Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women.

This article explores cross-sectional associations between depressive symptoms and body mass index (BMI) in women working in schools in the Greater New Orleans area. Self-efficacy for eating and exercise, eating styles, and exercise are examined as potential pathways. This is a secondary data analysis of 743 women who were participating in a workplace wellness randomized controlled trial to address environmental factors influencing eating and exercise behaviors using baseline data prior to the intervention. BMI was the primary outcome examined. Path analysis suggested that increased depressive symptoms were associated with increased BMI in women. Indirect effects of depressive symptoms on BMI were found for increased healthy eating self-efficacy, increased emotional eating, and decreased exercise self-efficacy. The association between greater healthy eating self efficacy and BMI was unexpected, and may indicate a suppressor effect of eating self-efficacy in the relationship between depressive symptoms and BMI in women. The findings suggest the importance of depressive symptoms to BMI in women. Targets for interventions to reduce BMI include targeting depressive symptoms and related sequelae including self-efficacy for exercise, and emotional eating. Further investigation of eating self-efficacy and BMI are recommended with particular attention to both efficacy for health eating and avoidance of unhealthy foods.

Inter-observer agreement according to malaria parasite density.

BACKGROUND: Recent developments in diagnostic techniques for malaria, particularly DNA probes and sero-immunology, have raised questions as to how these techniques might be used to facilitate malaria diagnosis at the most peripheral levels of the primary health care system. At present, malaria diagnosis is based on the standard microscopic examination of blood films in most field epidemiologic studies and is likely to remain so in the immediate future in Africa. The objective of this study was to assess inter-observer agreement for the examination of Giemsa-stained slides for Plasmodium falciparum parasites. METHODS: Children aged 0 to 10 years were enrolled yearly in Bancoumana village (West Africa), mainly during the transmission season (June to October). The blood smears obtained from the persistently negative children in June 1996, August 1996, October 1996 and March 1997 were systematically re-examined. A stratified random sample (10%) proportional to the following parasite density classes 1-100, 101-5000, and 5001 and over was taken from the slides collected. The kappa statistics and the intra-class correlation were used as measures of agreement the first and the second slide examinations. RESULTS: The weighted kappa statistic, widely used as a chance-corrected measure for nominal agreement, showed excellent inter-observer agreement (κ(w)=0.7926; 95% CI [0.7588, 0.8263]; p=0.01). The intra-class correlation co-efficient had the same value of 0.7926 confirming the appropriateness of the weighted kappa statistic. Inter-observer agreement for slides read as negative by one observer, or as containing more than 100 parasites per µl, was excellent: 97% (493/506) and 92% (145/158), respectively. In contrast, the inter-observer agreement for slides read by one observer as containing 1-100 parasites/µl was poor, 36% (96/268). CONCLUSIONS: In field conditions in Mali, there was a high reproducibility for slides reported as negative or as having more than 100 parasites per µl. However, smears with readings of 1-100 parasites per µl were less reproducible and should be re-examined carefully.

Parental Spanking and Subsequent Risk for Child Aggression in Father-Involved Families of Young Children.

This study examined separate and combined maternal and paternal use of spanking with children at age 3 and children's subsequent aggressive behavior at age 5. The sample was derived from a birth cohort study and included families (n = 923) in which both parents lived with the child at age 3. In this sample, 44% of 3-year-olds were spanked 2 times or more in the past month by either parent or both parents. In separate analyses, being spanked more than twice in the prior month at age 3, by either mother or father, was associated with increased child aggression at 5 years. In combined analyses, there was a dose-response association; the greatest risk for child aggression was reported when both parents spanked more than twice in the prior month (adjusted odds ratio: 2.01; [confidence interval: 1.03-3.94]). Violence prevention initiatives should target and engage mothers and fathers in anticipatory guidance efforts aimed at increasing the use of effective and non-aggressive child discipline techniques and reducing the use of spanking.

Parents' professional sources of advice regarding child discipline and their use of corporal punishment.

Parents (n = 500) were surveyed about which professional groups they were most likely to seek and follow advice from regarding child discipline as well as their use of corporal punishment (CP). Nearly half of the parents reported that they were most likely to seek child discipline advice from pediatricians (48%), followed by religious leaders (21%) and mental health professionals (18%). Parents who sought advice from religious leaders (vs pediatricians) had nearly 4 times the odds of reporting use of CP. Parents reported that they were more likely to follow the advice of pediatricians than any other professional; however, black parents were as likely to follow the advice of religious leaders as that of pediatricians. Pediatricians play a central role in advising parents about child discipline. Efforts to engage pediatricians in providing violence prevention counseling should continue. Increased efforts are needed to engage other professionals, especially religious leaders, in providing such advice to parents.

Cardiovascular risk factors and physical activity behavior among elementary school personnel: baseline results from the ACTION! worksite wellness program.

BACKGROUND: Although the prevalence of obesity is increasing during adulthood, there have been few assessments of obesity, cardiovascular risk factors, and levels of physical activity among adult elementary school staff. METHODS: Data were collected from 745 African-American and White female school personnel in a suburban school district in southeastern Louisiana as part of the baseline assessment before implementation of a program to improve eating and physical activity behaviors. Anthropometry, blood pressure, serum lipids and lipoproteins, and glucose were measured using established protocols. Physical activity was assessed by accelerometry. RESULTS: For both White and Black females, 30% were overweight (body mass index [BMI]) ≥25 kg/m(2) but <30 kg/m(2) ). Whereas 37% of White females were obese (BMI ≥ 30 kg/m(2) ), 61% of the Black females were obese. There was a positive association between BMI and other cardiovascular risk factors except for high-density lipoprotein cholesterol, where the association was negative. The mean number of minutes of daily moderate-to-vigorous physical activity was <1 minute per day and was lower for overweight and obese women than for normal weight women. CONCLUSIONS: School personnel in the study have adverse cardiovascular risk factors, including high rates of obesity and very low levels of physical activity. Because these individuals are often called upon to promote health for children, they are an important target population for wellness interventions.

Neighbourhood food environments and obesity in southeast Louisiana.

Supermarkets might influence food choices, and more distal outcomes like obesity, by increasing the availability of healthy foods. However, recent evidence about their effects is ambiguous, perhaps because supermarkets also increase the availability of unhealthy options. We develop an alternative measure of food environment quality that characterizes urban neighborhoods by the relative amounts of healthy (e.g. fruits and vegetables) to unhealthy foods (e.g. energy-dense snacks). Using data from 307 food stores and 1243 telephone interviews with residents in urban southeastern Louisiana, we estimate a multilevel multinomial logistic model for overweight status. We find that higher quality food environments - but not food store types - decrease the risk of obesity (RR 0.474, 95% CI 0.269-0.835) and overweight (RR 0.532, 95% CI 0.312-0.907). The findings suggest a need to move beyond a sole consideration of food store types to a more nuanced view of the food environment when planning for change.

Environmental lead after Hurricane Katrina: implications for future populations.

BACKGROUND: As a result of Hurricane Katrina, > 100,000 homes were destroyed or damaged and a significant amount of sediment was deposited throughout the city of New Orleans, Louisiana. Researchers have identified the potential for increased lead hazards from environmental lead contamination of soils. OBJECTIVES: We assessed the distribution of residential soil and dust lead 2 years poststorm and compared soil lead before and after the storm. METHODS: We conducted a cross-sectional study in New Orleans in which households were selected by stratified random sampling. A standard residential questionnaire was administered, and lead testing was performed for both the interior and exterior of homes. Logistic regression was used to identify significant predictors of interior and exterior lead levels in excess of allowable levels. RESULTS: One hundred nine households were enrolled; 61% had at least one lead measurement above federal standards. Of homes with bare soil, 47% had elevated lead and 27% had levels exceeding 1,200 ppm. Housing age was associated with soil lead, and housing age and soil lead were associated with interior lead. Race, income, and ownership status were not significantly associated with either interior or exterior lead levels. The median soil lead level of 560 ppm was significantly higher than the median level of samples collected before Hurricane Katrina. CONCLUSIONS: The high prevalence (61%) of lead above recommended levels in soil and dust samples in and around residences raises concern about potential health risks to the New Orleans population, most notably children. Steps should be taken to mitigate the risk of exposure to lead-contaminated soil and dust. Further research is needed to quantify the possible contribution of reconstruction activities to environmental lead levels.

Age, race, weight, and gender impact normative values of bone mineral density.

BACKGROUND: Osteoporosis and fractures represent a major public health issue. Accurate normative reference bone mineral density (BMD) values are vital for diagnosing osteoporosis. The generalizability of the T-score method across gender, race, and age in clinic decision-making has been debated. Our aim was to identify the best statistical model to derive normative BMD values in both men and women in the multiethnic United States population. METHODS: The Third National Health and Nutrition Examination Survey was used as a data source. Gender- and race/ethnicity-stratified data analyses and modeling were conducted on 9779 persons (ages 20 to 65 years) who reported no conditions or medications likely to affect bone metabolism. Sampling and design effects were addressed using STATA 10. Model comparisons were conducted by partial F tests and residual plots. RESULTS: Polynomial regression provided a statistically significant better fit than linear regression in predicting normative BMD in both men and women. Age-centered polynomial models provided the best model for predicting normative BMD values. CONCLUSION: The gender- and race-specific lower limit of normal values obtained created a new classification method of low BMD, which might mitigate some of the T-score limitations in men and minority populations.

Installation of bicycle lanes and increased ridership in an urban, mixed-income setting in New Orleans, Louisiana.

BACKGROUND: People are more physically active in neighborhoods that are well designed for walking and bicycling. Building infrastructure for safer cycling is one way to promote physical activity. On-road bike lanes are one type of infrastructure hypothesized to positively impact levels of cycling. The first on-street bike lane was painted in New Orleans, LA during the spring of 2008. METHODS: In November of 2007 and again in November 2008, trained observers conducted manual counts of cyclists riding on St. Claude Avenue in New Orleans, LA. The data collected included the number of men, women, adults, and children riding a bicycle with traffic, against traffic, and on sidewalks. RESULTS: Data showed a 57% increase in the average number of riders per day (P < .001). There was a 133% increase among adult female riders (P < .001) and a 44% increase among adult male riders (P < .001). The percentage of cyclists riding in the correct direction, with the flow of traffic, increased from 73% to 82% (P < .001). CONCLUSIONS: Bike lanes can have a positive impact in creating a healthy physical environment. Future research should include other streets for comparison purposes and surveys to determine whether riders are substituting biking for nonactive forms of transportation.

The effects of Hurricane Katrina on food access disparities in New Orleans.

Disparities in neighborhood food access are well documented, but little research exists on how shocks influence such disparities. We examined neighborhood food access in New Orleans at 3 time points: before Hurricane Katrina (2004-2005), in 2007, and in 2009. We combined existing directories with on-the-ground verification and geographic information system mapping to assess supermarket counts in the entire city. Existing disparities for African American neighborhoods worsened after the storm. Although improvements have been made, by 2009 disparities were no better than prestorm levels.

Use of spanking for 3-year-old children and associated intimate partner aggression or violence.

OBJECTIVES: The objective of this study was to examine associations between maternal and paternal use of corporal punishment (CP) for 3-year-old children and intimate partner aggression or violence (IPAV) in a population-based sample. METHODS: The study sample (N=1997) was derived from wave 3 of the Fragile Families and Child Wellbeing Study. Mother and father reports regarding their use of CP and their IPAV victimization were analyzed. IPAV included coercion and nonphysical and physical aggression. RESULTS: Approximately 65% of the children were spanked at least once in the previous month by 1 or both parents. Of couples who reported any family aggression (87%), 54% reported that both CP and IPAV occurred. The most prevalent patterns of co-occurrence involved both parents as aggressors either toward each other (ie, bilateral IPAV) or toward the child. The presence of bilateral IPAV essentially doubled the odds that 1 or both parents would use CP, even after controlling for potential confounders such as parenting stress, depression, and alcohol or other drug use. Of the 5 patterns of co-occurring family aggression assessed, the "single aggressor" model, in which only 1 parent aggressed in the family, received the least amount of empirical support. CONCLUSIONS: Despite American Academy of Pediatrics' recommendations against the use of CP, CP use remains common in the United States. CP prevention efforts should carefully consider assumptions made about patterns of co-occurring aggression in families, given that adult victims of IPAV, including even minor, nonphysical aggression between parents, have increased odds of using CP with their children.

The association between obesity and urban food environments.

Several studies have examined associations between the food retail environment and obesity, though virtually no work has been done in the urban South, where obesity rates are among the highest in the country. This study assessed associations between access to food retail outlets and obesity in New Orleans. Data on individual characteristics and body weight were collected by telephone interviews from a random sample of adults (N = 3,925) living in New Orleans in 2004-2005. The neighborhood of each individual was geo-mapped by creating a 2-km buffer around the center point of the census tract in which they lived. Food retailer counts were created by summing the total number of each food store type and fast food establishment within this 2-km neighborhood. Hierarchical linear models assessed associations between access to food retailers and obesity status. After adjusting for individual characteristics, each additional supermarket in a respondent's neighborhood was associated with a reduced odds for obesity (OR 0.93, 95% CI 0.88-0.99). Fast food restaurant (OR 1.01, 95% CI 1.00-1.02) and convenience store (OR 1.01, 95% CI 1.00-1.02) access were each predictive of greater obesity odds. An individual's access to food stores and fast food restaurants may play a part in determining weight status. Future studies with longitudinal and experimental designs are needed to test whether modifications in the food environment may assist in the prevention of obesity.

Mothers' spanking of 3-year-old children and subsequent risk of children's aggressive behavior.

OBJECTIVE: The goal was to examine the association between the use of corporal punishment (CP) against 3-year-old children and subsequent aggressive behavior among those children. METHODS: Respondents (N = 2461) participated in the Fragile Families and Child Well-being Study (1998-2005), a population-based, birth cohort study of children born in 20 large US cities. Maternal reports of CP, children's aggressive behaviors at 3 and 5 years of age, and a host of key demographic features and potential confounding factors, including maternal child physical maltreatment, psychological maltreatment, and neglect, intimate partner aggression victimization, stress, depression, substance use, and consideration of abortion, were assessed. RESULTS: Frequent use of CP (ie, mother's use of spanking more than twice in the previous month) when the child was 3 years of age was associated with increased risk for higher levels of child aggression when the child was 5 years of age (adjusted odds ratio: 1.49 [95% confidence interval: 1.2-1.8]; P < .0001), even with controlling for the child's level of aggression at age 3 and the aforementioned potential confounding factors and key demographic features. CONCLUSIONS: Despite American Academy of Pediatrics recommendations to the contrary, most parents in the United States approve of and have used CP as a form of child discipline. The current findings suggest that even minor forms of CP, such as spanking, increase risk for increased child aggressive behavior. Importantly, these findings cannot be attributed to possible confounding effects of a host of other maternal parenting risk factors.

Disparities in food access: does aggregate availability of key foods from other stores offset the relative lack of supermarkets in African-American neighborhoods?

OBJECTIVE: Recent work demonstrates the importance of in-store contents, yet most food access disparity research has focused on differences in store access, rather than the foods they carry. This study examined in-store shelf space of key foods to test whether other types of stores might offset the relative lack of supermarkets in African-American neighborhoods. METHODS: New Orleans census tract data were combined with health department information on food stores open in 2004-2005. Shelf space of fruits, vegetables, and energy-dense snacks was assessed using a measuring wheel and established protocols in a sample of stores. Neighborhood availability of foods was calculated by summing shelf space in all stores within 2km of tract centers. Regression analyses assessed associations between tract racial composition and aggregate food availability. RESULTS: African-American neighborhoods had fewer supermarkets and the aggregate availability of fresh fruits and vegetables was lower than in other neighborhoods. There were no differences in snack food availability. CONCLUSIONS: Other store types did not offset the relative lack of supermarkets in African-American neighborhoods in the provision of fresh produce, though they did for snack foods. Altering the mix of foods offered in such stores might mitigate these inequities.

The influence of weekday eating patterns on energy intake and BMI among female elementary school personnel.

Many health practitioners recommend eating small, frequent meals for weight loss, yet the relationship of eating patterns, such as eating occasion frequency (EOF), to energy intake and body weight is controversial. Broad-based efforts to promote worksite wellness programs increase the importance of this issue, as many work environments inherently restrict eating patterns. The eating patterns of school personnel are understudied, but are of particular interest, not only because they have limited eating opportunities during the day but also because their diet and weight outcomes are likely to influence behaviors of a much larger population. We examined relationships between weekday EOF and energy intake and BMI among female elementary school personnel in 22 schools in a suburban county of southeastern Louisiana. Two 24-h dietary recalls were administered to randomly-selected employees (n = 329) on nonconsecutive days by registered dietitians. Measured heights and weights were used to calculate BMI (weight/height(2)). On average, employees consumed 2.2 of their total 5.9 meals and snacks during the school day, accounting for 37% of daily energy. In multiple regression models controlling for demographic and health variables, EOF as well as separate counts of meal and snack frequency were each positively and significantly associated with energy intake. However, neither the number of meals, snacks, nor overall EOF was associated with BMI. The proportion of energy consumed during the school day and the positive association of weekday EOF with energy intake suggest an important role for worksite wellness programs that target the dietary improvement of elementary school personnel.

The ubiquity of energy-dense snack foods: a national multicity study.

OBJECTIVES: We assessed the availability and accessibility of energy-dense snacks in retail stores whose primary merchandise was not food and whether these varied by store type, region, or socioeconomic factors. METHODS: We conducted systematic observations of 1082 retail stores in 19 US cities and determined the availability and accessibility of 6 categories of energy-dense snack foods. RESULTS: Snack food was available in 41% of the stores; the most common forms were candy (33%), sweetened beverages (20%), and salty snacks (17%). These foods were often within arm's reach of the cash register queue. We observed snack foods in 96% of pharmacies, 94% of gasoline stations, 22% of furniture stores, 16% of apparel stores, and 29% to 65% of other types of stores. Availability varied somewhat by region but not by the racial or socioeconomic characteristics of nearby census tracts. CONCLUSIONS: Energy-dense snack foods and beverages, implicated as contributors to the obesity epidemic, are widely available in retail stores whose primary business is not food. The ubiquity of these products may contribute to excess energy consumption in the United States.

Neighborhood food environments and Body Mass Index: the importance of in-store contents.

BACKGROUND: Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store shelf-space on consumer behavior. PURPOSE: This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents. METHODS: Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area. RESULTS: After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI. CONCLUSIONS: Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods, because the results suggest that the availability of energy-dense snack foods plays a role in weight status.

Are school employees role models of healthful eating? Dietary intake results from the ACTION worksite wellness trial.

BACKGROUND: Little is known about the dietary intake of school employees, a key target group for improving school nutrition. OBJECTIVE: To investigate selected dietary variables and weight status among elementary school personnel. DESIGN: Cross-sectional, descriptive study. SUBJECTS/SETTING: Elementary school employees (n=373) from 22 schools in a suburban parish (county) of southeastern Louisiana were randomly selected for evaluation at baseline of ACTION, a school-based worksite wellness trial. METHODS: Two 24-hour dietary recalls were administered on nonconsecutive days by registered dietitians using the Nutrition Data System for Research. Height and weight were measured by trained examiners and body mass index calculated as kg/m(2). STATISTICAL ANALYSES PERFORMED: Descriptive analyses characterized energy, macronutrient, fiber, and MyPyramid food group consumption. Inferential statistics (t tests, analysis of variance, chi(2)) were used to examine differences in intake and compliance with recommendations by demographic and weight status categories. RESULTS: Approximately 31% and 40% of the sample were overweight and obese, respectively, with higher obesity rates than state and national estimates. Mean daily energy intake among women was 1,862+/-492 kcal and among men was 2,668+/-796 kcal. Obese employees consumed more energy (+288 kcal, P<0.001) and more energy from fat (P<0.001) than those who were normal weight. Approximately 45% of the sample exceeded dietary fat recommendations. On average, only 9% had fiber intakes at or above their Adequate Intake, which is consistent with the finding that more than 25% of employees did not eat fruit, 58% did not eat dark-green vegetables, and 45% did not eat whole grains on the recalled days. Only 7% of employees met the MyPyramid recommendations for fruits or vegetables, and 14% of the sample met those for milk and dairy foods. CONCLUSIONS: These results suggest that greater attention be directed to understanding and improving the diets of school employees given their high rates of overweight and obesity, poor diets, and important role in student health.

The role of mental health factors, behavioral factors, and past experiences in the prediction of rapid repeat pregnancy in adolescence.

PURPOSE: This study investigates the predictors of rapid repeat pregnancy (subsequent pregnancy within 24 months of previous pregnancy outcome) in a sample of urban adolescents. METHODS: Adolescents aged 12-19 years (N = 354) who were predominantly African-American (94.1%) completed individual interviews during pregnancy and at 24 months postpartum. Logistic regression was used to determine the relationship among mental health factors, behavioral factors, and negative life experiences in the prediction of rapid repeat pregnancy. RESULTS: Of the adolescents, 42% (n = 147) of adolescents reported a rapid repeat pregnancy. Baseline reports of later age at menarche (12.43 vs. 11.91; p = .003) and a greater likelihood of aggression were significantly associated with having a rapid repeat pregnancy within 24 months. Age at menarche and self-reported aggression contributed independently to the prediction of a closely spaced second pregnancy (p < .05). CONCLUSIONS: It is suggested that pubertal onset and individual mental health as it relates to measures of aggression should be considered when developing programs targeting adolescents at highest risk for rapid repeat pregnancy.