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The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: at 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.

Objective: Estimate the population attributable fraction (PAF) for a set of recognized risk factors for orofacial clefts. Design: We used data from the National Birth Defects Prevention Study. For recognized risk factors for which data were available, we estimated crude population attributable fractions (cPAFs) to account for potential confounding, average-adjusted population attributable fractions (aaPAFs). We assessed 11 modifiable and 3 nonmodifiable parental/maternal risk factors. The aaPAF for individual risk factors and the total aaPAF for the set of risk factors were calculated using a method described by Eide and Geffler. Setting: Population-based case–control study in 10 US states. Participants: Two thousand seven hundred seventy-nine cases with isolated cleft lip with or without cleft palate (CL±P), 1310 cases with isolated cleft palate (CP), and 11 692 controls with estimated dates of delivery between October 1, 1997, and December 31, 2011. Main Outcome Measures: Crude population attributable fraction and aaPAF. Results: The proportion of CL±P and CP cases attributable to the full set of examined risk factors was 50% and 43%, respectively. The modifiable factor with the largest aaPAF was smoking during the month before pregnancy or the first month of pregnancy (4.0% for CL±P and 3.4% for CP). Among nonmodifiable factors, the factor with the largest aaPAF for CL±P was male sex (27%) and for CP it was female sex (16%). Conclusions: Our results may inform research and prevention efforts. A large proportion of orofacial cleft risk is attributable to nonmodifiable factors; it is important to better understand the mechanisms involved for these factors.

Introduction: This study examines sex differences in the prevalence of low clinical cardiovascular health (CVH) scores from ages 8-50 years old. Methods: Five cardiovascular cohorts (Bogalusa, Young Finns, HB!, CARDIA, and STRIP) were used to create a pooled cohort spanning from ages 8 to 50 years old. The American Heart Association criteria for poor, intermediate and ideal levels for 4 CVH factors (blood pressure, BMI, cholesterol, and glucose) were summed to calculate a clinical CVH score (range 0-8; higher being more ideal). Sex differences in the prevalence rates of low clinical CVH by age group (defined as a score ≤3) were estimated using logistic regression models. Results: Sex differences were examined among 9,386 participants with data on clinical CVH (56% female, 66% White and average follow-up time of 23 yrs). The prevalence of low clinical CVH increased for both men and women with age from 0.72% at age 8-14 yrs to 15% at 45-50 yrs of age in women and from 0.44% at ages 8-14 yrs to over 23% at ages 45-50 yrs in men. There were no significant sex differences in the prevalence of low clinical CVH at younger ages (8-20 years old, p>0.05). Between the ages of 21-26 years old, males were 2 times more likely to have low clinical CVH than women (odds ratio [OR] 2.2, 95% confidence interval [CI], 1.4-3.4). Sex differences in the prevalence of low clinical CVH persisted through adulthood and with only a slight decrease by ages 45-50 years old (OR 1.6, 95%CI 1.4-1.9). Conclusions: Sex differences in the prevalence of low clinical CVH change over the lifetime. In childhood the prevalence of low clinical CVH is similar. By young adulthood, men are more than twice more likely to have low clinical CVH than women; that sex difference is maintained throughout middle age. Understanding the reasons for the growing sex differences in the prevalence of low clinical CVH with age may help to identify targets for primordial prevention, especially prevention strategies to target young men.

Objective The aim of this study was to determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. Methods The impact of TF20 on firefighters' 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 10 departments. TF20 has web-based nutrition, physical activity, and behavioral health components. Results An adjusted treatment-induced weight loss from 1.7 to 2.8 lb was observed for all participants and 2.3 to 3.1 lb among overweight and obese participants. An average weight gain was observed among firefighters in the control condition and weight loss for those in the treatment condition. Conclusions TF20 supports firefighters' weight loss. Firefighters need wellness interventions to improve nutrition and physical activity given their high prevalence of obesity.

Background Decreased muscle strength is strongly associated with future mobility limitations in older adults. Homocysteine is a risk factor for vascular disease and may exacerbate muscle strength decline. The present study aimed to examine the association between homocysteine levels and muscle strength in adults aged 50 years or older. Methods Data were from 1,101 participants of The Baltimore Longitudinal Study of Aging between December 2004 and March 2015. Muscle strength was measured using grip strength. Mixed effects linear regression was used to estimate the association between homocysteine and muscle strength in men and women, separately. Results Total mean follow-up time was 4.7 ± 3.1 years, range from 0 to 10.1 years. Baseline mean grip strength was 39.9 kg for men and 25.5 kg for women. Grip strength declined over the follow-up time for both men and women. Among women, there was a significant inverse relationship between homocysteine and grip strength, where grip strength declined as a function of increasing homocysteine over time (β = -0.05, p = .031). Among men, an increase of 1 μmol/L in homocysteine was associated with -0.10 kg decrease in grip strength, though not significantly. Conclusions In this study of healthy older adults aged 50 years or older, higher homocysteine was related to lower muscle strength in women. This is the first study to characterize the relationship over a long follow-up period. Future research should focus on assessing homocysteine as a marker of physical function decline and translating the relationship into clinical and public health practice.

Capturing portion size estimates is a constant challenge. Our objective was to characterize reported portion size during face-to-face and telephone 24-hour diet recalls among career fire fighters in the Fuel 2 Fight study. Trained nutritionists reviewed recalls and categorized reported portion size into weights, household measures, servings & items (including common alternatives for portion size), or food models. Two-dimensional models were most frequently used in face-to-face recalls, whereas household measures, and servings & items were more frequently used in telephone recalls. Thus, expanding use of common non-food objects with a known volume could be an important portion size alternative for telephone recalls.

Few studies have investigated long-term effects of physical activity (PA) interventions. The goal of this study was to evaluate whether or not increased levels of moderate to vigorous physical activity (MVPA) were maintained by cancer survivors 1 year after receipt of two home-based interventions. The FRESH START trial randomized 543 breast and prostate cancer survivors to 1-of-2 mailed print diet and exercise interventions: sequentially-tailored vs. standardized (attention control). Each arm received eight mailings over a 1-year period, with follow-up at 1 and 2 years. This analysis focuses solely on the 400 participants who had suboptimal levels of MVPA at baseline (measured by the 7-Day Physical Activity Recall) and who completed the 2-year study. Median minutes of MVPA at baseline, 1-year and 2-year follow-up in the tailored intervention arm were as follows: 0, 90, and 60 min/week, respectively. The corresponding values in the attention control group were 0, 30, and 30 min/week. Significant improvements in MVPA from baseline to 2-year follow-up were observed in both study arms (p

ObjectiveThe present study analysed the impact of using the 2006 WHO Child Growth Standards (‘the WHO standards’) compared with the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) on the calculated prevalence of chronic malnutrition in children aged 6·0–59·9 months.DesignAnthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland–Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories.SettingThe study was conducted in thirteen rural villages within Honduras's department of Intibucá.SubjectsChildren aged 6·0–59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study.ResultsThe WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0–35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender.ConclusionsThe choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.

Introduction Cell phone use while driving restricts peripheral awareness and impairs reaction time. This study assessed the 3-year prevalence of cell phone use (CPU) of drivers and characteristics associated with its use in six cities across Texas, 2011–2013. Methods CPU and driver characteristics were observed among motor vehicles (n = 1280) stopped at major intersections in medical and academic campuses. A multivariable logistic regression model described the association between driver characteristics and CPU. Results The overall prevalence of any CPU was 18.7%. Any type of CPU and talking tended to decline, while texting seemed to increase from 2011 to 2013. CPU was more likely among female drivers (OR = 1.63; 95% CI = 1.21, 2.20), drivers, Highlights • Cell phone use and drivers were observed in Texas medical and academic campuses. • The overall prevalence of any cell phone use tended to decline from 2011 to 2013. • Texting appeared to increase from 2011 to 2013. • Cell phone use was more likely among females, those

Despite proven benefits of regular physical activity, estimates indicate that few cancer survivors meet physical activity guidelines. The purpose of this paper is to identify and compare exercise barriers among cancer survivors, both cross-sectionally and longitudinally as they undergo home-based behavioral interventions.Data on a sample of 452 breast and prostate cancer survivors who completed the FRESH START trial were analyzed collectively, as well as separately by cancer type.More total barriers (3.5 vs. 2.4; p 0.01) were reported among breast cancer survivors compared with prostate cancer survivors. Commonly reported baseline exercise barriers among both groups were "too busy" (breast, 52% and prostate, 45%) and "no willpower" (breast, 51% and prostate, 44%). At baseline, breast cancer survivors who reported "no willpower" also reported 18.7 fewer minutes of physical activity compared with those not reporting this barrier (p 0.01). Among prostate cancer survivors, this difference was 39.5 min (p 0.01). Change in barriers was not associated with change in minutes of physical activity from baseline to post-intervention in either cancer survivor group.This is the largest study evaluating barriers and physical activity over time among cancer survivors. There are similarities and differences that both need to be taken into consideration when promoting physical activity among subgroups of survivors.Knowledge concerning barriers associated with reported physical activity may be helpful in designing optimally targeted physical activity interventions among breast and prostate cancer survivors.

To determine predictors of adherence to cervical cancer screening guidelines among women working in Monterrey, Mexico. Cases (n = 94) were sexually active female store clerks working in Monterrey, Mexico, aged 18-64, who were not adherent to Official Mexican Standard cervical cancer screening guidelines; controls (n = 135) were adherent to guidelines. The outcome of interest was adherence to cervical cancer screening services according to national screening guidelines.Multivariate logistic regression analyzed knowledge factors and perceptions associated with adherence.Having no or inaccurate knowledge of screening guidelines (odds ratio [OR] 11.1, 95% confidence interval [95% CI] 4.3-28.5) and no knowledge of Pap examination utility (OR 6.8, 95% CI 1.0-46.4) were associated with screening guideline nonadherence. Perceptions of fear/embarrassment (OR 16.2, 95% CI 5.1-51.5) and lower levels of spousal/partner acceptance (OR 5.8, 95% CI 1.3-25.3) of the Pap examination were associated with screening guideline nonadherence. Results were adjusted for age at initiation of sexual activity, civil status, level of education, use of family planning/birth control, and income.Identification of knowledge factors and perceptions that predict screening guideline adherence can inform population-specific recommendations to increase screening and reduce cervical cancer morbidity and mortality among employed Mexican women.

Major cardiovascular disease (CVD) risk factors begin development in childhood and adolescence. Project HeartBeat! studied early development of these risk factors as growth processes. Growth, body composition, sexual maturation, major CVD risk factors, and cardiac structure and function were monitored every 4 months for up to 4 years among 678 children and adolescents (49.1% girls; 20.1% blacks) aged 8, 11, or 14 years at study entry. All resided in The Woodlands or Conroe TX. Interviews were conducted at entry and annually on diet, physical activity, and health history of participants and their families. Data were collected from 1991 to 1995, and study investigators continue data analysis and reporting. Overlap in ages at examination among three cohorts (aged 8–12, 11–15, and 14–18 years at baseline) and use of multilevel modeling methods permit analysis of some 5500 observations on each principal variable for the synthetic cohort from ages 8 to 18 years. The mixed-longitudinal design provides trajectories of change with age, for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; systolic, and fourth-phase and fifth-phase diastolic blood pressure, and left ventricular mass. These trajectories are then related to concurrent measures of multiple indices of body composition and sexual maturation and adjusted for energy intake and physical activity. The data provide valuable insights into risk factor development and suggest a fresh approach to understanding influences on blood lipids, blood pressure, and left ventricular mass during the period of childhood and adolescence, a period of dynamic change in these risk factors.

Background Body composition and fat distribution change dramatically during adolescence. Data based on longitudinal studies to describe these changes are limited. The aim of this study was to describe age-related changes in fat free–mass index (FFMI) and fat mass index (FMI), which are components of BMI, and waist circumference (WC) in participants of Project HeartBeat!, a longitudinal study of children. Methods Anthropometric measurements and body composition data were obtained in a mixed longitudinal study of 678 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years, every 4 months for 4 years (1991–1995). Trajectories of change from ages 8 to 18 years were measured for FFMI, FMI, and WC. Because of the small number of observations for black participants, trajectories for this group were limited to ages 8.5–15 years. Results Body mass index, FFMI, and WC increased steadily with age for all race–gender cohorts. However, in nonblack girls, FFMI remained constant after about age 16 years. For black boys and girls, FFMI was similar at age 8.5 years but increased more steeply for black boys by age 15 years. In girls, FMI showed an upward trend until shortly after age 14 years, when it remained constant. In boys, FMI increased between age 8 years and age 10 years, and then decreased. Conclusions The extent to which each component of BMI contributes to the changes in BMI depends on the gender, race, and age of the individual. Healthcare providers need to be aware that children who show upward deviation of BMI or BMI percentiles may have increases in their lean body mass rather than in adiposity.

Project HeartBeat! was a longitudinal “growth” study of cardiovascular disease (CVD) risk factors and body composition in childhood and adolescence. Its findings demonstrate patterns of change from ages 8 to 18 years in anthropometric indicators of adiposity, blood lipid components, and blood pressure measurements, as well as the varying inter-relations among these patterns. Especially noteworthy are differences among associations between the two components of BMI (kg/m2)—the lean or fat-free mass index, and the fat mass index—and each of several CVD risk factors. Policy development and public health recommendations for CVD prevention beginning in childhood have evolved over 30 years or more. A new impetus to action is the recognized increase in the prevalence of childhood overweight and obesity. Intervention to prevent obesity can have a major impact in preventing CVD risk factors more broadly. Opportunities to strengthen interventions for CVD prevention in childhood and adolescence include updated algorithms for monitoring body composition, blood lipids, and blood pressure throughout childhood and adolescence through use of the Project HeartBeat! study results.

Background Associations among dietary intake, physical activity, and cardiovascular disease (CVD) risk factors are inconsistent among male and female youth, possibly from lack of adjustment for pubertal status. The purpose of this report is to describe the associations of CVD risk factors among youth, adjusted for sexual maturation. Methods Data analyzed in 2007 from a sumsample of 556 children aged 8, 11, and 14 years in Project HeartBeat!, 1991–1993, provide cross-sectional patterns of CVD risk factors by age and gender, adjusting for sexual maturation, within dietary fat and physical activity categories. Results Girls consuming moderate- to high-fat diets were significantly less physically active than those consuming low-fat diets. Boys and girls consuming high-fat diets had higher saturated fat and cholesterol intakes than children in low-fat categories. Boys had no significant differences in physical activity, blood pressure, waist circumference, or plasma cholesterol levels across fat categories. Girls' plasma cholesterol levels showed no significant differences across fat categories. Dietary intake did not differ across moderate-to-vigorous physical activity (MVPA) categories within gender. There were no differences in BMI by fat or MVPA categories for either gender. Girls' waist circumference differed significantly by fat category, and systolic blood pressure differed significantly across fat and MVPA categories. Boys' fifth-phase diastolic blood pressure was significantly different across MVPA categories. Conclusions Girls consuming atherogenic diets were significantly less physically active than those with low fat intakes, whereas boys consuming high-fat diets did not show differences in physical activity measures. With the prevalence of overweight rising among youth, the impact of atherogenic diets and sedentary lifestyles on CVD risk factors is of concern to public health professionals.

Purpose Factors that determine persistence of untreated Helicobacter pylori (H. pylori) infection in childhood are not well understood. We estimated risk differences for the effect of incidental antibiotic exposure on the probability of a detected clearance at the next test after an initial detected H. pylori infection. Methods The Pasitos Cohort Study (1998–2005) investigated predictors of H. pylori infection in children from El Paso, Texas, and Juarez, Mexico. Children were screened for infection at 6-month target intervals from 6 to 84 months of age, using the 13C-urea breath test corrected for body-size-dependent variation in CO2 production. Exposure was defined as courses of any systemic antibiotic (systemic) or those with anti-H. pylori action (HP-effective) reported for the interval between initial detected infection and next test. Binomial regression models included country of residence, mother's education, adequacy of prenatal care, age at infection, and interval between tests. Results Of 205 children with a test result and antibiotic data following a detected infection, the number of children who took ≥1 course in the interval between tests was 74 for systemic and 33 for HP-effective. The proportion testing negative at the next test was 66% for 0 courses, 72% for ≥1 systemic course, and 79% for ≥1 HP-effective course. Adjusted risk differences (95%CI) for apparent clearance, comparing ≥1 to 0 courses were 10% (1–20%) for systemic and 11% (0–21%) for HP-effective. Conclusions Incidental antibiotic exposure appears to influence the duration of childhood H. pylori infection but seems to explain only a small portion of spontaneous clearance. Copyright © 2009 John Wiley & Sons, Ltd.

Objective To examine the association between nutrition knowledge and eating behavior in a predominantly Mexican American population on the Texas-Mexico border. Design Cross-sectional using data from the baseline survey of the Que Sabrosa Vida community nutrition initiative. Setting El Paso and surrounding counties in Texas. Participants Data gathered in 2000 using random-digit dialing telephone survey. Response rate was 42.6% and final sample size was 963. Main Outcome Measures Knowledge of recommended servings of food items was the independent variable and number of servings of food items consumed was the dependent variable. Data analysis Multiple logistic regression was used to examine the association between nutrition knowledge and eating behavior. Results 74% of the population was Mexican American. Nutrition knowledge was a significant predictor of eating behavior for grains (odds ratio [OR] = 6.42; 95% confidence interval [CI]: 2.4, 17.1), dairy (OR = 2.25; 95% CI: 1.5, 3.4), meats (OR = 2.02; 95% CI: 1.5, 2.8), beans (OR = 8.18; 95% CI: 5.1, 13.0), water (OR = 2.49; 95% CI: 1.7, 3.6), but not for fruits and (nonstarchy) vegetables (OR = 1.69; 95% CI: 0.89, 3.2). Conclusions and Implications Nutrition knowledge predicts eating behavior for all food groups except fruits and vegetables. The role of cultural factors in eating behavior should be investigated to elucidate this finding. Results have implications for developing nutrition education programs for Mexican Americans.

A Nigerian-specific food and nutrient coding database was developed by adding Nigerian-specific foods, recipes, measure descriptions, and gram weights to information from the US Department of Agriculture (USDA) databases used for the 1994–1996, 1998 Continuing Survey of Food Intakes by Individuals. The Nigerian database was used to analyze intakes from the 2001 Nigerian Food Consumption and Nutrition Survey. The Food Intake Analysis System (FIAS) (developed by The University of Texas School of Public Health and the USDA Agricultural Research Services Food Surveys Research Group) and food and nutrient data from the USDA databases were used to aid creation of foods and recipes specific to Nigeria. USDA data had only 214 of the basic foods reported consumed by Nigerians. Researchers developed food descriptions and nutrient profiles for another 117 foods specific to Nigerian intake. An additional 14 foods were created from ingredients in the USDA database. Complete profiles of 14 nutrients were included for every new food from food composition books and tables. A total of 422 recipes were created from the USDA and Nigerian foods using the nutrient retention factor recipe methodology and the FIAS software. Recipes were kitchen tested to obtain a weight before and after cooking, and the weight of a typical serving. It was necessary to add measure descriptions and gram weights to 359 USDA and 164 Nigerian foods. Development of this unique population-specific database of foods and recipes for this African country constitutes an important milestone for future diet and nutrition studies.

Background The Pasitos Cohort Study has followed children in El Paso, Texas and Ciudad Juarez, Mexico since 1998 to identify determinants of Helicobacter pylori infection. This paper describes patterns of acquisition and elimination of H. pylori infection in 468 children from birth to 24 months. Methods Mothers were recruited during pregnancy at maternal-child clinics; children were targeted for follow-up examinations every 6 months after birth. H. pylori infection was detected using the 13 C-urea breath test, corrected for age-dependent variation in CO 2 production. Results Test results were available for 359, 341, 269, and 215 children around target ages of 6, 12, 18, and 24 months, respectively. The person-time at risk of a first detectable infection was 7742 person-months; 128 first infections were detected, thus the incidence rate was 1.7% per month (95% confidence interval 1.4-2.0%). Rates were similar in boys and girls and on both sides of the border; evidence suggests, however, that this similarity could be due to selection bias. Among children with follow-up after a positive test, 77% tested negative at a later visit. Conclusions The initial acquisition of detectable H. pylori infection occurred at a rate of 20% per year among Pasitos Cohort children from birth to 24 months of age. A key finding, with implications for clinical, community health, and research settings, is that most of these infections did not persist. The transient nature of early H. pylori infection should be considered when designing research or contemplating therapeutic intervention for this age group.

Introduction The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on firefighter weight perceptions and weight loss behaviors among overweight and obese male firefighters. Methods A national sample of 763 overweight and obese male firefighters who recalled visiting a healthcare provider in the past 12 months reported information regarding healthcare visits, weight perceptions, current weight loss behaviors, and other covariates in 2011–2012. Analyzed in 2013, four unique multilevel logistic regression models estimated the association between healthcare professional weight loss advice and the outcomes of firefighter-reported weight perceptions, intentions to lose weight, reduced caloric intake, and increased physical activity. Results Healthcare professional weight loss advice was significantly associated with self-perception as overweight (OR=4.78, 95% CI=2.16, 10.57) and attempted weight loss (OR=2.06, 95% CI=1.25, 3.38), but not significantly associated with reduced caloric intake (OR=1.26, 95% CI=0.82, 1.95) and increased physical activity (OR=1.51, 95% CI=0.89, 2.61), after adjusting for confounders. Conclusions Healthcare professional weight loss advice appears to increase the accuracy of firefighter weight perceptions, promote weight loss attempts, and may encourage dieting and physical activity behaviors among overweight firefighters. Healthcare providers should acknowledge their ability to influence the health behaviors of overweight and obese patients and make efforts to increase the quality and frequency of weight loss recommendations for all firefighters.

Obesity is an epidemic in the United States, especially among Hispanics and African Americans. Studies of obesity and breast cancer risk have been conducted primarily in non-Hispanic whites. There have been few studies of the association between body mass index (BMI) or weight gain and the risk of breast cancer in minorities, and the results have been inconsistent. Because most studies are conducted primarily in non-Hispanic whites, the etiology of breast cancer in minorities is not well understood. The authors of the current report reviewed the literature on the association between obesity, weight, and weight gain and breast cancer in minorities using a combination of the Medical Subject Heading (MeSH) terms "obesity," "body mass index," "weight," "weight gain," "Hispanic," and "African American." Only publications in English and with both risk estimates and 95% confidence intervals were considered. Forty-five studies of body size and breast cancer risk in non-Hispanic whites were identified. After an exhaustive search of the literature, only 3 studies of body size and breast cancer were conducted in Hispanic women were identified, and only 8 such studies in African American women were identified. The results were inconsistent in both race/ethnicity groups, with studies reporting positive, inverse, and null results. Thus, as obesity rates among Hispanics and African Americans continue to rise, there is an urgent need to identify the roles that both obesity and adult weight gain play in the development of breast cancer in these minorities. Additional studies are needed to provide more understanding of the etiology of this disease and to explain some of the disparities in incidence and mortality.

Although national and state estimates of child obesity are available, data at these levels are insufficient to monitor effects of local obesity prevention initiatives. The purpose of this study was to examine regional changes in the prevalence of obesity due to statewide policies and programs among children in grades 4, 8, and 11 in Texas Health Services Regions (HSRs) between 2000-2002 and 2004-2005, and nine selected counties in 2004-2005. A cross-sectional, probability-based sample of 23,190 Texas students in grades 4, 8, and 11 were weighed and measured to obtain BMI. Obesity was >95th percentile for BMI by age/sex using Centers for Disease Control and Prevention growth charts. Child obesity prevalence significantly decreased between 2000-2002 and 2004-2005 for 4th grade students in the El Paso HSR (-7.0%, P = 0.005). A leveling off in the prevalence of obesity was noted for all other regions for grades 4, 8, and 11. County-level data supported the statistically significant decreases noted in the El Paso region. The reduction of child obesity levels observed in the El Paso area is one of the few examples of effective programs and policies based on a population-wide survey: in this region, a local foundation funded extensive regional implementation of community programs for obesity prevention, including an evidence-based elementary school-based health promotion program, adult nutrition and physical activity programs, and a radio and television advertising campaign. Results emphasize the need for sustained school, community, and policy efforts, and that these efforts can result in decreases in child obesity at the population level.

Obesity has been implicated as a risk factor for pancreatic cancer.To demonstrate the association of excess body weight across an age cohort and the risk, age of onset, and overall survival of patients with pancreatic cancer.A case-control study of 841 patients with pancreatic adenocarcinoma and 754 healthy individuals frequency matched by age, race, and sex. The study was conducted at a university cancer center in the United States from 2004 to 2008. Height and body weight histories were collected by personal interview starting at ages 14 to 19 years and over 10-year intervals progressing to the year prior to recruitment in the study.The associations between patients' body mass index (BMI) and risk of pancreatic cancer, age at onset, and overall survival were examined by unconditional logistic regression, linear regression, and Cox proportional hazard regression models, respectively.Individuals who were overweight (a BMI of 25-29.9) from the ages of 14 to 39 years (highest odds ratio [OR], 1.67; 95% confidence interval [CI], 1.20-2.34) or obese (a BMIor = 30) from the ages of 20 to 49 years (highest OR, 2.58; 95% CI, 1.70-3.90) had an associated increased risk of pancreatic cancer, independent of diabetes status. The association was stronger in men (adjusted OR, 1.80; 95% CI, 1.45-2.23) by mean BMI from the ages of 14 to 59 years than in women (adjusted OR, 1.32; 95% CI, 1.02-1.70) and in ever smokers (adjusted OR, 1.75; 95% CI, 1.37-2.22) than in never smokers (adjusted OR, 1.46; 95% CI, 1.16-1.84). The population-attributable risk percentage of pancreatic cancer based on the mean BMI from the ages of 14 to 59 years was 10.3% for never smokers and 21.3% for ever smokers. Individuals who were overweight or obese from the ages of 20 to 49 years had an earlier onset of pancreatic cancer by 2 to 6 years (median age of onset was 64 years for patients with normal weight, 61 years for overweight patients [P = .02], and 59 years for obese patients [P.001]). Compared with those with normal body weight and after adjusting for all clinical factors, individuals who were overweight or obese from the ages of 30 to 79 years or in the year prior to recruitment had reduced overall survival of pancreatic cancer regardless of disease stage and tumor resection status (overweight patients: hazard ratio, 1.26 [95% CI, 0.94-1.69], P = .04; obese patients: hazard ratio, 1.86 [95% CI, 1.35-2.56], P.001).Overweight or obesity during early adulthood was associated with a greater risk of pancreatic cancer and a younger age of disease onset. Obesity at an older age was associated with a lower overall survival in patients with pancreatic cancer.

Calcium intake has been associated with promoting bone health in children and adolescents, thus, preventing osteoporosis later in life. Behavior change such as increased calcium intake, as well as physiological factors such as bone quality, may be facilitated by psychosocial and environmental factors. The purpose of this study was to identify pathways by which psychosocial factors influence calcium intake and bone quality in middle-school girls. The study design was cross-sectional. Baseline data from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study, collected in 2001–2003, were utilized. IMPACT, was a 1 ½ years nutrition and physical activity intervention study, designed to improve bone density in 717 middle-school girls in Texas. Main outcome measures were: 1) calcium intake determined using mean milligrams of calcium consumed per day and number of glasses of milk consumed per day, and 2) bone quality determined using calcaneal stiffness index. Confirmatory factor analysis and path analysis were performed to identify the direct and indirect pathways used by various psychosocial factors such as knowledge, self-efficacy, outcome expectations and milk availability at home, to influence calcium intake and bone quality. Results showed that knowledge of osteoporosis and calcium rich foods had an indirect effect on calcium intake, with outcome expectations as the mediating variable (β=0.035 and β=0.03 respectively, p < 0.05). Calcium self-efficacy had a significant indirect effect on calcium intake, with outcome expectations as the mediator (β=0.085, p < 0.05). None of the variables significantly influenced bone quality. Thus, several direct and indirect pathways used to influence calcium intake among adolescent girls, were identified. These findings are critical for the development of effective interventions to promote calcium intake in this population.

The purpose of this study was to identify the psychosocial, environmental and behavioral factors associated with calcium intake, physical activity and bone health in a cohort of adolescent girls. Baseline data (N = 718 girls, mean age: 11.6 +/-0.4 years) from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study conducted in Texas, 2001-03, were utilized for the analyses. Hierarchical linear regression was used to examine the associations of interest. Confounders adjusted for included ethnicity, menarchal status, body mass index and lactose intolerance. Several psychosocial and behavioral factors were significantly associated with bone quality. These included knowledge of calcium content of foods (beta = 0.08, P = 0.016), self-efficacy toward consuming calcium-rich foods (beta = 0.16, P = 0.047), physical activity self-efficacy (beta = 0.20, P = 0.002), physical activity outcome expectations (beta = 0.5, P = 0.004), family encouragement to do physical activity (beta = 0.96, P = 0.027), friend engagement in physical activity (beta = 1.3, P = 0.001) and participation in sports teams (beta = 1.7, P0.001). Self-efficacy, social support and participation in sports teams appear to be strongly associated with bone health in adolescent girls. Future health education/health promotion programs need to address these factors for effective primary prevention of osteoporosis in this population.

The purpose of this study was to predict calcaneal QUS measurements in healthy adolescent females as a function of anthropometric measures, pubertal stage and menarchal status.This was a secondary data analysis from a 2-year intervention designed to increase bone accretion. Simple Pearson correlation and Spearman's rank correlation analyses, followed by linear stepwise regression analyses were conducted.12 middle schools.672 female students, baseline; 587 students at 18 months.Calcaneal stiffness index (SI) by quantitative ultrasound.Eighty percent of the subjects were premenarchal at baseline; 33% at 18 months. Although SI correlated with self-assessed pubic hair (rho = .21) and menarchal status (rho = .23, p.01 for both) at baseline, the model for predicting SI included menarchal status, not pubic hair, and calf circumference, controlling for BMI (R(2) = .22, p.01). At 18 months, SI correlated with self-assessed pubic hair (rho = .21) and menarchal status (rho = .25, p.01 for both). The best model to predict SI included calf circumference and pubic hair stage (R(2) = .14, p.01), and not menarchal status as 67% of the subjects at 18 months were postmenarchal.In research assessing calcaneal SI in groups of adolescents, assessment of pubertal stage could be replaced with menarchal status and calf circumference when the majority of subjects are premenarchal. When the majority is postmenarchal, pubic hair stage and calf circumference together may be used to assess for pubertal maturation without menstrual status.

Objective To determine the correlation between fruit/vegetable and bean stage of change and heritage retention with fiber intake in Hispanic mothers. Design Cross-sectional study design used baseline survey data from the Que Sabrosa Vida nutrition intervention developed by the University of Texas School of Public Health, Human Nutrition Center (Houston, TX). Participants were recruited and data gathered from telephone surveys using random digit dial methodology ensuring proportional representation of demographic subgroups. Subjects Hispanic mothers (N=293) responded to the baseline survey in El Paso, TX. Analyses Using SPSS version 11.0 (SPSS Inc, Chicago, IL), descriptive statistics, χ 2 , correlations, and analyses of variance were used to determine the relationship of variables to fiber intake. Potential confounding variables included were grain stage of change, age, education level, and marital status. Results Mean fiber intake for mothers was 21.9 g/day and mean age was 35.8 years. χ 2 of fruit/vegetable stage was P =.784. χ 2 of bean stage, heritage retention score, age, and education to fiber intake were significant, P =.008, P =.004, P =.005, and P =.001, respectively. Bean stage, heritage retention score, age, and education level were significantly correlated. One-way analysis of variance of bean stage, heritage retention score, age, and education level by fiber intake were significant, P =.006, P =.001, P =.004, and P =.002, respectively. Conclusions Older Hispanic mothers in the action/maintenance bean stage with strong heritage retention score had greater fiber intakes than younger mothers in pre-action bean stage with weak heritage retention score. As education level increased fiber intake decreased. Encouragement of bean consumption and heritage retention may increase fiber intake in this Hispanic mother population.

Rates of Helicobacter pylori infection are traditionally higher in developing countries than in developed countries, but the specific reasons for these differences are not fully clear. While chronic diseases resulting from H. pylori are generally of adult onset, chronic infection usually begins in childhood. In this cross-sectional study (1998-2000), the authors compared prevalences of H. pylori infection among children under age 6 years on both sides of the Rio Grande. Participants included 264 children of women from low-income families who were receiving services at health clinics in Juarez, Mexico, or El Paso, Texas, from April 1998 through October 2000. Data were collected through personal interviews and serologic testing for H. pylori antibodies. The crude odds ratio for H. pylori prevalence among Mexican children as compared with US children was 3.94 (95% confidence interval: 1.72, 9.06). After adjustment for covariates, the odds ratio decreased to 1.70 (95% confidence interval: 0.64, 4.52). The adjustments that produced the greatest reduction in the odds ratio for location were those for household crowding and maternal education. This study identified specific factors that may explain geographic variation in H. pylori prevalence among children.

Objective To evaluate the reproducibility and validity of the School-Based Nutrition Monitoring (SBNM) secondary level student questionnaire. Design Reproducibility was evaluated using a test-retest study design by administering the questionnaire on the same day (morning and afternoon, n=254) and, when appropriate, 9 to 14 days apart (n=259). Validity was assessed by comparing foods selected on the questionnaire with foods reported from a single 24-hour recall covering the same referent period (yesterday) in 209 students. Subjects/setting Eighth grade students in middle schools from central Texas were used: male and female, approximately 75% white, for the reproducibility study, with 15% Hispanic, 6% African American; for the validation study, approximately 38% white, 41% Hispanic, and 17% African American. Statistical analysis Spearman rank order correlation, κ statistic, and percentage agreement were used for both reproducibility and the validation. Results For the reproducibility study, agreement for questions about food intake ″yesterday" were 70% to 98%, with κ statistics ranging from 0.54 to 0.93 and correlations between 0.66 and 0.97. Questions on recent physical activity had high agreement (66% to 89%) as did ″usual" physical activity items, weight loss, and food selection behaviors. Nutrition knowledge items showed relatively weaker reliability: agreements ranged from 47% to 92%, with κ statistics between 0.30 and 0.56. Attitude questions had weaker agreement (50% to 87%), κ statistics (0.27 to 0.52), and correlations (0.33 to 0.63). For the validation study, correlation coefficients ranged from 0.32 for breads to 0.68 for milk and beans. Percentage agreement ranged from 38% for breads to 89% for gravy. Applications/conclusions Most questions on the SBNM secondary questionnaire were found to have acceptable reproducibility, whereas validation of food choice behaviors showed results similar to or better than other dietary assessment instruments for this age group. This questionnaire is a useful epidemiologic tool for surveillance, assessing broad intervention effects among groups or providing needs assessment data on selected nutrition and physical activity-related constructs. J Am Diet Assoc. 2003;103:186-194.

Background: Obesity is an epidemic in the United States, and nearly one-third of American adults over the age of 20 are considered obese. Studies of obesity and breast cancer risk have been conducted primarily in non-Hispanic whites. While obesity decreases the risk of premenopausal breast cancer, it is positively associated with risk of postmenopausal disease. Studies also suggest that a change in weight leading to adult obesity increases the risk of postmenopausal breast cancer. There have been few studies of body mass index (BMI) or weight gain and risk of breast cancer in minorities, and the results have been inconsistent. The effect of obesity on breast cancer risk in Hispanic women is of great public health significance. Hispanics are the fastest-growing minority in the United States, and obesity rates among Hispanic women are high and continuing to rise. Hispanics have a lower incidence but higher mortality rate of breast cancer than non-Hispanic whites. Elucidating the role of obesity in breast cancer development in Hispanic women will provide more understanding of the etiology of this disease and perhaps explain some of the disparities in incidence and mortality. We hypothesized that in a study of Mexican-American women obesity would decrease the risk of premenopausal breast cancer but increase the risk in postmenopausal women. Further, we hypothesized that weight gain would increase the risk of breast cancer. Methods: Using two ongoing cohort studies of Mexican-American women, we identified 155 women with incident breast cancer and 333 age-matched, healthy controls. In-person interviews were conducted on all study subjects, and medical records were abstracted for the cases to verify all cancer-related data. Self-reported weights at ages 15, 30, and at diagnosis (or at baseline for age-matched controls) were collected, and weight gain from age 15 to diagnosis/baseline was calculated. Logistic regression was used to calculate odds ratios. Exploratory analyses of effect measure modification by both menopausal status and hormone replacement therapy (HRT) use were conducted. Results: There were no significant associations between BMI at any of the time points and breast cancer in Mexican-American women, regardless of menopausal status. However, there was a 7% reduction in the risk of breast cancer for every 5 kg of weight gained from age 15 to diagnosis/baseline (OR=0.93, 95% CI: 0.87-1.00). These results did not vary by menopausal status, but there was a non-significant decrease in risk in never-HRT users (OR=0.89, 95% CI: 0.78-1.01) and no association in ever-HRT users. Conclusions: Obesity at three time points across the lifetime was not associated with breast cancer risk in Mexican-American women, while adult weight gain reduced the risk independently of menopausal status. These results are contradictory of those in non-Hispanic white women and suggest that the etiology of breast cancer may differ by race/ethnicity. Our study sample was small, but we intend to validate the results with a larger sample size. Research supported by Grant KG0901010, Susan G. Komen Breast Cancer Foundation, “A Transdisciplinary Training Program for Public Health Researchers and Practitioners Wanting to Impact Breast Cancer Disparities.” Citation Information: Cancer Prev Res 2010;3(12 Suppl):A77.

Lipoxygenases (LOXs) are key enzymes for the oxidative metabolism of polyunsaturated fatty acids into products that influence cell signaling, structure, and metabolism. Previous data on comparative levels of various LOX products in human tumorigenesis are limited primarily to retrospectively collected surgical samples from cancer patients. Therefore, we examined LOX product profiles by liquid chromatography/tandem mass spectrometry in the major steps of colorectal tumorigenesis (normal, polyp, and cancer) in a clinical study of 125 subjects (49 with a normal colon, 36 with colorectal polyps, and 40 with colorectal cancer) who underwent prospective colorectal biopsies to control for various potential confounding factors (e.g. diet, medications). Mean 13-hydroxyoctadecadienoic acid (13-HODE) levels were significantly higher in normal colons (mean = 36.11 ng/mg protein, 95% confidence interval [CI]: 31.56-40.67) than in paired colorectal cancer mucosa (mean = 27.01 ng/mg protein, 95% CI: 22.00-32.02; P = 0.0002) and in normal colons (mean = 37.15 ng/mg protein, 95% CI: 31.95-42.34) than in paired colorectal polyp mucosa (mean = 28.07 ng/mg protein, 95% CI: 23.66-32.48; P < 0.001). Mean 13-HODE levels, however, were similar between the left (mean = 37.15 ng/mg protein, 95% CI: 31.95-42.35) and right normal colons (mean = 32.46 ng/mg protein, 95% CI: 27.95-36.98; P = 0.09). No significant differences with regard to 12-hydroxyeicosatetraenoic acid (12-HETE), 15-HETE, or leukotriene B4 (LTB4) levels were detected between normal, polyp and cancer mucosa. Downregulation of 15-LOX-1 expression, the rate limiting enzyme for 13-HODE production, in human colorectal neoplastic mucosa was confirmed by quantitative real time PCR in a subset colorectal cancer patients for whom samples with adequate RNA quality were available. This study establishes that reduced 13-HODE levels are a specific alteration in the LOX product profile associated with human colorectal tumorigenesis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2897.

Background Firefighters suffer from high prevalence of obesity, substandard fitness, and cardiovascular-related deaths. There have been a limited number of firefighter health promotion programs that have been developed and empirically-tested for this important occupational group. We evaluated the health of firefighters from departments with well-developed health promotion programs and compared them with those from departments not having such programs using a large national sample of career fire departments that varied in size and mission. We measured a broad array of important individual firefighter health outcomes (e.g., body composition, physical activity, and general and behavioral health) consistent with national fire service goals and addressed significant statistical limitations unaccounted for in previous studies. Methods Using the approach of purposive sampling of heterogeneous instances, we selected and conducted a national evaluation of 10 departments already implementing wellness and fitness programs (Wellness Approach; WA) with 10 departments that did not (Standard). Participants were 1,002 male firefighters (WA n = 522; Standard n = 480) who underwent assessments including body composition, fitness, and general/behavioral health (e.g., injury, depressive symptoms). Results Firefighters in WA departments were healthier than their Standard department counterparts. For example, they were less likely to be obese (adjusted [A]OR = 0.58; 95% CI = 0.41-0.82), more likely to meet endurance capacity standards for firefighting (AOR = 5.19; 95% CI = 2.49-10.83) and have higher estimated VO2max (40.7 ± 0.6 vs. 37.5 ± 1.3 for firefighters in Standard departments; p = 0.001). In addition, WA firefighter were substantially less likely to smoke (AOR = 0.30; 95% CI = 0.17-0.54) or ever have been diagnosed with an anxiety disorder (AOR = 0.27; 95% CI = 0.14-0.52) and they expressed higher job satisfaction across several domains. However, WA firefighters were somewhat more likely to have reported an injury to Workers’ Compensation (AOR = 1.74; 95% CI = 1.05-2.90). It was notable that both groups evidenced high prevalence of smokeless tobacco use and binge drinking. Conclusions Firefighters in departments selected based on having strong wellness programs (WA) were healthier along a number of dimensions important to firefighter wellness and operational readiness. However, several health areas require greater attention including problematic alcohol consumption and smokeless tobacco use, suggesting that more emphasis on these behavioral health issues is needed in the fire service.