Association between health literacy and child and adolescent obesity.

OBJECTIVE: We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity. METHODS: We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL. We used multivariable logistic regression to test adjusted association between child and parental NVS and obesity. Analyses were stratified for school-aged children (aged 7-11) vs. adolescents (aged 12-19). RESULTS: We surveyed 239 child-parent dyads. Median child age was 11 [inter-quartile range 9-13]; 123 (51%) were male; 84% Medicaid recipients; 27% obese. For children, the odds of obesity [adjusted odds ratio (95% confidence interval)] decreased with higher parent NVS [0.75 (0.56,1.00)] and increased with parent obesity [2.53 (1.08,5.94)]. For adolescents, odds of obesity were higher for adolescents with the lowest category of NVS [5.00 (1.26, 19.8)] and older parental age [1.07 (1.01,1.14)] and lower for Medicaid recipients [0.21 (0.06,0.78)] and higher parental education [0.38 (0.22,0.63)]. CONCLUSION: Obesity in school-aged children is associated with parental factors (obesity, parental HL); obesity in adolescents is strongly associated with the adolescent's HL. PRACTICE IMPLICATIONS: Strategies to prevent and treat obesity should consider limited HL of parents for child obesity and of adolescents for adolescent obesity.

Can the Newest Vital Sign be used to assess health literacy in children and adolescents?

CONTEXT: We evaluated the validity of the Newest Vital Sign (NVS) as a brief screen for health literacy in children. OBJECTIVES: To (a) test the hypothesis that child performance on the NVS correlates with performance on a test of child reading comprehension and (b) establish age-based cutoffs for expected performance on the NVS. DESIGN: Children aged 7 to 17 years were administered the NVS followed by the Gray Silent Reading Test (GSRT). RESULTS: The NVS score correlated strongly with GSRT score (ρ = 0.71, P < .0001) and increased with age. Children aged 7 to 9 years had a median NVS score of 1 (interquartile range = 1-2); children aged 10 to 17 years had a median score of 3 (interquartile range = 2-4), P < .0001. CONCLUSION: The NVS performs well in this population. Children aged 10 to 17 years with an NVS score lower than 2 may have low health literacy.

Do overweight and obese youth take longer to recover from injury?

The objective of the study was to examine the effects of overweight and obesity on times to recovery among Canadian youth who have suffered one or more types of injury. The data source was the 2002 Canadian Health Behaviour in School-Aged Children (HBSC) survey. The study population included 7266 youth in grades 6 through 10 sampled from all Canadian provinces and territories. Of these, 2831 students reported an injury event and were included in the analysis. Kaplan-Meier curves and hazard ratios (HR) were used to profile survival functions and estimate relative hazards for non-recovery from injury events among normal weight, overweight and obese youth. Youth who were obese and suffered a combined injury (broken bone and strain/sprain) took longer to recover (HR: 1.81, 95% CI 0.99-3.32) compared to normal weight youth. HR for injury recovery in obese youth were not significantly elevated for broken bones (1.15, 95% CI 0.61-2.19) and sprain/strains (1.17, 95% CI 0.73-1.85) in isolation. Obesity was associated with times for injury recovery among injured youth. If these findings are confirmed in other settings, clinicians providing an injury recovery prognosis may need to take into account BMI status and allow for extra recovery time for patients in this age range.

Are overweight and obese youth at increased risk for physical activity injuries?

OBJECTIVE: To determine whether relationships between physical activity and physical activity injuries are modified by BMI status in youth. METHOD: Data were obtained from the 2006 Canadian Health Behaviour in School-Aged Children survey; a representative study of 7,714 grade 6-10 youth. A sub-sample of 1,814 were re-administered the survey in 2007. Analyses considered relationships among the major variables in theory-driven cross-sectional and longitudinal analyses. RESULT: Among normal weight youth, cross-sectional analyses indicated that those who reported high levels of physical activity outside of school experienced 2.28 (95% confidence interval 1.95-2.68) the relative odds for physical activity injury in comparison to those with low levels of physical activity outside of school. Analogous odds ratios for overweight and obese youth were 1.89 (1.31-2.72) and 3.72 (1.89-7.33), respectively. BMI status was not an effect modifier of the relationship between physical activity and physical activity injury. Similar observations were made in the confirmatory longitudinal analyses. CONCLUSION: Concerns surrounding the design of physical activity programmes include side-effects such as injury risk. This study provides some re-assurance that physical activity participation relates to injury in a consistent manner across BMI groups.

Effects of changing body-checking rules on rates of injury in minor hockey.

OBJECTIVE: In this study we explored the effects of the 2002 rule change in Ontario minor hockey, in which body-checking was introduced at the atom (ages 9-10) instead of the peewee (previously ages 12-13) age level. It was hypothesized that the introduction of body-checking at younger ages would result in higher overall rates of injury to minor hockey players, with concomitant increases in neurotraumatic injuries. PATIENTS AND METHODS: Participants included injured minor hockey players between the ages of 7 and 14 years in the Kingston area of Ontario, Canada. The Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program were used to identify injuries that presented to the only 2 emergency departments in this community. In our analyses, we compared rates and patterns of injury that required hospital-based emergency medicine care before (1997-1998 to 2001-2002 seasons) and after (2002-2003 to 2006-2007 seasons) implementation of the body-checking rule change. RESULTS: Overall rates of injury to minor hockey players declined in the years after the rule change. Rates of injury attributable to body-checking, as well as the natures and anatomic sites of injury caused by body-checking, remained consistent in the 2 study periods. CONCLUSIONS: In this historical study, we did not observe an increase in the overall rates of injury and concomitant neurotraumatic events. Increased enforcement of playing rules as well as temporal declines in emergency department use may have contributed to these findings.

Farm work exposure of older male farmers in Saskatchewan.

BACKGROUND: The average age of farmers in North America is increasing each year. Research has determined that age and health status are both related to increased risk of injury. The purpose of this research was to determine the association of health and medication factors with exposure to farm work in older male farmers. METHODS: As part of a cohort study to study determinants of injury on Saskatchewan farms, 5,502 farm people associated with 2,386 Saskatchewan farms were surveyed by mail questionnaire during the winter of 2007. The primary dependent variable was average hours per week of farm work. Independent variables included illnesses, age, and medication use. RESULTS: The mean number of hours worked per week by farmers aged 55 years and older was 48. There was a significant relationship between age and hours worked with each year of age accounting for about 0.85 hr less work per week. Medication use was related to a reduction in weekly work hours during the busy fall season but was not related to work exposure averaged over the whole year. In multivariable linear regression analysis, the main contributing variables to farm work exposure were: retired status (-), working off farm (-), and age (-). CONCLUSION: The amount of hours older farmers work on the farm is considerable compared to any other occupational category. While there is a declining trend in the amount of work, a 75-year-old farmer still works, on average, about 34 hr per week. Some farmers do appear to self-limit during busy times of the year if they are taking medication.

A systematic review of the association between body checking and injury in youth ice hockey.

OBJECTIVE: The objective of this study is to systematically examine the risk of injury associated with body checking in youth ice hockey. DATA SOURCES: A systematic review of the relevant electronic databases was conducted including PubMed and Web of Science. The main search terms included "hockey, ice hockey, injury, body checking, child, adolescent, and pediatric." STUDY SELECTION: The initial search identified 898 potential articles, and, after verifying inclusion criteria, 260 articles were selected for further assessment. The Downs and Black instrument for nonrandomized studies (Downs 1998) was used to assess the quality of the articles. DATA EXTRACTION: Studies included reported on body checking as a mechanism of injury and compared injury rates in checking to non-checking leagues in children 20 years or younger. DATA SYNTHESIS: Twenty studies met the inclusion criteria and they predominantly found increased injuries associated with body checking. The relative risk of injury associated with body checking in comparative studies ranged from 0.6 to 39.8. Checking was the reported mechanism of injury between 2.9% and 91% of injuries. All but 1 study that met our inclusion criteria found an increased risk of injuries when body checking was permitted. CONCLUSIONS: Increased injuries attributable to checking were found where checking was allowed. This study supports policies that disallow body checking to reduce injuries in young children.