Economic Recessions and Infant Mortality in the U.S., 1999-2008
Pages 60-66
David Bishai, Qingfeng Li and Sai Ma

DOI: http://dx.doi.org/10.6000/1929-4247.2014.03.01.8

Published: 10 March 2014

Abstract: Objectives: Prior studies of US data from the 1990s have shown that economic growth is associated with higher all cause mortality. This paper updates prior findings to more recent data on US infant mortality for blacks and whites.

Methods: We analyzed data from 50 US states from 1999 to 2008 using state fixed-effects regression models stratified to identify the racially disparate impact of each state’s economic performance on infant mortality, controlling for state policy-related variables, reflecting population,% black, % on TANF, % on Medicaid, and alcohol consumption.

Results: Economic recessions are significantly associated with lower post-neonatal mortality for white infants, but not black infants. Each 1% decrement a state’s gross state product, would be associated with an approximately 2.3 fewer infant deaths (95% CI: -0.294-4.894) in an average state with 64,000 total births. Results were robust to the inclusion of state trends, national trends, state fixed effects, lagged gross state product, and the inclusion of measures of unemployment and state policy variables.

Conclusions: This study in combination with studies from the 1990s reflects growing evidence that economic growth in the US can be harmful to child health. Policy makers need to be informed and mindful about the “side effects” of economic growth on health.

The Utilization of Process Evaluations in Childhood Obesity Intervention Research: A Review of Reviews
Pages 270-280
Paul Branscum and Logan Hayes

DOI: http://dx.doi.org/10.6000/1929-4247.2013.02.04.1

Published: 25 November 2013

Abstract: Process evaluations are an essential component to evaluating health promotion programs, however they are consistently under-utilized and oftentimes not reported upon in the literature. This study reports the use of process evaluations in childhood obesity prevention interventions implemented over the past three decades. Seven meta-analyses and systematic reviews were located for this review or reviews, and from these, 119 unique references were identified. Each article was retrieved and read for appropriateness, and 20 were excluded for a variety of reasons (ex. not published in English language), resulting in 99 articles included for this study. Overall, process evaluations were not well reported upon. Only 38 studies reported the fidelity of program implementation, 25 studies tracked participant attendance, 29 studied evaluated participant satisfaction, and 49 studies reported how staff members were trained. Additionally, one-third of the studies did not report using a single type of process evaluation, and only 5 studies reported using all four types. Results from this study suggest that the use of process evaluations has been low in this area of research, which may explain why many obesity prevention studies have reported mixed or modest results. Suggestions for implementing simple, yet effective process evaluations in future studies will be presented.

Maternal and Neonatal Factors Influencing Preterm Birth and Low Birth Weight in Oman: A Hospital Based Study
Pages 281-295
M. Mazharul Islam, Khalid Al-Thihliand Mohamed Abdellatif

DOI: http://dx.doi.org/10.6000/1929-4247.2013.02.04.2

Published: 25 November 2013

Abstract: Background: Preterm births (PTB) and low birth weight (LBW) - the two distinct adverse pregnancy outcomes - are the major determinants of perinatal survival and development. The purpose of this study was to determine the incidence of LBW and PTB and identify the maternal and neonatal risk factors influencing them.

Methods: Data for the study come from a cross-sectional retrospective study conducted at the maternity ward of Sultan Qaboos University Hospital (SQUH) in Oman during the period between November 2011 and February 2012. Data on 534 singleton live births that occurred during the study period were extracted from hospital record. Descriptive statistics, bivariate analysis and multivariate logistic regression model were used for data analysis.

Results: The incidence of PTB and LBW were observed to be 9.7% and 13.7% respectively. Half (51.8%) of the LBW babies were PTB and 48.2% of the LBW babies were of term births. Differences and similarities were noted for the risk profile for PTB and LBW. Risk factors specific to PTB were maternal age, previous pregnancy loss, and infant’s length, while birth interval, maternal weight and BMI during pregnancy, and gestational age were the risk factors unique to LBW. ANC visit, infant’s gender, Apgar score, and head circumference of infants were the common significant risk factors influencing both LBW and PTB.

Conclusions: The incidence of PTB and LBW are moderately high in Oman. They are associated with different risk factors. A greater understanding and modification of identified risk factors would help reduce the incidence of PTB and LBW in Oman.

The Children in Action Pilot Study
Pages 296-308
Theresa A. Nicklas, Tuan Nguyen, Nancy F. Butte and Yan Liu

DOI: http://dx.doi.org/10.6000/1929-4247.2013.02.04.3

Published: 25 November 2013

Abstract: Interventions that can successfully alter the trajectory toward obesity among high-risk children are critical if we are to effectively address this public health crisis. The goal of this pilot study was to implement and evaluate an innovative physical activity program with Hispanic-American (HA) preschool children attending Head Start. The Children in Action (CIA) program was a five month physical activity intervention. This intervention was a pilot study with 3- to 5-year-olds enrolled in four HA Head Start centers. After baseline assessment, centers were matched by enrollment and randomly assigned to either the intervention or the control condition. A total of 295 preschool children were randomly selected across the four centers. The primary endpointsof this study were favorable changes in physical activity levels and gross motor skills. Using mixed effect time-series regression models, changes in weight was a secondary endpoint. We did not observe a statistical difference between intervention and control groups in physical activity levels during the awake time, gross motor skills,or weight status. Process evaluation data showed that there was adherence to protocols and the intervention was delivered 92% of the time, four times per week, during the five month intervention. We demonstrated that it is feasible to conduct the SPARK-Early Childhood (EC) curriculum among preschool children attending Head Start centers but that an increased dose and/or longer intervention duration will be required to impact gross motor skills, physical activity levels and weight status during this critical early childhood development stage.

Suboptimal Omega-3 Levels in Australian Adolescents
Pages 309-315
Ross Grant, Jade Guest, Ayse Bilgin, Margaret J. Morris, Manohar Garg and Robyn Pearce

DOI: http://dx.doi.org/10.6000/1929-4247.2013.02.04.4

Published: 25 November 2013

Abstract: Objective:To quantitate the omega-3 status in a cohort of Australian adolescents.

Design, Setting and Participants:A cross-sectional descriptive study of 251 apparently healthy adolescents (192 female, 59 male) aged 15-17 years, in year 11, from 10 schools within the Northern Sydney and Central Coast areas of New South Wales. Participants provided a morning non-fasting blood sample via finger-prick and written answers to specific demographic and lifestyle questions. Omega-3 index was calculated by adding %EPA and %DHA values in the whole blood. Equivalent erythrocyte omega-3 index values were obtained by using conversion factors (1.33 for EPA and 2.22 for DHA) from published erythrocyte/whole blood values.

Main Outcome Measures: Quantitation of the individual, and estimation of the group average, blood omega-3 Index.

Results:The blood omega-3 Index for this adolescent cohort ranged from 2.1-22.3 with a mean of 8.3±3.2, and median of 7.8. On average males had a higher omega-3 Index compared to females (10.5±3.7 vs 7.7±2.6, p<0.001). Fifty three percent of adolescents tested had an omega-3 Index below the optimum of >8. Three percent had an Index of <4, placing them in the high risk category for disease.

On average, adolescents from low or medium socioeconomic communities had a significantly lower omega-3 Index compared to those from higher socioeconomic neighbourhoods (mean difference=1.4, p=0.018). Overall 20% of boys and 17% of girls reported regularly taking omega-3 supplements. Regular use of omega-3 supplements was associated with a higher average omega-3 Index (9.8±3.7, n=44 compared to 8.0±3.0, n=203, p=0.001 in those not taking supplements).

Conclusion:This study indicates that Australian adolescents, even when from advantaged homes, have a high probability of below optimum omega-3 levels. As reduced omega-3 levels are linked to conditions of public health concern such as diabetes, asthma and depression, targeted strategies to improve the omega-3 status in the childhood population may be warranted.