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PURPOSE: To begin to explore the possible roles of childhood diet and growth in prostate cancer (PCa) development, we investigated these exposures in relation to two known/suspected PCa risk factors, earlier pubertal timing and greater attained height, in the Longitudinal Studies of Child Health and Development. METHODS: We used biannual/annual height, weight, and dietary history data to investigate childhood diet, body mass index (BMI), birth length, and childhood height in relation to PCa risk factors (age at peak height velocity (APHV), height at age 13, and adult height) for 64 Caucasian-American boys. RESULTS: In adjusted models, childhood fat and animal protein intake was positively associated with height at age 13 and adult height (P

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.

Promotion of oral rehydration therapy (ORT) for the treatment of diarrheal diseases and the WHO case management strategy for acute respiratory infections (ARI) have contributed to significant reductions in infant mortality, but these two conditions remain the leading causes of infant deaths in most developing countries. Identification of the factors contributing to these deaths may contribute to reduce infant mortality from preventable causes. To gain insight into the circumstances and maternal and health services factors that may contribute to infant deaths we used a verbal autopsy method to interview mothers of all infants who died during the previous 12 months (June 1995-May 1996) in 11 municipalities in the State of Ceara, Northeast Brazil. Our results revealed that one-third of the deaths occurred in a hospital and two-thirds at home. Almost all the infants who died at home, however, had been examined one or more times by a doctor, and 36% of them had been hospitalized during the disease episode that resulted in death. For most (85%) of these children the causes of death were diarrhea or acute respiratory infection, and it is likely that death could have been averted if appropriate treatment had been initiated promptly. Three major groups of factors that alone or in combination appeared to contribute to most deaths were delays in seeking medical care on behalf of the parents, medical interventions reported as ineffective by mothers and delays in providing medical care to children who arrived at the hospital too late in the day to be scheduled for consultation. Our findings suggest that government efforts to further reduce infant mortality in Ceara should focus on health education interventions that address quality of home care, recognition of signs of severity and danger and importance of seeking timely medical care: and on improving the quality of care provided at community health centers and hospitals. Measures likely to improve infants' chance of survival include: ensuring prompt access to medical consultation for young children brought to health centers or hospitals with potentially life-threatening symptoms related to infections, health education to mothers on the need for continued home care after discharge and to return to the medical care facility if the child does not recover, and that they have access to medicine prescribed by hospital physicians. Further benefits could be obtained by using community health workers, now integrated into the Family Medicine Program (PSF) health teams, to provide health education, supervise home care, refer mothers to health centers and facilitate their access to hospitals.

BACKGROUND Breast carcinoma risk may be modified by early life factors, including physical growth and development, diet, and life-style factors of preadolescence and adolescence, as well as genetic factors. METHODS The authors tested their hypothesis that adolescent growth and development are related to breast carcinoma incidence by evaluating 65,140 women who participated in the Nurses' Health Study. During 16 years of follow-up, 806 women were diagnosed with breast carcinoma prior to menopause, and another 1485 were diagnosed after menopause. Because adolescent growth was not directly observed in this cohort, the peak height growth velocity for each participant was estimated by using a model from another longitudinal study. Finally, Cox proportional hazards regression models were used to study associations between breast carcinoma incidence and adolescent factors in the Nurses' Health Study. RESULTS Later menarche (relative risk [RR] = 0.52 for ≥15 vs. ≤11 years) and more body fatness at age 10 years (RR = 0.60 for fattest vs. leanest) were associated with a decreased risk of premenopausal breast carcinoma. The risk of postmenopausal breast carcinoma was lower for girls with later menarche (RR = 0.80), more body fat at age 10 years (RR = 0.72), and shorter adult height (RR = 1.29 for ≥67 vs. ≤62 inches). Higher peak height growth velocity, derived from these 3 variables, was associated with increased risk of both premenopausal (RR = 1.31 for highest vs. lowest quintile) and postmenopausal (RR = 1.40) breast carcinoma. These analyses controlled for birth cohort, other possible risk factors from the adolescent period, and family history. These associations persisted after controlling for age at the birth of a first child, parity, adult adiposity, and age at menopause. Post-hoc analyses suggested that, although childhood body fatness was associated with lower risk, increasing body fatness between ages 10 and 20 years was not protective against either premenopausal or postmenopausal breast carcinoma. CONCLUSIONS Earlier menarche, extremely lean body mass at age 10 years, and taller adult height were predictive of elevated breast carcinoma risk. The same three factors were also predictive of higher peak growth velocities during adolescence, lending credence to the hypothesis that more rapid adolescent growth may increase the risk of breast carcinoma development. Cancer 1999;85:2400–9. © 1999 American Cancer Society.

Background Infant mortality rates vary substantially among municipalities in the State of Ceara, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. Methods Ecological study across 140 municipalities in the State of Ceara, Brazil. Results To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R 2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R 2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R 2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. Conclusions These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceara.

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.

Purpose: With the patient standing and supine we determine the differences in dynamic changes of the bladder neck and directions of dynamic bladder neck displacement.Materials and Methods: To evaluate the dynamic movement of the bladder neck we recruited into the study 78 consecutive women 27 to 69 years old with various urogynecological complaints. The anatomical changes of the bladder neck from rest to maximal straining and from rest to holding were evaluated and compared with the patients supine and standing.Results: Except for bladder neck rotational angle with the patient standing, all parameters were significantly different from corresponding measurements with the patient supine. Mean rotational angle of rest to maximal straining plus or minus standard deviation was 39.4 +/− 18.9 degrees when standing versus 39.8 +/− 23.4 degrees when supine (p >0.05). The distances between the bladder neck and symphysis pubis at rest, and during maximal straining and holding the bladder neck in the supine p...

This study reports on diet quality and variety in food selection among a culturally diverse group of 335 low-income pregnant Massachusetts women. The Index for Nutritional Quality (INQ), which is the observed nutrient density divided by the recommended nutrient density, was estimated for seven nutrients from data reported on food frequency questionnaires and diet recalls. Mean INQs for protein and vitamin C were above the recommended level of 1.0, whereas INQ for iron was 0.6 or less. Mean INQ for calcium was 1.2 for whites and between 0.9 and 1.0 for non-whites. When comparisons were made among ethnic groups by site of prenatal care, significant differences in INQ were found for all nutrients except iron and vitamin B-6. WIC participants had higher diet quality for protein, calcium, iron, and vitamin B-6 than did non-participants. Employed women had higher protein and zinc INQs than did unemployed women, and non-smokers had higher iron and vitamin B-6 INQs than did smokers. Variety was not significantly correlated with diet quality but differed (p

Among a culturally diverse group of 344 low-income pregnant women, self-reported rates of supplement use prior to confirmation of pregnancy were much lower than those reported for young women in national surveys (16% vs. up to 40%, respectively). Prenatal vitamins, prescribed routinely for all patients, were reportedly taken at least four times a week by 86% of the subjects and two to three times a day by 5%. About 5% of the sample reported consuming highly fortified cereal at least once daily. There is a possibility of higher than recommended use of supplemental vitamins among these women resulting from misunderstanding of the number of pills to be taken and/or high consumption of highly fortified cereals.

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.

Adolescent growth and development may be affected by factors such as dietary intake and body size from much earlier in childhood. In a longitudinal study of 67 Caucasian girls in Boston, Massachusetts, data were collected prospectively from birth during the 1930s and 1940s. Heights and weights were measured semiannually, and dietary history interviews were conducted with mothers. Stepwise linear regression methods were used to seek factors which best predicted age at menarche, adolescent peak height growth velocity, and the age at which peak growth velocity occurred. Girls who consumed more (energy-adjusted) animal protein and less vegetable protein at ages 3-5 years had earlier menarche, and girls aged 1-2 years with higher dietary fat intakes and girls aged 6-8 years with higher animal protein intakes became adolescents with earlier peak growth. Controlling for body size, girls who consumed more calories and animal protein 2 years before peak growth had higher peak growth velocity. These findings may have implications regarding adult diseases whose risks are associated with adolescent growth and development factors.

Objectives. To evaluate the association of negative stressful life events experienced over 12 months and the risk of moderate to severe immune suppression among children and youth infected with human immunodeficiency virus type 1 (HIV-1). Methods. Longitudinal study of 618 HIV-1-infected children, baseline ages 1 to 20 years (mean age: 6.4 years), who completed 52 weeks of participation in the Pediatric Late Outcomes Study (Pediatric AIDS Clinical Trials Group Protocol 219). Severity of immune suppression was indicated by the Centers for Disease Control and Prevention Pediatric HIV Disease Classification System, based on CD4 percentages. The total number of negative life events—categorized as none, 1, or >1 life event reported as having occurred in the previous 12 months (previous 6 months for children Results. At week 52, 379 subjects (61% of total study population) had moderate to severe immune suppression. Of 275 children with normal immune function at baseline, 68 (24.7%) subsequently developed moderate to severe suppression levels by week 52 of follow-up. Of 343 children with immune suppression at baseline, 32 (9.2%) had recovered to normal CD4% levels by week 52. More than 1 negative life event was associated with an increased risk (prevalence) of immune suppression (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.44,5.31), controlling for baseline CD4%, total life events, and other covariates. Children without immune suppression at baseline who experienced >1 negative life event had an increased incidence of immune suppression (OR: 2.93; 95% CI: 1.34,6.39), controlling for baseline covariates. Conclusions. Results indicate that negative stressful life events increase the risk of children with HIV-1 infection having impaired immune function. Further research is needed to identify potential mechanisms of the relationship between stressful life events and impaired immune function. These mechanisms include psychoneuroendocrinologic response and difficulties in adherence to therapy after exposure of a child to major negative life events.

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.

Recalled body weight and self-reported current weight were validated in a longitudinal study population by comparing recalls at 50 y to actual measures taken at ages 18, 30, 40, and 50 y. Recalled body weights were also compared with reported desired weights at these same ages. Self-reported weights at 50 y were equally accurate for both males and females; the mean reporting underestimate was -1.98 kg for males and -1.86 kg for females. Males' self reports at age 50 y were influenced by years of education (P less than 0.005) and current body size (P less than 0.0001) whereas females' were not. Correlations between recall of past weights and measured weights ranged from r = 0.87 at 18 y to 0.95 at 40 y. Recalls of past body weight were not significantly influenced by the passage of time, the number of years of education, or the accuracy of current weight reports. Current body size (wt/ht2) was significantly associated with life-time weight dissatisfaction in both sexes (P less than 0.0005).

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).

Objective. In an era when expanding publicly funded health insurance to children in higher income families has been the major strategy to increase access to health care for children, it is important to determine if the benefits to higher income children attributable to the receipt of health coverage are similar to those observed for lower income children. This study investigated how the likely impact of child health insurance expansions varies with family income. Methods. We surveyed parents or guardians of children who were enrolled in a state-sponsored health insurance program (Massachusetts Children’s Medical Security Plan [CMSP]) that, before the implementation of the State Children’s Health Insurance Plan (SCHIP), was open to all children regardless of income. A stratified sample of children was drawn from administrative files. We grouped children by income category (low-income [LI]: ≤133% of the federal poverty limit [FPL], middle-income [MI]: 134%–200% of the FPL, high-income [HI]: >200% of the FPL) that corresponded to eligibility for public health insurance programs in the state (Medicaid-eligible, SCHIP-eligible, and income that exceeded SCHIP eligibility). The majority of telephone interviews were conducted between November 1998 and March 1999. The overall response rate was 61.8%, yielding a sample of 996 children. The CSMP benefit package included comprehensive coverage for preventive and specialty care and limited coverage for ancillary services. Children enrolled in CMSP were not covered for inpatient hospital stays but those whose family income was We used survey responses to develop 2 sets of indicators: the first for reported need for services and the second for unmet need or delays in care among children whose parents reported a need for the service. Within each set, we created indicators for 5 types of service (medical care, dental care, prescription drugs, vision services, and mental health care) and an additional composite indicator. The composite indicator aggregated all categories of services covered under CMSP in a single measure; it included all services except dental services, which, at the time of the study, were not covered by the program. The composite indicator served as the dependent variable in regression models. We used weighted χ2 tests to identify statistically significant differences in reported need and unmet need for the 5 types of medical services and the aggregate measure of all services covered by CMSP. We examined differences across income groups at 2 points in time: during the period children were uninsured before enrollment and while enrolled. We used weighted logistic regression to assess the independent association of family income with our dependent variables: reported need for health services and the presence of unmet need, controlling for other covariates. To evaluate the impact of participation in a child health insurance program, we examined unmet need before and after program enrollment, testing for statistical significance using McNemar’s test for within-subject changes. Results. During the period of uninsurance before enrollment, prescription drugs (70%) was the health service needed most frequently, followed by medical (65%) and dental (57%) care. For the composite measure of services covered by CMSP, reported need for services was not significantly different by income. Need for medical care, dental care, and prescription drugs were significantly greater among children who had been uninsured for >6 months before enrollment. In addition, a significantly greater proportion of adolescent participants needed dental, vision, and mental health services than younger enrollees. While enrolled, among recently enrolled children, 77% need medical services, 68% prescription drugs, and 59% dental. In unadjusted models MI and HI children were more than 2 times as likely to report need for covered services as LI children. After adjusting for possible confounders, the effect of income was no longer significant. Instead, nonadolescents (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.25–4.76) and children with white ethnicity (OR: 3.03; 95% CI: 1.43–6.67) were significantly more likely to report need for services. Before enrollment, unmet need among those who reported need for services was 5% for medical, 4% prescription drugs, 31% dental, 30% vision, and 33% mental health. For the composite measure of services covered by CMSP, LI children were significantly more likely to have had unmet need before enrollment than MI and HI children (20%, 10%, 7% by income). As compared with younger children, adolescents also had significantly greater unmet need for the composite measure (19% vs 10%). In multivariate models, not having a usual site of care was a highly significant predictor of unmet need or delayed care (OR: 3.41; 95% CI: 1.28–9.11). Ninety-eight percent of parents cited cost as the reason they had difficulty obtaining needed care. After enrollment, the proportion of children who needed care and had difficulty obtaining it decreased for all categories of care. Less than 1% of enrollees reported unmet need or delays in care for medical services and 3% for prescription drugs. Children who needed vision and mental health services continued to experience difficulty obtaining these services (17% for each category of care), although they were covered as part of the benefit package. Unmet need or delays in care for dental services, which at the time of the study were not covered under CMSP, remained high (27%). We found a significant reduction in unmet need among children in all income groups and no significant differences in unmet need by income. Controlling for other covariates, adolescents (OR: 3.11; 95% CI: 1.58–6.12) and children with compromised health (OR: 3.20; 95% CI: 1.35–7.58) were more likely to have had difficulty obtaining needed services while enrolled in the program. Children in larger families (OR: 0.40; 95% CI: 0.17–0.96) and who were previously uninsured for >6 months (OR: 0.45; 95% CI: 0.22–7.58) were less likely to have difficulty obtaining care. Conclusion. Our findings demonstrate the positive impact of providing health insurance coverage to children regardless of income. The HI children who enrolled in the program looked similar to children with incomes that meet current SCHIP eligibility guidelines, suggesting that expansions of SCHIPs to HI children should not qualitatively change the program dynamics.

Background The Questionnaire for Identifying Children With Chronic Conditions (QuICCC) is an instrument based on a conceptual noncategorical definition that uses parental responses to identify children with chronic conditions for epidemiological purposes. Objectives To determine whether the QuICCC is sufficiently valid, sensitive, and specific to be used to identify individual children as having a chronic condition or disability; whether parents are accurate enough that their answers to QuICCC items can be accepted as valid; and what kinds of errors in classification occur when the QuICCC is used to identify children with chronic conditions. Methods The sample consisted of 424 children who were patients of 9 physicians in separate practice settings throughout New England. Each physician was briefly trained in the conceptual definition on which the QuICCC is based and then was asked to identify 25 children in his or her practice who met the definition and 25 children who did not meet the definition. The QuICCC was administered to the parents of these children by blinded interviewers via telephone. The QuICCC classification was compared with physician categorization. Discrepant cases were then followed up by asking physicians and parents to answer the original questions a second time. Results Complete data were available on 379 (89.4%) of 424 children. There was agreement on 89% (κ=0.78). The sensitivity was 94%; specificity, 83%; positive predictive value, 86%; and negative predictive value, 92%. Of the 42 discordant cases, 30 parent reports on the QuICCC qualified the child as having a chronic condition when the physician classified the child as being without such a condition. Fewer (n=12) discrepancies occurred because physicians identified children with chronic conditions that the QuICCC failed to identify. When the questions were readministered at follow-up, physicians corrected errors in rating in 9 cases; mothers changed their answers in 5 instances. In 13 instances the issues were known to both parties and appeared to arise in the "gray zone" or boundary area, where there was disagreement over whether a particular child qualified using the theoretical definition. For 11 children identified as having a chronic condition only by the parent's responses to the QuICCC, physician report appeared to be inaccurate primarily due to the physician's lack of information. In 3 cases where the physician reported the child to have a chronic condition, but the parent did not, the physician appeared to be correct. Follow-up data were incomplete on 1 child. Conclusions These data support the validity of parent-generated information for the evaluation of health status. Although these findings should be replicated, this study suggests that the QuICCC may be applicable also as a screening tool for individual child identification, provided that several sources of error are considered.

SUMMARY Tracking of blood pressure in adolescent boys is investigated using a mathematical model that corresponds to progression along a constant percentile. A more general analysis, based on the method of principal components, is also proposed that determines various alternative tracks or patterns that are most prevalent in the longitudinal blood pressure data. The degree of tracking along a constant percentile curve for systolic pressure was moderately high, as evidenced by a tracking index of .78 explaining 81 % of the variance, but less strong for diastolic (tracking index of .60) where tracking along a percentile explained 66% of the variance. The value of the more general analysis of blood pressure patterns may lie in the assessment of adolescent risk factors for elevated adult blood pressure. Using adolescent patterns determined by either statistical model, adult systolic at age 38 was predicted (R2 = .22) by the concept of a systolic fixed percentile curve in adolescence, and similarly for diastolic (R2 = .21). However, the more general analysis based on longitudinal principal components further suggests that boys who have a larger than usual systolic peak at age 14 years, which is near the time of the adolescent physical growth spurt in these boys, may be more likely to have higher systolic pressures at age 38. Because the adult data were incomplete and highly unbalanced, these findings were obtained using random-effects models for longitudinal data.

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.

The aim of this study was to develop a self-administered food frequency questionnaire for use with low-income pregnant women and to evaluate its performance in classifying women according to nutrient intake. Index nutrients used were energy, protein, calcium, iron, zinc, and vitamins A, B-6, and C. Two hundred ninety-five Massachusetts women, aged 14 to 43 years, participated in the field test of the questionnaire. A subset of 95 women provided three 24-hour diet recalls for use in comparative studies. Correlation coefficients between questionnaire and diet recall scores were adjusted for measurement error resulting from the limited number of 24-hour recalls per subject, and their confidence intervals were computed. When subjects with implausibly high energy scores (>4,500/day) were removed from the sample, reducing sample size by about 15%, correlation coefficients increased substantially (25% to 64%) for all nutrients except vitamin A. Adjusted correlation coefficients exceeded 0.5, excluding vitamin A (r∼0.15), and quintile comparisons indicated that the questionnaire would correctly identify a high proportion of the women having low intake of selected nutrients. We conclude that a self-administered questionnaire can provide useful data about individual recent intake of selected nutrients in a majority of English-speaking, low-income pregnant women, but that overestimation of food use may occur among up to 20% of this population. J Am Diet Assoc 89:1786-1794, 1989.

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.

Are there factors occurring in childhood and adolescence that influence the reproductive and gynecological health of women? The logic that leads to this possibility includes: The reproductive organs increase greatly in size and weight during pre-adolescence and adolescence. During periods of rapid growth (critical periods) body organs are most vulnerable to insults. The rate of growth and development can be slowed or otherwise modified by disease, deficient diet or other more obscure factors. If factors (such as undernutrition) are imposed on organs while cell division is occurring, the process slows and may stop before full organ growth. If this does occur the number of cells in the organ will always be too few. Body organs with abberrations in cell number or cell size have altered patterns of functioning. Therefore, the overall aim of this study is to identify factors which occur during adolescence that may affect adult reproductive system functioning.

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.

Recall of eight childhood communicable diseases and other illnesses was validated among 95 adults by comparison to longitudinal childhood health records. Self-reports at age 50 of several illnesses were highly accurate; however, German measles was correctly recalled by only 34% of subjects. Similar levels of accuracy were consistently found among a subset who also completed health history interviews 8 and 20 years earlier. Over-reporting of some health events was common. Past exposure to viral or bacterial agents is sometimes assessed in case-control studies by self-reports. Misclassification of prior exposure due to faulty recall may distort true associations between childhood illness and chronic disease in later life.

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.

Long term recalls of dietary intake are frequently used in case-control studies, but their validity and reliability have not been established. In this study, 91 middle-aged adults (median age, 50 years) who were participants in the Longitudinal Study of Child Health and Development at the Harvard School of Public Health in Boston, Massachusetts, starting in the early 1930s, were asked in 1984-1985 to report present food intake and to recall food intakes at ages 5-7 years. 18 years, and 30 years using food frequency questionnaires. Their recalled intakes were validated by comparison with historical records of intake collected during the earlier time periods. Recall of food intake in the distant past was a better predictor of historical intake than was current diet. However, correlations between recalled and historical consumption for individual foods and food groups were generally low, rarely exceeding 0.3. Current intakes exerted a powerful influence on accuracy of recall. The consideration of participant characteristics did not prove to be consistently useful in explaining variations in food item and food group-related recall. The authors conclude that recall of food intake in the distant past may be a sufficiently valid estimate of past intake to justify its collection.