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Objectives: The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program. Methods: 1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted χ2 tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics. Results: Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to “know-how”—that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes. Conclusions: This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency.

Objective: In 1989, a validation study of eight nutrients was performed on a modified food frequency questionnaire (FFQ) specifically designed for low-income pregnant women. The purpose of this study was to broaden the scope of the previous study by assessing the validity of the FFQ for 17 additional nutrients. Methods: The Pregnancy Food Frequency Questionnaire (PFFQ) was administered to a sample of 295 low-income, pregnant women aged 14–43 years living in Massachusetts. A randomly selected subsample of 101 women who provided at least one diet recall and reported intake of less than 4,500 calories were included in this analysis. Results: Mean intake of 25 nutrients as assessed by one administration of the PFFQ and up to three diet recalls collected over 1 month were similar. Unadjusted correlation coefficients between nutrient intake measured by diet recalls and the questionnaire ranged from .28 (carotene) to .61 (folate). After adjusting for energy intake the correlations ranged from .03 (B12) to .46 (folate). The correlations corrected for day-to-day variation were higher, ranging from .07 (B12) to .90 (zinc). The mean correlation was .47 and there were 54% over .40. Conclusions: A food frequency questionnaire for English-speaking, low-income, pregnant women can provide maternal and child health practitioners and researchers a valid estimate of diet across a wide range of nutrients.

Objective: To assess the validity of the Harvard Service Food Frequency Questionnaire (HFFQ) in the diet assessment of Native American and Caucasian children 1 to 5 years of age participating in the North Dakota WIC program. Methods: The 84-item HFFQ was administered twice to the parent or guardian of 131 Native American and 102 Caucasian children ages 1 to 5 years (total n = 233), first at the child's routine WIC visit and then following the completion of three 24-hr dietary recalls taken over approximately 1 month. Average nutrient intakes from the three 24-hr dietary recalls were compared to average nutrient intakes from the HFFQs by calculating Pearson correlation coefficients and adjusting for energy intake and within person variation. Results: Correlation coefficients ranged from 0.26 for dietary fiber to 0.63 for magnesium. The average correlation was 0.52, similar to that found in validation studies among adolescents and adults. The following nutrients had correlations of 0.50 or greater: carbohydrate, sucrose, total fat, vitamin C, vitamin E, vitamin Bl, vitamin B2, niacin, folate, vitamin B6, calcium, magnesium, and iron. Conclusions: The HFFQ is a simple self-administered questionnaire completed by the child's parent or guardian and is useful in assessing the diets of Native American and Caucasian children. It may also provide important nutritional information about this age group for future program planning, research, education, and intervention purposes.

Background Food frequency questionnaires (FFQs) have been validated in pregnant women, but few studies have focused specifically on low-income women and minorities. The purpose of this study was to examine the validity of the Harvard Service FFQ (HSFFQ) among low-income American Indian and Caucasian pregnant women. Methods The 100-item HSFFQ was administered three times to a sample of pregnant women, and two sets of 24-hour recalls (six total) were collected at approximately 12 and 28 weeks of gestation. The sample included a total of 283 pregnant women who completed Phase 1 of the study and 246 women who completed Phase 2 of the study. Deattenuated Pearson correlation coefficients were used to compare intakes of 24 nutrients estimated from the second and third FFQ to average intakes estimated from the week-12 and week-28 sets of diet recalls. Results Deattenuated correlations ranged from 0.09 (polyunsaturated fat) to 0.67 (calcium) for Phase 1 and from 0.27 (sucrose) to 0.63 (total fat) for Phase 2. Average deattenuated correlations for the two phases were 0.48 and 0.47, similar to those reported among other groups of pregnant women. Conclusion The HSFFQ is a simple self-administered questionnaire that is useful in classifying low-income American Indian and Caucasian women according to relative dietary intake during pregnancy. Its use as a research tool in this population may provide important information about associations of nutrient intakes with pregnancy outcomes and may help to identify groups of women who would benefit most from nutritional interventions.

In this retrospective cohort study, we assessed the risk that in addresses where children had been lead poisoned (blood lead level ≥25 µg/dL) in the past, at least 1 subsequently resident child would have a blood lead level of 10 µg/dL or greater. The study was conducted in adjacent areas in 2 states in the northeastern United States. Enforcement of lead poisoning prevention statutes differed between the states during the 5-year study period (1993‐1998). In one state, where such statutes were strictly enforced, addresses where lead-poisoned children lived were subject to enforcement, including criminal and civil penalties against property owners who failed to abate lead hazards. Inspectors reported dangerous levels of lead to the owner, to all tenants at the address, and to the state lead poisoning prevention program. Tenants living in units other than the one inspected were informed of the process for obtaining an inspection of their units. In the other state, with limited enforcement of lead poisoning prevention statutes, inspection was limited to the unit where the poisoned child lived and seldom resulted in lead hazard abatement. Criminal and civil sanctions were not initiated against property owners, and tenants were not notified of the presence of lead hazards.

This ecological study examines the variations in diarrhoea-specific infant mortality rates among municipalities in the State of Ceará, north-east Brazil, using data from a community health workers’ programme. Diarrhoea is the main cause of postneonatal deaths in Ceará, and diarrhoea mortality rates vary substantially among municipalities, from 7 to 50 per thousand live births. To determine the inter-relationships between potential predictors of diarrhoea-specific infant mortality, eleven variables were classified into proximate determinants (i.e. adequate weight gain and exclusive breast-feeding in first 4 months) and underlying determinants (i.e. health services and socioeconomic variables). The health services variables included percentage with prenatal care up-to-date, participation in growth monitoring and immunization up-to-date, while the socioeconomic factors included female illiteracy rate, per capita gross municipality product and percentage of households with low income, percentage of households with inadequate water supply and inadequate sanitation, and urbanization. Using linear regression analysis variables were included from each group to build regression models. The significant determinants of variability in diarrhoea-specific infant mortality between municipalities were prevalence of infants exclusively breast-feeding, percentage of infants with adequate weight gain, percentage of pregnant women with prenatal care up-to-date, female illiteracy rate and inadequate water supply. These findings suggest that community-based promotion of exclusive breast-feeding in the first 4 months and care-giving behaviours that prevent weight faltering, including weaning practices and feeding during and following diarrhoea episodes, may further reduce municipality-level diarrhoea-specific mortality. Primary heath care strategies addressing these two proximate determinants provide only a partial solution to reducing diarrhoeal disease mortality. Improvements in municipal health services (prenatal care) and socioeconomic status variables, including water supply and maternal education, can also contribute to reduction of infant mortality due to diarrhoea. These results may be used by government health officials to set priorities by considering not only the strength of the association between selected risk factors and diarrhoea mortality rates, but also the prevalence of the risk factors being considered at the municipality level. Finally, the methods used are applicable to other settings with community-based primary health care decentralized to the state or municipal level.

Objective: Obesity is an established risk factor for higher systolic (SBP) and diastolic (DBP) blood pressure in adolescence and early adulthood, but birth size may also have a role. We analyzed the effects of adolescent and adult obesity and birth size on BP in the young adult. Research Methods and Procedures: In a prospective longitudinal study, anthropometric measurements were obtained at birth on 67 boys and 67 girls bom in Boston. Their body mass indices (BMI) and BP were recorded 17 years and 30 years later. Results: For women, adolescent and early adult obesity appeared to be the stronger determinants of higher BP, although smaller head and chest circumferences at birth may also be related. We found some evidence of birth (ponderal index [PI] and head circumference) anthropometric influences on age 17 BP levels in boys. By age 30, body mass variables were the dominant predictors of male BP levels. Female BMI at age 17 was positively correlated with birth adiposity (PI), but BMI at 30 was related only to age 17 BMI. Similarly, male BMI at 17 years was higher for those who weighed more at birth, but BMI at 30 years was again related only to age 17 BMI. Discussion: We conclude that adult weight and weight gain are the major determinants of adult BP.

An approach is illustrated for the analysis of longitudinal variables collected during adolescence. Since the method requires complete data, three techniques are compared for application when some individuals have missing values. These methods are implemented in a study of systolic blood pressures and dietary fat intakes collected longitudinally in adolescent girls. The value of adolescent systolic and fat variables in predicting systolic pressure in adult women is investigated.

The validity of long-term recall and current assessments of height, weight, and fatness relative to peers was investigated among 91 middle-aged participants in a longitudinal growth study. The recollections of 50-year-old participants concerning perceived body size in comparison to peers during childhood (aged 5-7 years), adolescence (aged 10-18 years), and at ages 30, and 40 years were compared with physical measurements taken at these times. Correlations between perceived and actual body size at all ages from childhood through middle-age were moderate but significant (P less than 0.005) and were influenced by gender and phases of physical growth (early and late adolescence). In general, accuracy of self-reports of current body size were not significantly better than recalls of body size up to 50 years earlier. Respondents' recall of various physiological events was also assessed. Females' actual and recalled year of menarche were correlated (r = 0.67; P less than 0.0001). Age at menarche was recalled within 1 year of the actual event by 84% of the females. Fifty percent of both sexes recalled their year of maximal growth in height within 1 year and recalled the timing of their maturation (early, average, or late) in relationship to their peers equally well (P less than 0.001).

The gynaecological index (GYNDEX) was developed to facilitate observing differences in gynaecological health among and between groups of women. It takes into account menstrual characteristics, premenstrual changes, and gynaecological diagnoses and treatments. The objective of this study is to contribute to knowledge of the changes in gynaecological health at different times in the reproductive life cycles of women and to develop a measurement technique which can be used in future studies in women's health. In this investigation a GYNDEX is determined for each of the first three decades postmenarche in a sample of 54 women who have been followed in a longitudinal study since birth, and the characteristics of the changes in the GYNDEX over time are analysed. There is a significant increase in the GYNDEX (P less than 0.05) in each successive decade. Further studies are being done to determine to what extent factors that occurred in the childhood and adolescence act as predictors of adult gynaecological health. Knowledge of these relationships will provide a rationale for planning health care programmes for women of all ages.

Concern is growing about the adequacy and safety of health services provided for medically complex children in public schools. A national survey of state health and education agencies was conducted to learn if guidelines existed governing the practice of eight selected nursing procedures in schools. Thirteen states (26%) had no written guidelines, 13 states (26%) had guidelines only for medication administration, and only six states (12%) had guidelines for the eight selected nursing procedures.

Ina sample of 54 women who have participated in a longitudinal study since birth there is a significant relationship between adolescent menstrual characteristics and gynaecological health as measured by GYNDEX (Gardner 1982) in the second and third decades postmenarche. The menstrual characteristics were recorded in health histories taken in the 1940s as part of a yearly evaluation of growth, development and health status. Using stepwise multiple regression analysis, the measures of regularity and dysmenorrhoea in adolescence explain 46% of the variation in GYNDEX from 11 to 20 years postmenarche (P less than 0.001). These variables are still significant predictors 21 to 30 years postmenarche, explaining 26% of the variance (P less than 0.005). The risk of having poor gynaecological health (high GYNDEX) is greatly increased for women experiencing both dysmenorrhoea and irregularity in the first few years postmenarche.

Validity of recalled cigarette data was assessed among 87 middle-aged adults by comparing recall to longitudinal records. Agreement on smoking status and amount smoked 20 years ago occurred for 87 per cent and 71 per cent of subjects, respectively. Corresponding proportions for 32-year recall were 84 per cent and 55 per cent. Gender did not influence recall accuracy. Ex-smokers tended to make the most errors. Accuracy of recalled smoking information 20 years ago was comparable to that of alcohol status and consumption frequency category.