Disparities in women's health across a generation: a mother-daughter comparison.

BACKGROUND: The U.S. Centers for Disease Control and Prevention has set national goals to eliminate health disparities by race, sex, and socioeconomic status. Progress in meeting these goals has been mixed. This paper provides a different view on the evolving health of U.S. women by examining a sample of daughters and their mothers. METHODS: The aim was to determine if the health risk profiles of daughters (born 1975-1992) were different from their mothers (born 1957-1964) measured when both were between the ages of 17 and 24 years. The U.S.-based National Longitudinal Survey of Youth 1979 and associated Children and Young Adult Surveys were used. The sample was 2411 non-Hispanic white and African American girls born to 1701 mothers. Outcomes were height, weight, body mass index (BMI), age of menarche, and self-reported health. RESULTS: In both races, daughters were taller but entered adulthood at greater risk for the development of chronic illness than their mothers. Racial differences were greater in the daughters' generation than in the mothers'. Whites in both generations experienced educational differences in health based upon the mother's educational level, with fewer years of maternal education associated with poorer health. African Americans of both generations experienced differences by maternal education in self-reported health. However, when African American daughters were compared with their mothers, daughters born to college educated women gained more weight and had higher BMI and earlier menarche than did daughters born to high school dropouts. CONCLUSION: Health deterioration across generations in both races suggests that much work is needed to meet Healthy People 2020 goals of health equity.

The impact of prepregnancy obesity on children's cognitive test scores.

To examine the association between maternal prepregnancy obesity and cognitive test scores of children at early primary school age. A descriptive observational design was used. Study subjects consist of 3,412 US children aged 60-83 months from the National Longitudinal Survey of Youth 1979 Mother and Child Survey. Cognitive test scores using the Peabody Individual Achievement Test reading recognition and mathematics tests were used as the outcomes of interest. Association with maternal prepregnancy obesity was examined using the ordinary least square regression controlling for intrauterine, family background, maternal and child factors. Children of obese women had 3 points (0.23 SD units) lower peabody individual achievement test (PIAT) reading recognition score (p = 0.007), and 2 points (0.16 SD units) lower PIAT mathematics scores (p < 0.0001), holding all other factors constant. As expected, cognitive test score was associated with stimulating home environment (reading: ß = 0.15, p < 0.0001, and math: ß = 0.15, p < 0.0001), household income (reading: ß = 0.03, p = 0.02 and math: ß = 0.04, p = 0.004), maternal education (reading: ß = 0.42, p = 0.0005, and math: ß = 0.32, p = 0.008), and maternal cognitive skills (reading: ß = 0.11, p < 0.0001, and math: ß = 0.09, p < 0.0001). There was a significant association between maternal prepregnancy obesity and child cognitive test scores that could not be explained by other intrauterine, family background, maternal, and child factors. Children who live in disadvantaged postnatal environments may be most affected by the effects of maternal prepregnancy obesity. Replications of the current study using different cohorts are warranted to confirm the association between maternal prepregnancy obesity and child cognitive test scores.

African-American/white differences in the age of menarche: accounting for the difference.

Lifetime health disparity between African-American and white females begins with lower birthweight and higher rates of childhood overweight. In adolescence, African-American girls experience earlier menarche. Understanding the origins of these health disparities is a national priority. There is growing literature suggesting that the life course health development model is a useful framework for studying disparities. The purpose of this study was to quantify the influence of explanatory factors from key developmental stages on the age of menarche and to determine how much of the overall race difference in age of menarche they could explain. The factors were maternal age of menarche, birthweight, poverty during early childhood (age 0 through 5 years), and child BMI z-scores at 6 years. The sample, drawn from the US National Longitudinal Surveys of Youth Child-Mother file, consisted of 2337 girls born between 1978 and 1998. Mean age of menarche in months was 144 for African-American girls and 150 for whites. An instrumental variable approach was used to estimate a causal effect of child BMI z-score on age of menarche. The instrumental variables were pre-pregnancy BMI, high gestational weight gain and smoking during pregnancy. We found strong effects of maternal age of menarche, birthweight, and child BMI z-score (-5.23, 95% CI [-7.35,-3.12]) for both African-Americans and whites. Age of menarche declined with increases in exposure to poverty during early childhood for whites. There was no effect of poverty for African-Americans. We used Oaxaca decomposition techniques to determine how much of the overall race difference in age of menarche was attributable to race differences in observable factors and how much was due to race dependent responses. The African-American/white difference in childhood BMI explained about 18% of the overall difference in age of menarche and birthweight differences explained another 11%.