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Biomedical subjects

Elizabeth Goodman

Publications and source records attributed to Elizabeth Goodman.

At least 19 recordsLinked to original sources
PubMed2006

Socioeconomic disparities in insulin resistance: results from the Princeton School District Study.

OBJECTIVES: The objectives of this study were to determine whether lower socioeconomic status (SES) is associated with changes in insulin resistance in adolescents over a 3-year period and explore moderators of this effect. METHODS: A total of 1167 healthy non-Hispanic black and white participants in the Princeton School District Study, a longitudinal study of fifth to 12th graders in a suburban Midwestern public school district were included in this study. Inclusion criteria were a) physical examination and fasting morning blood draw at baseline and 3 years later, b) younger than 20 years old at follow up, and c) information available on SES provided by a parent. The influence of SES on insulin resistance and change in insulin resistance over time was examined using general linear models adjusting for multiple covariates. Models also assessed if race or baseline weight status changed the SES-insulin resistance relationship and explored the role of perceived stress. RESULTS: Blacks and lower SES youth had higher body mass index z score and increased insulin resistance (p < .001). In multivariable models, lower parent education, but not household income, was associated with higher baseline insulin resistance (F = 7.84, p < .001) and worsening insulin resistance over time (F = 18.86, p < .001). Parent education's effect on change in insulin resistance was more pronounced for obese youth compared with nonobese (F interaction = 10.12, p < .001) even with adjustment for multiple covariates. Perceived stress did not alter these relationships. CONCLUSIONS: Lower parent education appears to be related to increased insulin resistance both cross-sectionally and over time in black and white adolescents. Worsening insulin resistance is especially problematic for obese adolescents from families with low parent education.

Adolescent↗
PubMed2006

Adult male height in an American colony: Puerto Rico and the USA mainland compared, 1886-1955.

The links between adult height and socioeconomic-political marginality are controversial. We test hypotheses by comparing secular trends between two groups of USA adult male citizens born during 1886-1930: (a) 9805 men surveyed in Puerto Rico during 1965 and (b) 3064 non-Hispanic Whites surveyed on the mainland during 1971-1975. Puerto Rico provides an apt case study because it is the oldest colony in the world and was the poorest region of the USA during the 20th century. During the period considered the average adult man in Puerto Rico was 164.8 cm tall, 8.3 cm shorter than the average adult man on the mainland (173.1cm). Both groups experienced secular improvements in height, with men on the mainland having higher rates than men in Puerto Rico. In neither case were results statistically significant. The modest changes in Puerto Rico likely reflect the offsetting role of improved health and a stagnant rural economy during the first half of the 20th century.

Body Height↗
PubMed2006

Social status, stress, and adolescent smoking.

PURPOSE: Adolescent smoking is associated with increased perceived stress and lower social status, but past research has not explored links between lower social status, stress, and smoking risk. This study examined whether the relation between social status and perceived stress could explain the association between lower social status and increased risk of smoking. METHODS: Data were collected from 1021 non-Hispanic black and white adolescents participating in a longitudinal school-based study. Students completed a questionnaire and parents provided information on their highest level of education. Hierarchical logistic regression estimated the effects of parental education, subjective social status (SSS), and stress on smoking risk. RESULTS: At baseline, students from families without a college-educated parent were at greater risk of current smoking (odds ratio [OR] some college = 1.98, 95% confidence interval [CI] = 1.06-3.67, and OR high school degree or less = 3.34, 95% CI = 1.67-6.60). Higher school SSS decreased risk of current smoking (OR = .73, 95% CI = .62-.87), and higher stress increased smoking risk (OR = 1.05, 95% CI = 1.01-1.08). There was no evidence that the effects of parental education were mediated through stress. At one-year follow-up, both lower school SSS and higher baseline stress were significantly associated with smoking initiation in preliminary models, but only baseline stress (OR = 1.06, 95% CI = 1.02-1.11) predicted smoking initiation in multivariable models. DISCUSSION: These findings indicate that higher stress and lower social status increase risk of smoking, but that stress does not explain the association between lower social status and smoking. Therefore, stress reduction interventions may not alleviate social inequalities in teen smoking, but they do hold promise for youth smoking prevention.

Adolescent↗
PubMed2006

Trends in the use of psychotropic medications among adolescents, 1994 to 2001.

OBJECTIVES: Few psychotropic medications are approved for use among children younger than 18 years. Yet previous studies have shown an increase in the use of psychotropic medications among school-age children and adolescents. Most previous studies examined data only up to 1997; therefore, the results predate any impact of changing federal policies and newly marketed medications. This study examined trends in the prescription of psychotropic medications to adolescents aged 14 to 18 years in office-based care in the United States from 1994 to 2001. METHODS: Data from the National Ambulatory Medical Care Survey (NAMCS) were used to determine visit rates and prescribing patterns from 1994 to 2001 for psychotropics that were prescribed in office-based treatment settings to adolescents aged 14 to 18 years. Rates of visits that resulted in a prescription for psychotropic medication were calculated for two-year periods. Analyses were conducted by type of medication, gender, and the prescribing physician's specialty. RESULTS: Rates of visits that resulted in a psychotropic prescription increased from 3.4 percent in 1994-1995 to 8.3 percent in 2000-2001. These trends were evident for males and females. The average annual growth rates for psychotropic prescriptions were much higher after 1999. Trends were also significant across drug classes. By 2001, one out of ten office visits by adolescent males resulted in a prescription for a psychotropic medication. CONCLUSIONS: Average annual growth rates for the prescription of psychotropics to adolescents increased from 1994 to 2001, with especially rapid acceleration after 1999. This increase may be associated with changing thresholds of diagnosis and treatment, availability of new medications, and changes in federal regulatory policies concerning promotion of medications by the pharmaceutical industry.

Adolescent↗
PubMed2005

Physical stature of adult Tsimane' Amerindians, Bolivian Amazon in the 20th century.

We examine the association between exposure to the market and Western society on the height of adult Tsimane', a foraging-farming society in the Bolivian Amazon. As with other contemporary native peoples, we find little evidence of a significant secular change in height during 1920-1980. Female height bore a positive association with own schooling and fluency in spoken Spanish and with maternal modern human capital (schooling, writing ability, and fluency in spoken Spanish), but male heights bore no association with parental height or with modern human capital. The absence of a secular change likely reflects the persistence of traditional forms of social organization and production that protect health.

Adult↗
PubMed2005

The relationships of adiponectin with insulin and lipids are strengthened with increasing adiposity.

CONTEXT: Adipose tissue inflammation has been implicated in the pathogenesis of obesity-related comorbidities. Adiponectin, an antiinflammatory protein, improves insulin sensitivity and lipid levels systemically. Because adiponectin is secreted by adipocytes, it may also act locally to counteract insulin resistance and dyslipidemia worsened by inflammation. OBJECTIVE: The aim of this study was to determine whether associations between adiponectin and insulin sensitivity and lipids are stronger with increasing adiposity. DESIGN: This cross-sectional study involved participants in The Princeton School District Study. SETTING: The study was conducted in the Princeton City schools (Cincinnati, OH) during the 2001-2002 school year. PARTICIPANTS: A total of 1196 non-Hispanic White and Black students in grades 5-12 participated. MAIN OUTCOME MEASURE: The relationships between adiponectin and high-density lipoprotein, triglycerides, and insulin were measured. To test our hypothesis, we: 1) compared correlation and regression coefficients of lean and nonlean individuals, and 2) incorporated an adiponectin by adiposity interaction in regression models. RESULTS: For high-density lipoprotein and triglycerides, the relationship with adiponectin, although present among lean adolescents, strengthened with increasing adiposity. However, with insulin, a relationship with adiponectin was only present among nonlean adolescents. CONCLUSIONS: These analyses suggest that adiponectin's relationship with insulin and lipids strengthens with increasing adiposity, such that heavier adolescents have a greater benefit from high levels of adiponectin than their lean counterparts.

Adiponectin↗
PubMed2005

Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth.

BACKGROUND: Clustering of cardiovascular (CV) risks begins in childhood, yet studies of the factor structure underlying this clustering have focused on adults. The increasing rates of obesity and type 2 diabetes and the growing importance of metabolic syndrome among adolescents make assessment of CV risk clustering even more urgent in this age group. METHODS AND RESULTS: Exploratory factor analysis (principal components analysis) was performed with data from 1578 healthy seventh to 12th graders from the Princeton School District Study, a school-based study in Cincinnati, Ohio. Measured CV risks included cholesterol, triglycerides, fasting insulin and glucose, body mass index (BMI), waist circumference, fibrinogen, and blood pressure. Factor analysis yielded 4 uncorrelated factors (adiposity [BMI, waist, fibrinogen, insulin], cholesterol [LDL and total cholesterol], carbohydrate-metabolic [glucose, insulin, HDL cholesterol, triglycerides], and blood pressure [systolic and diastolic blood pressure]). These factors explained approximately 67% of the total variance. A summary cumulative risk scale was derived from factor scores, and high risk was defined as scoring in the top 5%. Although insulin loaded onto both the adiposity and carbohydrate-metabolic factors, obesity was a much stronger correlate of high cumulative risk (odds ratio=19.2; 95% CI, 7.6 to 48.5) than hyperinsulinemia (odds ratio=3.5; 95% CI, 1.8 to 6.8). A sizable proportion (18.5%; n=12) of those who were at high cumulative risk were not at high risk for any of the individual factors. CONCLUSIONS: The patterning of CV risk clustering seen among adults is present in healthy adolescents. Among youth, obesity is the predominant correlate of cumulative risk.

Adolescent↗
PubMed2005

Social disadvantage and adolescent stress.

PURPOSE: Low socioeconomic status (SES) and minority race/ethnicity are both associated with chronic stress and co-vary in American society. As such, these factors are often used synonymously, without clear theoretical conceptualization of their roles in the development of stress-related health disparities. This study theorized that race/ethnicity and SES reflect social disadvantage, which is the underlying factor in the development of stress-related illness, and examined how social disadvantage, defined in terms of both race/ethnicity and SES, influences adolescents' stress. METHODS: This is a cross-sectional school-based study of 1209 non-Hispanic black and white 7th-12th graders from a single Midwestern metropolitan public school district. Each student completed a questionnaire and a parent provided SES information. Race/ethnicity was obtained from school records. Linear regression analyses determined the influence of race/ethnicity and SES to stress. Race/ethnicity and presence or absence of at least one parent who graduated from college were used to define four subgroups for within-group analyses. RESULTS: Stress was higher among black students, those from lower SES families, and those with lower perceived SES. In subgroup analyses, neither race nor SES maintained their independent associations with stress among socially disadvantaged groups. Black race was not associated with stress among those without a college-educated parent, and parent education did not influence stress among black students. In contrast, among more socially advantaged groups, both SES and race explained variation in adolescents' stress. CONCLUSIONS: Social disadvantage is associated with increased stress, regardless of whether disadvantage is defined in terms of race or SES. This suggests that race and SES measure adversity in the social environment, and therefore, serve as risk markers, rather than risk factors. Future research should focus on the experience of adversity, which is reflected by these social characteristics, and the processes by which it operates.

Adolescent↗
PubMed2005

Frequency of abnormal carbohydrate metabolism and diabetes in a population-based screening of adolescents.

OBJECTIVE: To document the frequency of glucose intolerance in adolescents in a population-based study of primarily African-American/Non-Hispanic whites in an urban-suburban school district. STUDY DESIGN: Measurement of fasting and 2-hour post-glucose load plasma glucose concentrations. RESULTS: Carbohydrate intolerance (either impaired fasting glucose, impaired glucose tolerance, or both) was identified in 8.0%, near-diabetes (1 fasting glucose > or = 126 mg/dL [7.0 mmol/L] and/or 2-hour glucose > or = 200 mg/dL [11.1 mmol/L]) in 0.3%, and diabetes in 0.36% (type 1A = 0.24%; type 2 = 0.08%; undiagnosed type 2 = 0.04%). A model for abnormal carbohydrate metabolism was constructed with regression analysis in the Carbohydrate Intolerance (CI)/near-diabetes group and with logistic regression in the entire study population. Risk factors for the development of CI/near-diabetes included having a 1 unit increase in body mass index (BMI) z-score and either being non-Hispanic white or in the pubertal group. Increased fasting glucose correlated with having puberty and decreased BMI z-score, whereas 2-hour glucose correlated with increased BMI z-score. By using National Health and Nutrition Survey (NHANES) III (1988-1994) definitions, impaired fasting glucose was present in 2.0% in this study versus 1.7% (NHANES III). CONCLUSION: The prevalence of CI/near-diabetes was 8.3%. Undiagnosed diabetes mellitus was rare. One third of adolescents with diabetes mellitus could be classified as having type 2 diabetes mellitus. The adult model of the progression of insulin resistance to type 2 diabetes mellitus in adolescents may be valid. Despite the increase in the overweight population since NHANES III, abnormalities in glucose metabolism have not changed significantly.

Adolescent↗
PubMed2005

Adolescent sex differences in adiponectin are conditional on pubertal development and adiposity.

OBJECTIVE: Adiponectin is an adipose tissue protein with important insulin-sensitizing, anti-inflammatory, and cardioprotective properties but is paradoxically lower in obese individuals. Sex differences in adiponectin have been reported in adults and adolescents but not in prepubertal children. In this study, we hypothesized that sex differences in adiponectin would develop during puberty and would be influenced by level of adiposity. RESEARCH METHODS AND PROCEDURES: Adiponectin levels were measured in 1196 white and African-American adolescents. Insulin resistance was estimated using the homeostasis model (HOMA-IR). Demographic, developmental, and metabolic variables, including interactions with adiposity measurements, were evaluated for independent relationships with adiponectin levels. RESULTS: Overall, adiponectin levels varied significantly by sex, race, adiposity, and puberty stage. Significant sex differences in adiponectin developed after the onset of puberty, particularly in lean adolescents. Adolescent boys had lower adiponectin levels in post-puberty compared with pre-puberty (p = 0.01) and had lower levels than girls in both puberty and post-puberty (both p < 0.001), after adjusting for race, BMI z-score, and natural logarithm-(HOMA-IR). Sex differences were also conditional on adiposity level, with significant sex differences among lean (p < 0.001) but not among non-lean (p = 0.16) adolescents. Adiponectin levels in girls decreased more with increasing adiposity than in boys (p = 0.004), but only marginally so after standardizing for girls' higher mean adiponectin level (p = 0.11). DISCUSSION: Sex differences in adiponectin are dependent on both puberty stage and adiposity in adolescents, such that by post-puberty, non-lean boys exhibit the lowest levels of adiponectin.

Adiponectin↗
PubMed2005

Pediatric faculty members' attitudes about part-time faculty positions and policies to support part-time faculty: a study at one medical center.

PURPOSE: To examine pediatric faculty members' attitudes about part-time faculty positions and policies to support part-time faculty. METHOD: In 2001, an anonymous 26-item questionnaire assessing attitudes about part-time faculty was mailed to all 441 faculty members of Cincinnati Children's Hospital Medical Center. Multivariable analyses were used to determine faculty characteristics associated with specific attitudes, and qualitative methods were used to analyze responses to an open-ended item assessing beliefs about facilitating part-time careers. RESULTS: Three hundred (68%) faculty members completed questionnaires. Twenty-nine (10%) worked part-time and an additional 88 (33%) had considered part-time work, primarily because of dependent children. Although 177 (59%) believed that part-time faculty were perceived as being less committed to their careers and the institution, 207 (69%) believed part-time faculty should be eligible for all academic tracks and 219 (73%) that they should be allowed extension of time to obtain tenure. Most reported that policy changes to support part-time faculty would enhance diversity (N = 234, 78%) and improve recruitment, retention, and promotion of female faculty. Multivariable analysis demonstrated that women and respondents with dependent children were more likely to be concerned about perceived commitment and more likely to endorse policies to support part-time faculty. Participants suggested that part-time careers for faculty would be facilitated by clarifying productivity expectations, expanding resources, and modifying existing policies. CONCLUSIONS: Although women and respondents with dependent children were concerned about perceived commitment of part-time faculty and were most supportive of policies that would support part-time faculty, pediatric faculty generally supported such policies.

Adult↗
PubMed2005

Sexually transmitted infection testing and screening in hospital-based primary care visits by women.

OBJECTIVE: To explore determinants of sexually transmitted infection screening of asymptomatic women and sexually transmitted infection testing of women with genitourinary symptoms, to investigate the effect of specific genitourinary symptoms on sexually transmitted infection testing, and to examine trends in screening. METHODS: We performed secondary data analysis of nationally representative data from the National Hospital Ambulatory Medical Care Surveys, using 17,458 visits by nonpregnant 15- to 44-year-old women seen in primary care clinics between 1997 and 2000. Point estimates, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are presented. RESULTS: Sexually transmitted infection screening was performed in 2.4% of visits by women without genitourinary symptoms and was more likely among visits for preventive care (OR 6.9, CI 3.8-12.5), by nonwhite women (OR 4.3, CI 2.3-7.9), and in gynecology clinic (OR 3.9, CI 2.5-6.1). Sexually transmitted infection testing occurred in 13.2% of visits by women with genitourinary symptoms and was associated with Medicaid (OR 2.3, CI 1.4-3.6), preventive care (OR 2.0, CI 1.2-3.2), patient age less than 25 years (OR 1.7, CI 1.0-2.6), and nonwhite race (OR 1.7, CI 1.0-2.6). Among symptomatic women, vaginal symptoms (OR 4.8, CI 2.6-8.9) and abdominal/pelvic pain (OR 2.5, CI 1.4-4.5) were associated with sexually transmitted infection testing. Between 1997 and 2000, sexually transmitted infection screening rates remained stable. CONCLUSION: Despite national guidelines, sexually transmitted infection testing outpaces screening. Few visits by asymptomatic women under age 25 result in screening. Strategies to improve screening in primary care should target nongynecology settings and non-preventive care visits. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2004

Statistical assessment of mediational effects for logistic mediational models.

The concept of mediation has broad applications in medical health studies. Although the statistical assessment of a mediational effect under the normal assumption has been well established in linear structural equation models (SEM), it has not been extended to the general case where normality is not a usual assumption. In this paper, we propose to extend the definition of mediational effects through causal inference. The new definition is consistent with that in linear SEM and does not rely on the assumption of normality. Here, we focus our attention on the logistic mediation model, where all variables involved are binary. Three approaches to the estimation of mediational effects-Delta method, bootstrap, and Bayesian modelling via Monte Carlo simulation are investigated. Simulation studies are used to examine the behaviour of the three approaches. Measured by 95 per cent confidence interval (CI) coverage rate and root mean square error (RMSE) criteria, it was found that the Bayesian method using a non-informative prior outperformed both bootstrap and the Delta methods, particularly for small sample sizes. Case studies are presented to demonstrate the application of the proposed method to public health research using a nationally representative database. Extending the proposed method to other types of mediational model and to multiple mediators are also discussed.

Adolescent↗
PubMed2004

Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents.

OBJECTIVE: To determine prevalence of metabolic syndrome (MS) among adolescents by using definitions from the National Cholesterol Education Program Adult Treatment Panel III (NCEP) and World Health Organization (WHO) guidelines and to compare the populations identified by these definitions. STUDY DESIGN: School-based, cross-sectional study of 1513 black, white, and Hispanic teens who had a fasting morning blood sample drawn and a physical examination. RESULTS: Overall, the prevalence of NCEP-defined MS was 4.2% and of WHO-defined MS was 8.4%. MS was found almost exclusively among obese teens, for whom prevalence of NCEP-defined MS was 19.5% and prevalence of WHO-defined MS was 38.9%. Agreement between definitions was poor (kappa statistic=0.41). No race or sex differences were present for NCEP-defined MS. However, nonwhite teens were more likely to have MS by WHO criteria (RR, 1.40; 95% CI, 1.04, 1.87), and MS was more common among girls if the WHO-based definition was used (RR, 1.26; 95% CI, 1.08, 1.88). CONCLUSIONS: Among adolescents, obesity is a powerful risk for MS. Important demographic and clinical differences exist in the typology of MS, depending on the definition. Such discrepancies suggest that the concept of a common pathologic syndrome or etiologic mechanism underlying MS as defined by these guidelines may be flawed.

Adolescent↗
PubMed2003

Predictors of Papanicolaou smear return in a hospital-based adolescent and young adult clinic.

OBJECTIVE: Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits. METHODS: Participants in this longitudinal cohort study were sexually active young women 12-24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return. RESULTS: The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (+/- standard deviation) was 18.3 (+/- 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78). CONCLUSION: Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.

Adolescent↗