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Biomedical subjects

C E Basch

Publications and source records attributed to C E Basch.

At least 19 recordsLinked to original sources
PubMed1992

Blood pressure reactivity does not correlate with baseline blood pressure or blood pressure change over time in preschool children.

Few studies have examined the relation of blood pressure reactivity to subsequent change in blood pressure of preschool children. The authors investigated relations between measurement-induced reactivity, exercise reactivity, and change in blood pressure over 16 months among 140 preschool children (46-67 months of age at baseline, 50.7% female, 92.9% Hispanic). Within-session measurement-induced reactivity was defined as the change in blood pressure between the first and the mean of the fourth and fifth readings obtained at each of 11 sessions. Between-session measurement-induced reactivity was defined as the change between mean blood pressure at session 1 and the mean of sessions 2 and 3. Both indices of measurement reactivity displayed poor reproducibility. Exercise reactivity was measured using a treadmill on two occasions and was moderately reproducible. There was no association between measurement and exercise reactivity. The change in systolic blood pressure over time was not associated with any measure of reactivity. The mean diastolic blood pressure did not change over the study period. Neither blood pressure reactivity to measurement nor blood pressure reactivity to exercise appeared to be a useful predictor of change in blood pressure in preschool children during a 16-month period.

Blood Pressure↗
PubMed1992

Consistency of the Willett semiquantitative food frequency questionnaire and 24-hour dietary recalls in estimating nutrient intakes of preschool children.

A study was performed to determine the utility of the Willett semiquantitative food frequency questionnaire for assessing the habitual diets of preschool children. Children (n = 224) were recruited mainly through a New York City hospital-based pediatric practice during 1986-1987. The children's ages at baseline were 44-60 months; 50% were male, and 91% were Hispanic. Over a 12-month period, the Willett food frequency questionnaire was administered twice to each child's parent, and a 24-hour dietary recall was conducted four times. For energy and eight nutrients, group mean intakes derived from food frequency questionnaires were 1.4-1.9 times higher than those from 24-hour recalls. Group mean estimates of nutrient density of total and saturated fat, potassium, and calcium did not differ between the two methods. Correlations between methods for crude nutrient intakes (unadjusted for energy consumption) ranged from 0.16 (polyunsaturated fat in boys) to 0.60 (potassium in girls). Correlations generally decreased when intakes were adjusted for energy consumption. Adjustment for energy intake and residual intraindividual variability yielded correlations of 0.48 for total calories, 0.35 for total fat, and 0.37 for saturated fat. For intake of energy and nine nutrients, of those children classified into the highest quintile by dietary recall, 28.9-40.9% were so classified by the Willett questionnaire, and 48.9-68.9% were classified into the highest two quintiles. When data were expressed as nutrient densities, agreement was high for potassium and calcium and fair for saturated fat, cholesterol, and protein. The moderately low consistency of nutrient intake estimates across dietary assessment methods in this study may be due, in large part, to residual intraindividual variability in both the recall data and the food frequency data.

Child, Preschool↗
PubMed1992

The Washington Heights-Inwood Healthy Heart Program: a third generation community-based cardiovascular disease prevention program in a disadvantaged urban setting.

The Washington Heights-Inwood Healthy Heart Program (WHIHHP) is part of the New York State Healthy Heart Program, which comprises eight community-based programs in different areas of the state. WHIHHP is directed at a population of approximately 200,000 people, predominantly Hispanic and of low socioeconomic status, living in northern Manhattan in New York City. The initial 3 years of experience are presented. Six potential barriers to diffusion of the community-based disease prevention model in disadvantaged inner city communities are discussed: (a) issues of scale and complexity; (b) adaptation of this model to a "community" without geopolitical boundaries or infrastructure; (c) linguistic and cultural diversity; (d) competing problems; (e) the role of evaluation; and (f) sustainability of the program in a poor community. Strategies for addressing obstacles to model adoption are also described, including program legitimization, building program infrastructure, setting realistic expectations, focusing on one risk factor at a time, defining target population segments, and emphasizing a small number of communication channels. Finally, research issues related to the diffusion of the community-based model are discussed, specifically: (a) Does the model work in disadvantaged urban settings? (b) What are the program effects on social class gradients for risk factors? (c) What are the barriers to program adoption in such settings? (d) What changes in the model will facilitate adoption in such settings? (e) What are the best methods for conducting formative evaluation in such programs? (f) What is the best way to select communities that may be ready to adopt the model? Our initial experience implementing this model in a disadvantaged urban setting supports the feasibility of model adoption. Unanswered questions about efficacy in such settings and regarding research issues related to model diffusion will require additional research investment.

Adolescent↗
PubMed1992

Food sources, dietary behavior, and the saturated fat intake of Latino children.

BACKGROUND: Recent recommendations for Americans aged 2 and older call for a reduction in the average saturated fat intake to less than 10% of calories. METHODS: Using 24-hour dietary recalls collected from mothers of 4- to 7-year-old urban Latino children, we identified foods and dietary behavior patterns that distinguish children with higher and lower mean daily percentages of calories from saturated fat. RESULTS: Compared with children in the lowest quintile of intake, children in the highest quintile consumed more than twice as much saturated fat per day from high-fat milk products (18.5 g vs 7.8 g), mostly from whole milk. They did not consume different kinds of milk or different amounts of milk per eating occasion, but on average they consumed milk more frequently (2.8 vs 1.6 eating occasions per day). Even children in the lowest quintile, on average, exceeded the 10% of calories from saturated fat currently recommended. If low-fat (1% fat) milk had been substituted without other dietary changes, all but the highest two quintiles would have been within the recommended level. CONCLUSIONS: The substitution of low-fat for whole milk appears to be a key strategy for preschool children for achieving recommended levels of saturated fat intake.

Animals↗
PubMed1992

Variability and self-regulation of energy intake in young children in their everyday environment.

Recent data from small numbers of children studied under controlled protocols indicate that intraindividual variation in energy consumption over 24 hours is smaller than variation from eating occasion to eating occasion, implying that children self-regulate their energy consumption. This hypothesis was tested in children living in their everyday environment. Between 1986 and 1989, 24-hour recalls were administered on seven occasions (four times in 1986 through 1987 and three times in 1988 through 1989) to the mothers of 181 preschool children in New York City. Each 24-hour period was divided into six meals or snacks. The coefficient of variation (standard deviation divided by the mean) was calculated for each child for energy consumption at each eating occasion and for the day as a whole. Coefficients of variation for energy consumption at the six eating occasions ranged from 46.5% to 165.8%, compared with 30.3% for the whole day. This coefficient of variation for the observed whole-day energy consumption was significantly less (P < .001) than would be expected if no autoregulation of energy intake (no meal-to-meal correlation) occurred. These findings in children living in their everyday environment are consistent with observations under more controlled study conditions. These data suggest that children who eat less at one meal compensate at another, although the data do not address the issues of longer term energy self-regulation, overall energy balance, or diet quality.

Child Nutritional Physiological Phenomena↗
PubMed1991

Variability and tracking of nutrient intakes of preschool children based on multiple administrations of the 24-hour dietary recall.

The authors measured intra-individual day-to-day variation and tracking of nutrient intakes among 181 preschool children (53% male, 45-60 months of age at baseline, 93% Hispanic) recruited through a hospital-based pediatrics practice in New York City. From 1986 to 1989, 24-hour dietary recalls were administered on seven occasions (four times in year 1 and three times in year 3) to the children's mothers. Median follow-up (midpoint of year 1 to midpoint of year 3) was 19.3 months. The reliability of estimates (intraclass correlation coefficients) of energy and nine nutrients obtained from a single administration of the dietary recall ranged from 0.15 to 0.38. Based on unadjusted nutrient intakes, 33.1-55.6% of children in the top quintile of intake at year 1 remained in the top quintile, and 58.3-83.3% in the top two quintiles, at year 3. Of the children in the lowest quintile at year 1, 27.8-50.0% were in the lowest quintile and 55.6-80.6% in the lowest two quintiles at year 3. Consistency of classification decreased when intakes were adjusted for energy intake. Correlations between mean energy and unadjusted nutrient intakes at year 1 and year 3 ranged from 0.27 to 0.45. When energy intake was controlled, correlations decreased for most but not all nutrients (range, 0.09-0.59). Correction of correlations of energy and energy-adjusted nutrients for residual intra-individual variation yielded correlations between mean intakes at year 1 and year 3 in the range 0.15 to 0.71. These data indicate that despite considerable residual intra-individual day-to-day variability of dietary intakes there is substantial tracking of underlying diets among preschool children over a 19-month period.

Child Nutritional Physiological Phenomena↗
PubMed1991

Independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease.

The authors examined the independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease using data from the 1989 baseline survey for the New York State Healthy Heart Program. This telephone survey used the Centers for Disease Control Behavioral Risk Factor Survey interview instrument and was conducted in eight communities (total population, approximately 1.24 million people) in New York State. The response rate was 65.5% (n = 4,179); 3,606 subjects aged 20-64 years with self-described ethnicity of white (n = 1,935), black (n = 1,035), or Hispanic (n = 636) and of known educational status were retained in the analysis. After adjustment for age, sex, and ethnicity, significant associations were found between educational attainment and smoking, lack of regular exercise, overweight, diet atherogenicity, and knowledge about blood pressure and cholesterol. After adjustment for age, sex, and educational attainment, associations were found between ethnicity and most of these same variables. Blacks and Hispanics generally had less favorable risk factor profiles. These data indicate that the differences in cardiovascular disease risk profiles between whites and blacks or Hispanics cannot be fully explained by underlying differences in educational attainment. The differing patterns of risk factor distribution by educational attainment within ethnic groups have implications for the segmentation of risk reduction programs.

Adult↗
PubMed1991

Reliability of the behavioral risk factor survey in a triethnic population.

The Behavioral Risk Factor Survey (BRFS) is a telephone interview used widely by the Centers for Disease Control (CDC) in conjunction with state health departments to measure prevalences and time trends for health-related behaviors. We assessed the reliability of those parts of the BRFS related to cardiovascular disease (smoking, diet, obesity, exercise, and hypertension) and demographics by readministering the BRFS in July and August of 1989 to 145 randomly selected subjects between 10 and 21 days following completion of an initial interview. Sampling and data collection closely followed CDC procedures. The retest samples comprised 49 whites, 43 blacks, and 53 Hispanics living in northern Manhattan in New York City. Group prevalences or means were compared at first and second interviews for six demographic variables and 12 behavioral risk factor variables for the samples as a whole and separately for each ethnic group. All of these comparisons were highly consistent, and none showed a statistically significant difference. At the individual level, Pearson or kappa correlations for 19 questions related to demographics and behavioral risk factors other than diet were greater than or equal to 0.60 (p less than 0.001) for all except routine checkup in the past 2 years (kappa = 0.54; p less than 0.001) and blood pressure measured in the past 2 years (crude concordance, 96%; kappa = 0.23; p less than 0.01). For 17 food items, correlations for frequency of consumption ranged from 0.44 to 0.76 (p less than 0.01). For a composite index of diet "atherogenicity" based on the 17 food items, r = 0.62 (p less than 0.001). This test-retest reliability study of the BRFS showed high consistency at the group level and acceptable to high item reliability at the individual level for the parts of the BRFS related to demographics, cardiovascular behavioral risk factors, and a 17-item nutrition module. Findings were generally consistent in all three ethnic groups.

Adult↗
PubMed1991

Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children.

BACKGROUND: Studies of the relationship between dietary fat intake and serum lipids in young children have yielded inconclusive results. We studied this relationship in 108 Hispanic children ages 4-5 years. METHODS: Four 24-hr recalls approximately 3 months apart and two Willett semiquantitative food frequency questionnaires approximately 6 months apart were obtained by interviewing the children's mothers. Diet measures were averaged for the multiple administrations of each of these instruments. RESULTS: Based on the 24-hr recalls, children in the highest tertile of total fat consumption (36.2% of total calories) compared with the lowest tertile (30.2% of total calories) had mean total serum cholesterol of 4.32 mmol/liter (167 mg/dl) vs 3.91 mmol/liter (151 mg/d) (test for linear trend across tertiles, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.74 mmol/liter (106 mg/dl) vs 2.29 mmol/liter (89 mg/dl) (test for linear trend, P less than 0.01). Children in the highest tertile of saturated fat consumption (14.6% of total calories) compared with the lowest tertile (11.2% of total calories) had mean total serum cholesterol of 4.39 mmol/liter (170 mg/dl) vs 3.97 mmol/liter (154 mg/dl) (test for linear trend, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.80 mmol/liter (108 mg/dl) vs 2.35 mmol/liter (91 mg/dl) (test for linear trend, P less than 0.01). These relationships remained significant when calorie-adjusted nutrient intakes were examined and after adjustment in multiple linear regression models for age, sex, and body mass index, with the exception of the association of calorie-adjusted total fat with total serum cholesterol level (P = 0.07). Similar results were obtained using the Willett questionnaires. CONCLUSIONS: These findings indicate that dietary fat, particularly saturated fat consumption, is an important correlate of blood lipid levels in preschool children. These are also the first reported data indicating that the Willett questionnaire, as a method for measuring the atherogenic components of diet, has criterion-related validity in young children.

Child, Preschool↗
PubMed1990

Failure of family history to predict high blood cholesterol among hispanic preschool children.

Recommendations for screening children for high blood cholesterol remain controversial. The American Academy of Pediatrics, the American Heart Association, and the National Institutes of Health (NIH) Consensus Conference have recommended targeted screening of children with positive family history. We examined data from a sample of 108 Hispanic preschool children and their families to test targeted screening strategies. Thirty-seven children (34.3%) had total cholesterol levels of greater than or equal to 4.40 mmole/liter (170 mg/dl). Using the American Academy of Pediatrics definition of family history, sensitivity (proportion of those with high blood cholesterol with positive family history) was 0.57 (95% confidence interval, 0.40 to 0.73) and accuracy (overall proportion correctly classified) was 0.58 (0.48 to 0.68). Using the American Heart Association and NIH Consensus Conference definition of family history, sensitivity was 0.46 (0.30 to 0.63) and accuracy was 0.62 (0.52 to 0.71). Classification of children based on the mother's total cholesterol level of greater than or equal to 5.17 mmole/liter (200 mg/dl), the mother's low-density lipoprotein cholesterol level of greater than or equal to 4.14 mmole/liter (160 mg/dl), the mother's low-density lipoprotein cholesterol level of greater than or equal to 3.36 mmole/liter (130 mg/dl), or the child's own body mass index greater than or equal to 75th percentile was less sensitive and no more accurate. These findings indicate that current recommendations as well as other potential strategies for targeted cholesterol screening in young children have serious shortcomings and lend support to universal cholesterol screening in childhood.

Body Mass Index↗
PubMed1990

Validation of mothers' reports of dietary intake by four to seven year-old children.

The validity of mothers' recall of four to seven year-old children's diet was assessed among 46 first generation Latino immigrant families from the Dominican Republic by comparing intake recalled by the mother to unobtrusive home observations of children. Correlations were moderate to high for calories and for most nutrients. There were no differences in mean intake of total calories or in intake of most macronutrients and micronutrients assessed. At least two-thirds of the children in the lowest (or highest) quintile based on home observations were correctly classified into the lowest or second lowest (or highest) quintiles based on mother's reports for calories and most nutrients. For all food items that were both observed and reported, 51 percent of reported portion sizes were equivalent to observed portion sizes, 15.5 percent were smaller, and 33.5 percent were larger. There was fair to good agreement on the number of food items eaten, with the exception of vegetables. Mothers' recall appears to be useful for classifying children by intake of calories, macronutrients and micronutrients, but provides a somewhat less accurate measure of actual foods eaten, portion sizes, and nutrient levels consumed.

Child↗
PubMed1989

Screening using National Cholesterol Education Program guidelines in a population of urban Hispanic mothers.

We measured serum total cholesterol, high-density lipoprotein cholesterol, and triglycerides and calculated low-density lipoprotein cholesterol in 217 urban Hispanic mothers. On the basis of total cholesterol values, as recommended by the Expert Panel of the National Cholesterol Education Program, 6 subjects (2.8%) had high blood cholesterol (greater than or equal to 240 mg/dl), 27 (12.4%) had borderline-high blood cholesterol (200-239 mg/dl), and 184 (84.8%) had desirable blood cholesterol (less than 200 mg/dl). One of the 27 with borderline-high total cholesterol had two other coronary risk factors. Thus 7 of the 217 (3.2%, 95% confidence interval 1.4 to 6.8%) met Expert Panel criteria for lipoprotein measurement. Six of the seven had high-risk low-density lipoprotein cholesterol (greater than or equal to 160 mg/dl). Four additional subjects with borderline-high total cholesterol, not identified by this sequential screening strategy, also had high-risk low-density lipoprotein cholesterol. Thus a total of 10 of 217 (4.6%, 95% confidence interval 2.4 to 8.6%) met Expert Panel criteria for high-risk low-density lipoprotein cholesterol and initiation of cholesterol-lowering treatment. None of these 10 had been previously identified as having high-risk low-density lipoprotein cholesterol. Two years later subjects with high or borderline-high total cholesterol were rescreened. Seven of 22 subjects completing the second screening were classified differently with regard to having high-risk low-density lipoprotein cholesterol, illustrating the potential for misclassification of individuals on the basis of a single measurement. The prevalence of women with high-risk low-density lipoprotein cholesterol was not significantly different at the two screenings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Preventing AIDS through education: concepts, strategies, and research priorities.

Concepts related to the design and implementation of AIDS education programs in schools are presented. For each concept, the rationale and implications for curricular planning are described and health education research priorities are outlined. Teachers can make a major contribution in preventing HIV transmission among youth, perhaps the single largest contribution of any professional group. To do so, however, may require letting go of familiar roles and assuming a redefined and expanded role. Improvements in the theory base for school health education provide guidelines that can be used by teachers to clarify and reinforce curriculum efforts and to adapt to this new role.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A focus group study on decision processes of young drivers: reasons that may support a decision to drink and drive.

This article explores reasons that may support a decision by young drivers to drink and drive. Forty focus group discussions on driving and traffic safety were conducted with 316 volunteers 18 to 22 years of age in 10 cities in the United States and two cities in Canada. The audiotaped discussions identified some factors that may influence young peoples' decisions to drink and drive, such as inappropriate knowledge about alcohol and driving, lack of decision making skills, and the tendency to ignore the increased risk of drinking and driving. While some respondents drove intoxicated because they were unaware of the dangers, others rationalized their drinking and driving behavior. Improved understanding about the nature and extent of the factors influencing young drivers' decisions to drink and drive is essential to planning effective health education programs.

Adolescent↗
PubMed1988

The potential contribution of computerized school-based record systems to the monitoring of the disease prevention and health promotion objectives for the nation.

This article discusses the potential contribution of computerized school-based record systems to help monitor the 1990 and future health objectives for the nation, to provide a continuing health data base on nearly 50 million Americans, and to improve current school health record-keeping practices. Limitations of paper-based health record systems and the state-of-the-art and future potential of computerized record systems are described. Several key obstacles to computerization of school health records are considered, including technological problems, difficulties in appreciating and evaluating the benefits of computerization, costs, acceptability to individuals and organizational users, standardization problems, and concerns about confidentiality. Implementation steps involving research and surveillance measures for attaining the 1990 objectives that may be facilitated by improved school health records and information systems are specified. As school health education and school health services increasingly become vehicles for achieving national public health objectives, including those set for 1990, it will be desirable to establish data systems that link information collected in individual schools with research and surveillance activities at the state and national level. Moreover, it will be desirable for school's health records and information systems to contain data describing students' health-related knowledge, attitudes, behaviors, and physiological risk factors, in addition to the data traditionally maintained in such records.

Attitude to Computers↗
PubMed1987

Focus group interview: an underutilized research technique for improving theory and practice in health education.

The purpose of this article is to increase awareness about and stimulate interest in using focus group interviews, a qualitative research technique, to advance the state-of-the-art of education and learning about health. After a brief discussion of small group process in health education, features of focus group interviews are presented, and a theoretical framework for planning a focus group study is summarized. Then, literature describing traditional and health-related applications of focus group interviews is reviewed and a synthesis of methodological limitations and advantages of this technique is presented. Implications are discussed regarding: need for more inductive qualitative research in health education; utility of focus group interviews for research and for formative and summative evaluation of health education programs; applicability of marketing research to understanding and influencing consumer behavior, despite notable distinctions between educational initiatives and marketing; and need for professional preparation faculty to consider increasing emphasis on qualitative research methods.

Adolescent↗