Sleep duration, physical activity, and caloric intake are related to weight status in Mexican American children: a longitudinal analysis.

BACKGROUND: Obesity is a serious issue, spanning all ages, and, in the U.S., disproportionately affects Latinos and African Americans. Understanding sleep, physical activity and dietary behaviors that may predict childhood obesity can help identify behavioral intervention targets. METHODS: Data were drawn from a U.S. cohort study of 323 Mexican American 8-10-year-old children and their mothers, who participated in a longitudinal study over a 2-year period. Measures were collected at baseline (BL; child mean age = 8.87, SD = 0.83), year 1 (FU1) and year 2 (FU2). Mothers reported on household income and acculturation at BL. Child height and weight were collected and BMI z-scores (BMIz) were calculated for weight status at BL, FU1, and FU2. Accelerometer-estimated sleep duration (hours) and moderate-to-vigorous physical activity (MVPA; minutes) were collected across 3 days at BL, FU1, and FU2. Two 24-h dietary recalls were performed at each time point; from these, average energy intake (EI, kcals/day) was estimated. Cross-lagged panel analysis was used to examine behavioral predictors on BMIz at each time point and across time. RESULTS: At BL and FU1, longer sleep duration (ß = - 0.22, p < 0.001; ß = - 0.17, p < 0.05, respectively) and greater MVPA (ß = - 0.13, p < 0.05; ß = - 0.20, p < 0.01, respectively) were concurrently related to lower BMIz. At FU2, longer sleep duration (ß = - 0.18, p < 0.01) was concurrently related to lower BMIz, whereas greater EI (ß = 0.16, p < 0.01) was related to higher BMIz. Longer sleep duration at BL predicted lower BMIz at FU1 (ß = - 0.05, p < 0.01). CONCLUSIONS: Longer sleep duration was concurrently related to lower weight status at each time point from ages 8-10 to 10-12. Higher MVPA was concurrently related to lower weight status in earlier childhood (ages 8-10 and 9-11) and higher EI was concurrently related to higher weight status toward the end of childhood (ages 10-12 years). Furthermore, longer sleep in earlier childhood was protective of children's lower weight status 1 year later. These findings suggest that sleep duration plays a consistent and protective role against childhood obesity; in addition, MVPA and healthy EI remain important independent factors for obtaining a healthy weight.

Temporal associations between circadian sleep and activity patterns in Mexican American children.

OBJECTIVE: This study aimed to examine the relationship between circadian sleep and activity behaviors (sedentary time [SED], light-intensity physical activity [LPA], and moderate- to vigorous-intensity physical activity [MVPA]) across 3 consecutive days. METHODS: This study included 308 Mexican American children aged 8-10 years from the San Francisco Bay Area. Minutes of sleep duration, SED, LPA, and MVPA were estimated using hip-worn accelerometers from Wednesday night to Saturday night. A cross-lagged panel model was used to estimate paths between sleep duration the prior night and subsequent behaviors, and paths between behaviors to subsequent sleep duration across the 3 days. We adjusted for child age, sex, body mass index, and household income. RESULTS: Overall, children were 8.9 (SD 0.8) years old; the weighted average for weekday and weekend combined was 9.6 (SD 0.7) hours per night in sleep duration, 483 (SD 74) min/d SED, 288 (SD 61) min/d LPA, and 63 (SD 38) min/d MVPA. Cross-lagged panel analyses showed that, over 3 days, for every 1-hour increase in sleep duration, there were an expected 0.66-hour (40-minute) decrease in SED, 0.37-hour (22-minute) decrease in LPA, and 0.06-hour (4-minute) decrease in MVPA. For every 1-hour increase in LPA, there was an expected 0.25-hour (15-minute) decrease in sleep duration. CONCLUSION: An additional hour of sleep the night before corresponded to an hour decrease in combined SED and LPA the next day in Mexican American children. For every hour of LPA, there was an associated 15-minute decrease in sleep. Encouraging longer sleep may help to reduce SED and LPA, and help offset LPA's negative predictive effect on sleep.

Protective role of health values in adolescents' future intentions to use condoms.

PURPOSE: To examine the protective role of health values in adolescents' intentions to use condoms. METHODS: Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms. RESULTS: Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners. CONCLUSIONS: Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

Postabortion psychological adjustment: are minors at increased risk?

PURPOSE: To assess whether younger adolescents experience greater adverse psychological outcomes after abortion than those aged 18-21 years, whether abortion places all adolescents at risk for negative sequelae, and what factors predict negative outcomes. METHODS: A total of 96 young women aged 14-21 years seeking counseling for unwanted pregnancies at four clinics completed questionnaires after counseling. These included the Beck Depression Inventory (BDI), an emotion scale, questions regarding sociodemographic and reproductive background, feelings about pregnancy, and decision-making. Sixty-three respondents were reinterviewed 4 weeks postabortion and completed the BDI, emotion scale, Spielberger State Anxiety Inventory, Rosenberg Self-esteem Scale, Impact of Events Scale, and Positive States of Mind Scale. Chi-squares and Student's t-tests were used to compare: (a) responses of adolescents under 18 years of age with those 18-21 years, (b) preabortion and postabortion responses, and (c) the current sample with other samples of adolescents. RESULTS: Adolescents under age 18 years were less comfortable with their decision, but showed no other differences compared with those aged 18-21 years. Both groups showed significant improvement in psychological responses postabortion. Postabortion scores did not differ significantly from those of other adolescent samples reported in the literature. Preabortion emotional state and perception of partner pressure predicted postabortion response. CONCLUSIONS: Despite its legal significance, age 18 years was not a meaningful cutoff point for psychological response to abortion in this sample. There was no evidence that abortion poses a threat to adolescents' psychological well-being.

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

A violence-prevention and evaluation project with ethnically diverse populations.

The purpose of this paper is to describe some of the challenges encountered and lessons learned while providing and evaluating a violence-prevention program for and with ethnically diverse populations in child care settings. The paper discusses Safe Start, a violence prevention education program for child care staff and parents, and the evaluation of the program. Safe Start was designed to include culturally relevant content to increase cultural awareness for child care staff and parents from diverse ethnic backgrounds. The evaluation project enrolled child care centers with families representing the ethnically diverse communities in which they were located. Violence prevention research involving children from diverse ethnic backgrounds presents new methodologic challenges, but also provides new opportunities for creative, novel methods. This paper describes some of the challenges encountered with curriculum development, staff recruitment, instrument selection, and data collection procedures.

Injuries in child care centers: gender-environment interactions.

OBJECTIVES: To examine child characteristics (age, gender) and child care center environments (socioemotional quality, physical safety) that jointly predict injuries for preschool children. METHODS: A two year prospective study of 360 preschool children, ages 2-6 years, was conducted in four urban child care centers. Composite scores for center quality and physical safety were derived from on-site observations, and injury rates were based on teacher reports. Poisson regression analyses examined age, gender, center quality, center safety, and the interactions of gender with quality and safety as predictors of injury incidence over one child year. RESULTS: Age was significantly associated with injury rates, with younger children sustaining higher rates. An interaction between gender and center quality also significantly predicted injury incidence: girls in low quality centers experienced more injuries, while girls in high quality centers sustained fewer injuries than their male peers. Finally, an interaction between gender and center safety showed that girls in high safety centers sustained more injuries than boys, while girls in low safety centers sustained fewer injuries. CONCLUSIONS: Injuries occur even in relatively safe environments, suggesting that in child care settings, the socioemotional context may contribute, along with physical safety, to the incidence of injury events. Further, gender specific differences in susceptibility to environmental influences may also affect children's vulnerability and risks of injuries. The prevention of injuries among preschool children may thus require attention to and modifications of both the physical and socioemotional environments of child care.

Children in foster care: factors influencing outpatient mental health service use.

OBJECTIVE: To determine factors influencing outpatient mental health service use by children in foster care. METHOD: Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). RESULTS: Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60. CONCLUSIONS: Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services.

The epidemiology of injuries in 4 child care centers.

OBJECTIVES: (1) To describe the pattern of injury in preschool-aged children in 4 child care centers as compared with the results of other studies; (2) to compare injury rates by sex, age, and child care center; and (3) to examine environmental and child factors contributing to injury severity. DESIGN: A 2-year cohort study of 362 preschool-aged children attending 4 urban child care centers. Teachers completed standardized injury forms on the type of injury, body location, site of injury, and contributing factors. RESULTS: During the 2 years of the study, 1886 injuries were reported. The mean and median child injury rate was 6 and 4 injuries per 2000 exposure hours (equivalent to 1 full-time child care year), respectively. The majority of injuries (87%) were minor, occurred during free play (81%) and on the playground (74%), and were precipitated by child-related factors (59%), such as being pushed. Boys had significantly higher median injury rates than girls. Age-adjusted injury rates for each child care center were significantly different by center (F3 = 61, P<.001). While moderate to severe injuries were more often precipitated by combinations of child and environmental factors (chi2(4) = 20, P<.001), minor injuries were usually precipitated by child-related factors. CONCLUSIONS: Injury data from child care centers are important for identifying common risk factors for frequent or severe injury events and for designing injury prevention programs. More research is needed to identify factors contributing to injuries, such as children's behavior and the child care centers' physical and socioemotional environments.

Stigmatization, self-esteem, and coping among the adolescent children of lesbian mothers.

PURPOSE: To examine perceived stigma, coping, disclosure, and self-esteem among adolescents with lesbian mothers. METHOD: Interviews were conducted with 76 adolescents ages 11-18 years. Standardized measures of self-esteem and coping skills were used. A measure of stigma was adapted for this study and a measure of disclosure was developed. The relationship between perceived stigma and self-esteem was examined. General coping skills and level of disclosure about the adolescents' mothers' sexual orientation were assessed as potential moderators of the relationship between perceived stigma and self-esteem. RESULTS: Adolescents who perceived more stigma had lower self-esteem in five of seven self-esteem areas, compared to those who perceived less stigma. In addition, coping skills moderated the effect of stigma on self-esteem in three self-esteem areas. However, only one subtype of coping skills, that of decision-making coping, was found to moderate the relationship of perceived stigma and self-esteem in such a way that adolescents using more decision-making coping had higher self-esteem in the face of high perceived stigma. For social support coping, in the face of high perceived stigma, the adolescents with more effective coping skills had lower self-esteem. In the face of high perceived stigma, adolescents who disclosed more about their mother's sexual orientation had higher self-esteem in the subscale of close friendship than those who disclosed less. CONCLUSIONS: Results suggest that stigma is related to self-esteem among the adolescent children of lesbian mothers. The results indicate that this relationship is moderated by coping skills. These results have implications for intervention and prevention of stigmatization by the establishment of effective coping skills as well as through educational efforts to eradicate stigmatizing attitudes.

Underreporting sensitive behaviors: the case of young women's willingness to report abortion.

Accurate reports are important in health research, yet abortions are underreported in surveys by almost half. This study examined influences on reporting of abortion among adolescents. Participants were 63 young women from varied ethnic backgrounds who had undergone abortions at urban abortion clinics. Participants reported on their willingness to be honest about their abortion in various research settings and in comparison with other sensitive topics. Willingness to report was also examined in relation to the sponsor of the research, the mode of administration, and the characteristics of the interviewer. Adolescents indicated less willingness to report abortion than some behaviors such as cigarette smoking, but they were more willing to report abortion than family income, oral sex, or anal sex. Comparison of willingness to report across research settings indicated that face-to-face interviews appear to generate more accurate reporting than telephone surveys. The implications of these findings for the study of other health behaviors are discussed.

Predictors of risk for sexually transmitted diseases in ninth grade urban high school students.

This study examined risk factors associated with acquisition of sexually transmitted diseases (STDs) including HIV in adolescents, using the AIDS Risk Reduction Model. The study participants were 985 students who were 54% female, ethnically/racially diverse, had a mean age of 14.7 years, and were mostly 9th graders (74%). Logistic regression was used to predict sexual experience. Linear regression was used to predict risky sexual behaviors and condom use within the previous month. The results indicate that demographic factors are associated with being sexually experienced, but few demographics are associated with specific STD-related risk behaviors. STD and AIDS knowledge are not associated with any risk behaviors. Use of alcohol and drugs is associated significantly with being sexually experienced and sexual risk. The results also indicate that peer affiliation, perceptions of peer norms, perceptions of risk, perceptions of self-efficacy, and social support are associated with STD-related risk among sexually experienced youth.

The disclosure decision: concerns and issues of parents of children conceived through donor insemination.

OBJECTIVE: The purpose of our study was to examine the disclosure decision by parents of children conceived by donor insemination. STUDY DESIGN: A qualitative component of a self-administered questionnaire mailed to 184 couples who had become parents by donor insemination encouraged respondents to volunteer their written comments, concerns, or opinions about their disclosure decision. RESULTS: A total of 70 men and 86 women submitted written comments indicating that 54% did not plan to disclose the donor insemination treatment (nondisclosers), 30% indicated they would (disclosers), and 16% remained undecided. The only significant relationship between the disclosure decision and expressed concern was with regard to confidentiality and honesty (chi2 = 99.9, p < 0.05). CONCLUSIONS: Whether parents viewed the disclosure issue as one of honesty (disclosers) or confidentiality (nondisclosers) was the major determinant in the decision of whether to tell children about their donor insemination origin. There was no association between disclosure status or gender and expressed concerns about parenting, children, or family relations.

Self-efficacy to use condoms in unmarried Latino adults.

Measures of self-efficacy to use condoms can clarify the barriers to condom use Latinos encounter. A 20-item scale, that differed slightly for men and women, and was based on extensive elicitation interviews, was used in a random digit dial household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Self-efficacy was related to condom use for both men and women. Factor analyses revealed five correlated factors: Regular Partner, Impulse Control, Partner Resistance, STD Thoughts, and Condom Discussion. Both men and women reported lowest self-efficacy for impulse control and using condoms with a regular partner. Less-educated men and women had lower self-efficacy to discuss condoms, to manage partner resistance, to use condoms with a regular partner, and to control impulses, but there were few other demographic differences in self-efficacy. The scale can be helpful in the design and evaluation of HIV prevention.

Condom use in unmarried Latino men: a test of cultural constructs.

The effects of cultural factors on condom use were assessed in a random digit-dialing household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Measures of traditional gender-role beliefs, sexual coercion, sexual comfort, and self-efficacy in using condoms were developed specifically for this population. A multisample structural equation model analysis included 594 men who reported one or more heterosexual partners in the 12 months before interview. As predicted, men with more traditional gender-role beliefs reported more sexual coercion and less sexual comfort. Men reporting more sexual coercion and less sexual comfort had lower condom self-efficacy. Men with more condom self-efficacy and stronger condom social norms reported more condom use.

Stigma, disclosure, and family functioning among parents of children conceived through donor insemination.

OBJECTIVE: To examine the influence of gender, male infertility factor, and other demographic variables on stigma and whether parents tell their children that they were conceived by donor insemination (DI) and to ascertain if stigma and the disclosure decision affect parental bonding with the child or the quality of the interparental relationship. DESIGN: One hundred eighty-four San Francisco Bay Area couples who had become parents by DI were asked to complete a self-administered questionnaire. SETTING: A private infertility practice. PATIENT(S): Eighty-two men and 94 women who completed the questionnaire. MAIN OUTCOME MEASURE: A questionnaire assessing disclosure, stigma, parental bonding, and the quality of the interparental relationship. RESULT(S): Factors that increased the couple's likelihood of disclosure included younger age, azoospermia, lower stigma scores, and having more than one DI child. Fathers who scored higher on stigma reported less parental warmth and parental fostering of independence. CONCLUSION(S): Because the decision regarding disclosure of DI treatment was not linked to parental bonding with the child or to the quality of the interparental relationship, we cannot conclude that nondisclosure is harmful to family relationships or is a symptom of family problems. The husband's perceptions of stigma however, may affect the father--child relationship adversely.

Activating patients to practice skin cancer prevention: response to mailed materials from physicians versus HMOs.

OBJECTIVES: We investigated whether the source and emphasis of mailed messages about skin cancer would differentially activate patients to initiate skin cancer prevention by calling a toll-free number. METHODS: We mailed a questionnaire to 981 randomly selected patients of a large medical group to assess their concern about and risk for skin cancer: 48 were returned undeliverable (n = 933). The booklet was accompanied by a letter inviting patients to call a toll-free number. Patients received the letter from one of three sources: (1) their physician, (2) their HMO, or (3) a fictitious junk mail organization. Patients received one of three different messages emphasizing the effects of ultraviolet (UV) rays on (1) the risk of skin cancer, (2) aging and wrinkling of the skin, or (3) aging and wrinkling accompanied by a book further emphasizing these harmful effects of the sun. RESULTS: The overall activation rate was low (7%); nevertheless, the source of the preventive message significantly affected whether patients called in. Messages from physicians and HMOs were more activating than messages from the junk mail organization (odds ratio [OR] = 3.40, confidence intervals [CI] = 1.66, 6.97), but messages from physicians were not more activating than messages from HMOs (OR = 1.56, CI = .90, 2.72). The emphasis of the message did not significantly affect call-in rates. Risk for skin cancer was positively associated with patient activation, but attitudes and beliefs about skin cancer prevention were unrelated to activation. CONCLUSIONS: These results should encourage HMOs and physicians to continue their preventive health outreach as one aspect of multicomponent prevention efforts. The results also suggest that HMOs and physicians can activate patients most at risk for skin cancer by emphasizing both risks of cancer and aging and wrinkling when they deliver a skin cancer preventive message.

Evaluation of a knowledge- and cognitive-behavioral skills-building intervention to prevent STDs and HIV infection in high school students.

The purpose of this study was to evaluate the efficacy of a school-based knowledge- and cognitive-behavioral skills-building STD/HIV prevention intervention. Subjects were 513 ethnically and racially diverse students attending four urban public high schools. The sample was 59% female and had a mean age of 14.4 years. A quasi-experimental design was utilized to evaluate the intervention which consisted of three class sessions. Results of hierarchical regression analyses, controlling for baseline scores and demographic factors, indicate that this intervention was effective at increasing STD knowledge (p < .05), and skills related to prevention of risky sexual (p < .05) and drug use (p < .001) behavior. Although significant changes in risk behaviors were not detected, it is too soon to conclude that school-based education and skills building STD/HIV prevention interventions are ineffective at changing risk behaviors in adolescents. Implications for future study are addressed.

Life events, frontal electroencephalogram laterality, and functional immune status after acute psychological stressors in adolescents.

OBJECTIVE: Past studies have found that environmental stress affects cellular immune function and that extensive variability exists in the magnitude and direction of stress-induced immune changes. Past research also suggests that individuals with greater right, relative to left, resting frontal electroencephalogram (EEG) activation perceive environmental stress as more aversive and have lower baseline cellular immune function. In this study, we examined environmental stressors, resting frontal EEG laterality, and immune responses to short-term psychological stressors in adolescent boys. METHODS: A sample of twenty-four 14-16 year old right-handed boys underwent a recording of resting EEG and collections of blood taken before and after a laboratory protocol designed to induce psychological stress. Blood samples were used to measure changes in mitogen lymphoproliferative responses, natural killer (NK) cell activity, and T-cell phenotypic subsets. Life events were measured using self-report questionnaires. RESULTS: Life events and frontal laterality showed a first order interaction in predicting changes in lymphocyte proliferation to tetanus toxoid (R2 increment = .26, p < .01) and pokeweed mitogen (R2 increment = .25, p < .02). The interaction also predicted changes in NK activity (R2 increment = .24, p < .02). CONCLUSIONS: Changes in lymphocyte proliferation and NK activity were associated with negative life events only among individuals with greater left frontal cortical activation. Our results suggest that recent psychosocial stress and individual differences in resting frontal cortical activation are together linked to immunologic responses to acute psychological stressors.

Predicting contraceptive vigilance in adolescent females: a projective method for assessing ego development.

PURPOSE: To test the hypothesis that ego development would predict contraceptive use. Problems in ego development were defined in terms of three factors: (1) realism, (2) complexity, and (3) discontinuity. METHODS: Forty-one respondents aged 14-17 years were selected from a group of 233 adolescents who were administered a projective pregnancy scenario and participated in a 12-month follow-up. Twenty of these adolescents were randomly selected from the group determined to be effective contraceptive users, while 21 were randomly selected from the group of poor contraceptors. RESULTS: Chi-square test revealed a significant association (p < .0005) between the composite ego maturity (EM) measure and contraceptive outcome (chi 2 = 13.82, with df-1). Low scores on the ego maturity measure predicted poor contraceptive use. EM was unrelated to age but was associated with race (chi 2 = 7.535, .025 < p < .05). However, EM predicted contraceptive use when controlling for the effects of race. CONCLUSIONS: A simple, time-efficient projective pregnancy scenario is an effective way of determining adolescent females at risk for poor contraceptive effectiveness and, therefore, untimely pregnancy. These stories are analyzed using factors related to the ego development of the adolescent. Subjects who scored lower on this measure have poor contraceptive effectiveness while subjects with higher levels demonstrated effective contraception use, at 1-year follow-up.

PIP: The hypothesis that ego development predicts adolescent contraceptive use was investigated in 41 females 14-17 years of age. These 41 subjects were recruited from a broader group of 233 adolescents attending teen clinics in San Francisco, California, who completed a projective pregnancy scenario and were followed for up to 12 months; 20 subjects were randomly selected from the subgroup determined to be effective contraceptive users, while 21 were drawn from the subgroup of poor contraceptors. An ego maturity index was developed for each teen based on an assessment of three dimensions of the adolescents' projective stories: 1) realism, idealism, or cynicism; 2) complexity, concreteness, or overelaboration; and 3) continuity, mild discontinuity, or abrupt discontinuity. The 25 adolescents whose stories were realistic, continuous, and articulately told were rated high in ego maturity, and 18 of these young women were effective contraceptors (defined as always or almost always using at least 1 moderately or very effective method) at the 1-year follow-up. In contrast, only 2 of the 16 participants with low ego maturity were effective contraceptors. Chi-square test revealed a significant association (p 0.0005) between the composite ego maturity measure and contraceptive outcome. This association remained significant (p 0.01) even after controlling for race. These findings suggest the feasibility of targeting sexually active adolescents with signs of lower ego development for early intervention.