Household television access: associations with screen time, reading, and homework among youth.

OBJECTIVE: We examined how household factors that mediate television access are associated with screen time (television, videos, movies, and computer and video games), reading, and homework. METHODS: We conducted a self-report survey among 1197 sixth and seventh graders in 10 middle schools in 4 Boston-area communities in 1995. To assess independent associations, SUDAAN linear regressions were calculated to control for respondent characteristics and household access and to account for clustered sampling in the school-based design. RESULTS: Total viewing (television, videos, movies, and computer and video games) averaged 3.35 plus minus 2.2 hours per day. In multivariate regressions, independent direct associations with total viewing were observed for the following categories: youth has a television in the bedroom: 0.64 hours per day (P <.001), never/seldom has family dinners: 0.55 hours (P <.01); no parental limits on television time: 0.48 hours (P <.01); and each additional television outside the youth's bedroom, 0.12 hours (P <.05). Similar results held when television/video/movie use was examined separately from computer/video game use. Youth reported an average of 1.6 plus minus 1.1 hours of reading and homework per day. Parental limits on television time were associated with 0.21 hours more reading per day (P <.01), whereas a television in the bedroom was associated with 0.18 hours less (P <.01). CONCLUSIONS: Reducing intrahousehold television access may enhance clinical, school, and community strategies to reduce youth television viewing and other screen time.

Assessing unmet need for services for pediatric undernutrition. HSPH MPH Student Research Team.

Evaluation and treatment of undernourished children in Massachusetts has been provided since 1984 by the seven outpatient Growth and Nutrition (GN) Clinics administered by the Massachusetts Department of Public Health (MDPH). This study explored the potential unmet need for nutritional services among low-income, multiethnic children ages birth to 36 months presenting to an inner-city pediatric emergency department (ED). During March 1992, staff obtained weight and stature on all children under 36 months of age brought to the ED. A structured interview questionnaire obtained data on demographic characteristics, birth history, and participation in means-tested federal benefit programs and MDPH GN Clinics. Among 252 children with complete anthropometric data, 22 (8.9%) had at least one anthropometric index (weight-for-age, height-for-age, weight-for-height) below the fifth percentile. Birthweights < 2500 g were reported by 18.5% of caregivers; 58% of children with height-for-age less than the fifth percentile and 63% of those with weight-for-age less than the fifth percentile were low birthweight (LBW) (Fisher's exact test, P < .002 and P < .006, respectively). Thirteen percent of families had no health insurance, and 77.1% received Medicaid. Among 22 children with anthropometry less than the fifth percentile, one half to three quarters participated in federally funded programs including Special Supplemental Food Program for Women, Infants, and Children (WIC), Aid to Families With Dependent Children (AFDC), and Food Stamps, but only 11% had been referred to the GN Clinics. These findings suggest that federal means-tested benefit programs and MDPH GN Clinic services were underused by groups at nutritional risk.(ABSTRACT TRUNCATED AT 250 WORDS)

High prevalence of overweight and short stature among Head Start children in Massachusetts.

The Head Start Program measures children's heights and weights to screen for growth problems such as obesity, wasting, and short stature. At present, little public health use is made of these data. In this paper, the authors present serial cross-sectional nutrition surveillance data from Massachusetts Head Start Programs. Nonrandom samples of local Head Start Programs provided annual screening data from 1988 to 1991 on an average of 2,664 children per year. Height and weight measurements were compared with National Center for Health Statistics (NCHS) reference populations. On average, 87 percent of the children were 36 to 59 months of age and 51 percent were white. From 7.3 to 8.8 percent of children were below the 5th percentile of height for age each year, and from 1.2 to 3.3 percent were underweight, with weight below the 5th percentile for height (P < 0.05 compared with NCHS population). In each year overweight (weight for height above the 95th percentile) was most prevalent, ranging from 9.6 percent to 13.3 percent (P < 0.05 compared with NCHS) and demonstrating a statistically significant upward trend over the 4 years of study (chi-square = 9.21, P < 0.01). The prevalence of overweight and short stature varied by race and ethnicity. A statistically significant upward trend in overweight was seen among Hispanic children (chi-square = 5.99, P < 0.05). Also, children who were 48 months of age or older were more likely than younger children to be overweight (P < 0.05). The prevalence of short stature did not vary significantly by year, sex, or age. The authors conclude that children attending Head Start Programs in Massachusetts are at risk for short stature and are at increasing risk of obesity. These risks vary by race and ethnicity. Further research is needed to determine the generalizability of these findings to other regions and to evaluate social and behavioral correlates of poor nutrition outcomes among Head Start children.

Nutritional and economic advantages for homeless families in shelters providing kitchen facilities and food.

Food habits were examined in homeless families in Boston-area hotels and family shelters. Reported household income, food expenditures, food sources, and attitudes were analyzed for 77 caretakers grouped according to kitchen facilities provided and amount of food provided. Diets were analyzed using a 4-week semiquantitative food frequency questionnaire for 71 female respondents grouped by type of residence (hotel or shelter). Median monthly income was $589 and was similar among groups. Mean monthly food expenditures were lower for those who lived in shelters that provided standard kitchen facilities and substantial food support compared with those who lived in hotels without these amenities ($93 vs $244; P < .05). Compared with others, respondents who lived in hotels reported purchasing food more frequently (P < .05), were more likely to use food pantries (P < .01), and had fewer food items on hand (P < .01). They were less likely to be satisfied with their diets, access to food, and cooking and food storage facilities (P < .05). Nutrient intakes were frequently below two thirds of the Recommended Dietary Allowance for vitamin B-6 (63% of respondents), calcium (44%), and iron (44%). Vitamin A intakes were lower in hotel residents, as were vitamin B-6, vitamin C, and zinc per 1,000 kcal (P < .05). We conclude that services provided to homeless families in shelters and hotels may influence food expenditures, food procurement, and women's diets. Nutrition professionals should consider the availability of kitchen facilities and food when counseling homeless families.

Nutrition and health services needs among the homeless.

This review discusses nutrition and related health problems among homeless Americans, summarizes recent information, and identifies needs for services and future research. The nature of homelessness today provides a context for the discussion. Many homeless persons eat fewer meals per day, lack food more often, and are more likely to have inadequate diets and poorer nutritional status than housed U.S. populations. Yet many homeless people eligible for food stamps do not receive them. While public and private agencies provide nutritious food and meals for homeless persons, availability of the services to homeless persons is limited. Many homeless people lack appropriate health care, and certain nutrition-related health problems are prevalent among them. Compared with housed populations, alcoholism, anemia, and growth problems are more common among homeless persons, and pregnancy rates are higher. The risks vary among homeless persons for malnutrition, nutrition-related health problems, drug and alcohol abuse, and mental illness. For example, among homeless persons, fewer heads of families than single adults are substance abusers, and mental illness varies in prevalence among single men, single women, and parents in homeless families. Homeless persons need improved access to food, nutrition, and health services. More nutrition education needs to be available to them and to service providers. Use of representative samples and validation of self-reported nutrition and health data will help future investigators to clarify the relationships between the characteristics of the homeless and their nutritional status.

Multiple program participation: comparison of nutrition and food assistance program benefits with food costs in Boston, Massachusetts.

The values of government cash and food assistance benefits are compared to estimated food costs in Boston for households whose sole source of income is Aid to Families with Dependent Children (AFDC) and who have housing in the private sector. Methods developed by the General Accounting Office (GAO) in 1978 are replicated. GAO found that the value of combined benefits can exceed the cost of the United States Department of Agriculture's Thrifty Food Plan. Key assumptions underlying GAO's methodology are challenged, and an alternate method is applied. The new results contradict GAO's conclusions and suggest that Boston food costs exceed the combined value of benefits that AFDC households may receive, although participation in multiple food assistance programs is more beneficial than receipt of benefits from single programs. The authors conclude that food stamps and AFDC benefits indexed to actual costs of living are needed to meet the food needs of low-income families in Boston.