a control population. These are an excess of Sydney creases, hypothenar patterns, open fields (with fewer vestiges) in interdigital region IV, and arches on all digits (females only). These findings indicate a genetic or early intrauterine environmental influence in SIDS infants. An increased incidence of dysmorphism and anomalies including recognition of specific syndromes support this contention. One could speculate that these dermatoglyphic deviations reflect specific genotypes and/or phenotypes particularly vulnerable to postnatal challenges. Differences in multiple dermatoglyphic categories support the concept of heterogeneity of the SIDS population and multicausality of SIDS.

Head circumference of children with Down syndrome (0-36 months)

This study provides statistically appropriate head circumference reference curves for males and females with Down syndrome (DS) from birth to 36 months of age. A total of 239 males and 182 females from five study populations, yielding a combination of cross-sectional and longitudinal data, were used for the analysis. The method of least squares was used to test the fit of the growth model y = a+bx+c[log(x + 1)], where x is age in months. These standardized curves should provide information of value in the medical, physical, and developmental management of children with DS.

Assessment of linear growth of children with cerebral palsy: use of alternative measures to height or length.

Various linear measurements were made of 100 children with cerebral palsy to evaluate the effects of various factors on growth, and to investigate the use of alternative measurements to height or recumbent length. Linear growth was more retarded in children with spastic quadriplegia than in those with less widespread spasticity, and there was a tendency for the older children to be more growth-retarded. Upper-arm and lower-leg lengths provided useful information about linear growth. Growth charts using these alternative measurements have been developed which can be used to assess linear growth of children with cerebral palsy when it is difficult or impossible to measure height or recumbent length because of joint contractures. These charts should improve the assessment of the nutritional status of children with cerebral palsy.

Fat distribution in children with cerebral palsy.

Triceps and subscapular skinfolds were measured on 95 North American children with cerebral palsy. Triceps fat was far more depleted than subscapular fat in comparison with population standards for sex, age and race. This truncal distribution of fat may be related to the high prevalence of under nutrition found in the sample.

Growth charts for children with Down syndrome: 1 month to 18 years of age.

Centile charts for assessment of stature and weight reflecting expected deficient size and growth rate of home-reared children with Down syndrome are presented for two age intervals, 1 to 36 months and 2 to 18 years, based on 4650 observations on 730 children. Data were pooled and used to estimate five centiles which were smoothed using a flexible mathematical function. These data corroborate other studies of growth in children with Down syndrome demonstrating deficient growth rate throughout the growing period, but most marked in infancy and again at adolescence. Children with Down syndrome in the present sample were taller than those from institutionalized samples at all ages throughout the growing period. Children with moderate or severe congenital heart disease on average were 1.5 to 2.0 cm shorter and about 1 kg lighter than those without or with only mild disease. Mean weight and weight divided by stature squared show that children with Down syndrome have a tendency to be overweight beginning in late infancy and throughout the remainder of the growing years.

Assessment of overweight children with trisomy 21.

Mean weights for 5-cm stature intervals for three groups of children with trisomy 21 were compared with those for a group of nonretarded children. Children with trisomy 21 had statistically significant larger mean weights beginning at statures of 105 to 110 cm for boys and at 95 to 100 cm for girls and at most larger statures analyzed. These statures were typical of 4- to 6-year-old children with trisomy 21. Children with trisomy 21 living in institutions tended to have larger mean weights for each stature interval than did those reared at home. Differences between the trisomy 21 and nonretarded groups were greater for girls than for boys.