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Biomedical subjects

Frederick J Zimmerman

Publications and source records attributed to Frederick J Zimmerman.

At least 19 recordsLinked to original sources
PubMed2007

Associations between residential segregation and smoking during pregnancy among urban African-American women.

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

Adolescent↗
PubMed2006

Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation.

Residential segregation is a common aspect of the urban experiences of African-Americans in the United States (US), yet few studies have considered how segregation might influence perinatal health. Here, we develop a conceptual model of relationships between segregation and birth outcomes and test the implications of the model in a sample of 434,376 singleton births to African-American women living in 225 US Metropolitan Statistical Areas (MSAs). Data from the National Center for Health Statistics 2002 birth files were linked to data from the 2000 US Census and two distinct measures of segregation: an index of isolation (the probability that an African-American resident will encounter another African-American resident in any random neighborhood encounter) and an index of clustering (the extent to which African-Americans live in contiguous neighborhoods). Using multilevel regression models, controlling for individual- and MSA-level socioeconomic status and other covariates, we found higher isolation was associated with lower birthweight, higher rates of prematurity and higher rates of fetal growth restriction. In contrast, higher clustering was associated with more optimal outcomes. We propose that isolation reflects factors associated with segregation that are deleterious to health including poor neighborhood quality, persistent discrimination and the intra-group diffusion of harmful health behaviors. Associations with clustering may reflect factors associated with segregation that are health-promoting such as African-American political power empowerment, social support and cohesion. Declines in isolation could represent positive steps toward improving birth outcomes among African-American infants while aspects of racial contiguity appear to be mitigating or indeed beneficial. Segregation is a complex multidimensional construct with both deleterious and protective influences on birth outcomes, depending on the dimensions under consideration. Further research to understand racial/ethnic and economic health disparities could benefit from a focus on the contributory role of neighborhood attributes associated with the dimensions segregation and other social geographies.

Adolescent↗
PubMed2006

Early television viewing is associated with protesting turning off the television at age 6.

BACKGROUND: The effects of early exposure to television remain poorly defined. Although some have speculated that television may be habit-forming, evidence is lacking especially in young children. OBJECTIVE: To test the hypothesis that television viewing in the first 4 years of life is associated with protesting having the television turned off at age 6. METHODS: We used data from the National Longitudinal Survey of Youth. Parents reported how much television their children watched before the age of 4. They also reported how often their children protested having the television turned off at age 6. Their responses to this question were dichotomized to almost never vs other. Multivariate logistic regression was used to test the independent association of early television watching with subsequent protest at turning off the television, controlling for externalizing behavior scores at age 6, parenting style, and other covariates. RESULTS: Data were available for 1331 children. Sixty-three percent of children protested having the television turned off at age 6. In a logistic regression model, hours of television viewed per day before age 4 was associated with increased odds of protesting at age 6 (1.08 [1.02-1.15]). CONCLUSION: Early television exposure is associated with resistance to turning off the television at school age.

Age Factors↗
PubMed2006

Income inequality and physical and mental health: testing associations consistent with proposed causal pathways.

OBJECTIVES: To test associations between individual health outcomes and ecological variables proposed in causal models of relations between income inequality and health. DESIGN: Regression analysis of a large, nationally representative dataset, linked to US census and other county and state level sources of data on ecological covariates. The regressions control for individual economic and demographic covariates as well as relevant potential ecological confounders. SETTING: The US population in the year 2000. PARTICIPANTS: 4817 US adults about age 40, representative of the US population. MAIN OUTCOME MEASURES: Two outcomes were studied: self reported general health status, dichotomised as "fair" or "poor" compared with "excellent", "very good", or "good", and depression as measured by a score on the Center for Epidemiologic Studies depression instrument >16. RESULTS: State generosity was significantly associated with a reduced odds of reporting poor general health (OR 0.84, 95%CI: 0.71 to 0.99), and the county unemployment rate with reduced odds of reporting depression (OR 0.91, 95%CI: 0.84 to 0.97). The measure of income inequality is a significant risk factor for reporting poor general health (OR 1.98, CI: 1.08 to 3.62), controlling for all ecological and individual covariates. In stratified models, the index of social capital is associated with reduced odds of reporting poor general health among black people and Hispanics (OR 0.40, CI: 0.18 to 0.90), but not significant among white people. The inequality measure is significantly associated with reporting poor general health among white people (OR 2.60, CI: 1.22 to 5.56) but not black people and Hispanics. CONCLUSIONS: The effect of income inequality on health may work through the influence of invidious social comparisons (particularly among white subjects) and (among black subjects and Latinos) through a reduction in social capital. Researchers may find it fruitful to recognise the cultural specificity of any such effects.

Adult↗
PubMed2006

Improving pediatric prevention via the internet: a randomized, controlled trial.

BACKGROUND: Innovations to improve the delivery of pediatric preventive care are needed. METHODS: We enrolled children, 0 to 11 years of age, into a factorial, randomized, controlled trial of a tailored, evidence-based, Web site (MyHealthyChild) that provided information on prevention topics before a scheduled well-child visit. There were 2 components of the intervention, namely, parental Web content and provider notification. Parental Web content provided information to parents about prevention topics; provider notification communicated to physicians topics that were of interest to parents. We assigned 887 children randomly to 4 groups (usual care, content only, content and notification, or notification only). Outcomes were determined with telephone follow-up surveys conducted 2 to 4 weeks after the visit. Poisson regression analysis was used to determine the independent effects of each intervention on the number of topics discussed and the number of preventive practices implemented. RESULTS: Parents in the notification/content group and in the notification-only group reported discussing more MyHealthyChild topics with their provider. Parents in the notification/content group and in the content-only group reported implementing more MyHealthyChild topic suggestions (such as use of a safety device). CONCLUSIONS: A Web-based intervention can activate parents to discuss prevention topics with their child's provider. Delivery of tailored content can promote preventive practices.

Child↗
PubMed2005

Hospital characteristics associated with the management of pediatric splenic injuries.

CONTEXT: Despite evidence that more than 90% of children with traumatic injuries to the spleen can be successfully managed nonoperatively, there is significant variation in the use of splenectomy. As asplenic children are at increased risk of overwhelming postsplenectomy infection, nonoperative management may be considered a quality of care indicator. OBJECTIVE: To test the hypothesis that children are more likely to undergo splenectomy in general hospitals than in children's hospitals. DESIGN: Retrospective cohort study using data from the Kid's Inpatient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics. SETTING AND PARTICIPANTS: All children aged 0 to 16 years who were hospitalized with a traumatic (noniatrogenic) spleen injury in nonfederal short-stay hospitals in any of the 27 states participating in KID (N = 2851). MAIN OUTCOME MEASURE: Splenectomy performed within 1 day of arrival. RESULTS: A total of 11 children (3%) with splenic injuries receiving care at children's hospitals underwent splenectomy compared with 383 children (15.4%) cared for at general hospitals (P<.001). After adjusting for patient characteristics, injury severity, and hospital characteristics, splenectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95% confidence interval, 2.21-11.36) than among children treated at children's hospitals. CONCLUSIONS: There is considerable variation in the management of pediatric splenic injuries, with significantly lower rates of splenectomy at designated children's hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be needed to increase the use of spleen-conserving management practices.

Adolescent↗
PubMed2005

Early cognitive stimulation, emotional support, and television watching as predictors of subsequent bullying among grade-school children.

BACKGROUND: Bullying is a major public health issue, the risk factors for which are poorly understood. OBJECTIVE: To determine whether cognitive stimulation, emotional support, and television viewing at age 4 years are independently associated with being a bully at ages 6 through 11 years. METHODS: We used multivariate logistic regression, using data from the National Longitudinal Survey of Youth, to adjust for multiple confounding factors. RESULTS: Parental cognitive stimulation and emotional support at age 4 years were each independently protective against bullying, with a significant odds ratio of 0.67 for both variables associated with a 1-SD increase (95% confidence interval, 0.54-0.82 for cognitive stimulation and 0.54-0.84 for emotional support). Each hour of television viewed per day at age 4 years was associated with a significant odds ratio of 1.06 (95% confidence interval, 1.02-1.11) for subsequent bullying. These findings persisted when we controlled for bullying behavior at age 4 years in a subsample of children for whom this measure was available. CONCLUSION: The early home environment, including cognitive stimulation, emotional support, and exposure to television, has a significant impact on bullying in grade school.

Aggression↗
PubMed2005

Children's television viewing and cognitive outcomes: a longitudinal analysis of national data.

OBJECTIVE: To test the independent effects of television viewing in children before age 3 years and at ages 3 to 5 years on several measures of cognitive outcomes at ages 6 and 7 years. DESIGN: Using data from a nationally representative data set, we regressed 4 measures of cognitive development at ages 6 and 7 years on television viewing before age 3 years and at ages 3 to 5 years, controlling for parental cognitive stimulation throughout early childhood, maternal education, and IQ. RESULTS: Before age 3 years, the children in this study watched an average of 2.2 hours per day; at ages 3 to 5 years, the daily average was 3.3 hours. Adjusted for the covariates mentioned earlier, each hour of average daily television viewing before age 3 years was associated with deleterious effects on the Peabody Individual Achievement Test Reading Recognition Scale of 0.31 points (95% confidence interval [CI], -0.61 to -0.01 points), on the Peabody Individual Achievement Test Reading Comprehension Scale of 0.58 points (95% CI, -0.94 to -0.21 points), and on the Memory for Digit Span assessment from the Wechsler Intelligence Scales for Children of -0.10 points (95% CI, -0.20 to 0 points). For the Reading Recognition Scale score only, a beneficial effect of television at ages 3 to 5 years was identified, with each hour associated with a 0.51-point improvement in the score (95% CI, 0.17 to 0.85 points). CONCLUSIONS: There are modest adverse effects of television viewing before age 3 years on the subsequent cognitive development of children. These results suggest that greater adherence to the American Academy of Pediatrics guidelines that children younger than 2 years not watch television is warranted.

Adolescent↗
PubMed2005

Socioeconomic status, depression disparities, and financial strain: what lies behind the income-depression relationship?

Prior studies have consistently found the incidence and persistence of depression to be higher among persons with low incomes, but causal mechanisms for this relationship are not well understood. This study uses the National Longitudinal Survey of Youth 1979 cohort to test several hypotheses about the robustness of the depression-income relationship among adults. In regressions of depression symptoms on income and sociodemographic variables, income is significantly associated with depression. However, when controls for other economic variables are included, the effect of income is considerably reduced, and generally not significant. Employment status and the ratio of debts-to-assets are both highly significant for men and for women both above and below the median income. Fixed-effects estimates suggest that employment status and financial strain are causally related to depression, but income is not. Instrumental variable estimates suggest that financial strain may not lead to depression.

Adult↗
PubMed2005

Parental emotional support and subsequent internalizing and externalizing problems among children.

This study examined the association between early emotional support provided by parents and child internalizing and externalizing problems, using a nationally representative, longitudinal sample of 1361 children. Parental emotional support was assessed using the Home Observation for the Measurement of the Environment, incorporating both parent report and interviewer observation. We found that, controlling for child externalizing problems at age 6 years, parental emotional support at age 6 years was negatively related to child externalizing problems at age 8 years. A developmental model that assessed the timing of the emergence of this relationship was then analyzed by including parental emotional support at ages 2, 4, and 6 years as predictors of child externalizing problems at age 8 years. The developmental model suggested that less parental emotional support as early as age 2 years is associated with later externalizing problems in children. This study discusses the importance of very early parental emotional support in promoting positive child development.

Affect↗
PubMed2005

Association between parental satisfaction and antibiotic prescription for children with cough and cold symptoms.

BACKGROUND: Providers' interest in satisfying parents may provide an impetus for unnecessary antibiotic use in children. OBJECTIVES: To determine (1) whether receipt of antibiotics at a visit for cough and cold symptoms was associated with increased satisfaction and (2) whether nonreceipt of antibiotics at an initial visit but subsequent receipt of antibiotics in the course of the same illness episode was associated with decreased satisfaction. METHODS: Prospective cohort study of patients 2-10 years of age presenting to a university-affiliated pediatric clinic with cough and cold symptoms. Parents were enrolled at the index visit and then followed up by phone at least 7 days later (mean time to follow-up, 14.9 days). Satisfaction with the index visit on a 10 point scale was the primary outcome. The primary predictors were whether antibiotics were prescribed at the index visit and, if not, whether they were prescribed since that visit. Linear and median regression were used to adjust for income, child age, parental race and individual provider. RESULTS: A total of 539 parents were enrolled in the study, and 378 (70%) completed follow-up interviews. The mean age of participating children was 4.67 years (SD 2.16). Overall 47% of patients received antibiotics at the index visit, and 8% of those that did not reported receiving them between the index visit and the follow-up assessment. In the regression model, receiving antibiotics at the index visit trended toward being associated with higher satisfactions scores (0.28; P = 0.08). Among those who did not receive antibiotics initially, receiving them subsequently was associated with significantly lower median satisfaction score for the index visit (-3.0; P < 0.01). CONCLUSIONS: Receiving antibiotics after an initial visit for cough and cold symptoms at which antibiotics were not prescribed is associated with decreased satisfaction. Use of contingency prescriptions may be an important intervention.

Anti-Bacterial Agents↗
PubMed2005

Social and economic determinants of disparities in professional help-seeking for child mental health problems: evidence from a national sample.

OBJECTIVE: To test the role of social determinants-including race, education, income, and demographic factors-of child mental health services use, defined as having had a visit to a mental health professional for depression, attention-deficit, or for any reason. DATA SOURCES/STUDY SETTING: National Longitudinal Survey of Youth and the Child/Young Adult supplement, a nationally representative sample of 7-14-year-old children born to women who were 14-22 years old at the start of data collection, in 1979. African Americans and Latinos were over-sampled, and population weights are available to make nationally representative inferences. STUDY DESIGN: Indicators of mental health service use were regressed on social and economic determinants, family structure variables, and insurance variables, controlling for need as captured by several different symptom scales. PRINCIPAL FINDINGS: Girls are much less likely to obtain needed treatment for externalizing behavior disorders than are boys, and are somewhat less likely to obtain needed treatment for depression than boys. Middle children are less likely to obtain needed treatment for any mental health problem than are oldest, youngest, or only children. The presence of the father inhibits the likelihood that the child will receive treatment, particularly for depression. African Americans and Latinos are less likely than white children to receive treatment. In contrast to these rich results for the social and demographic determinants of children's specialty mental health utilization, the economic and insurance variables (including maternal education and income) seem to hold little predictive power. CONCLUSIONS: These results argue for interventions to sensitize parents-especially fathers-to the need to pay attention to the mental health needs of their children, in particular girls and middle children. The analysis also suggests that the literature on intrahousehold decision making and on the gender dimensions of investment in children is worth extending to mental health treatment decisions.

Adolescent↗
PubMed2005

Occupational injury and absence from work among African American, Hispanic, and non-Hispanic White workers in the national longitudinal survey of youth.

OBJECTIVES: We examined how race and ethnicity influence injury and illness risk and number of days of work missed as a result of injury or illness. METHODS: We fit logistic regression and negative binomial regression models using generalized estimating equations with data from 1988 to 2000 on currently employed African American, Hispanic, and non-Hispanic White participants in the National Longitudinal Survey of Youth. RESULTS: Occupational factors-having a blue-collar occupation, working full-time, having longer tenure, working 1 job versus 2, and working the late shift-were associated with increased odds of an occupational injury or illness. Although racial/ethnic minority workers were no more likely than Whites to report an occupational injury or illness, they reported missing more days of work. African American and Hispanic men missed significantly more days of work than non-Hispanic White men, and African American women missed significantly more days of work than non-Hispanic White women. CONCLUSIONS: Factors associated with occupational health are multifaceted and complex. Our findings suggest that race/ethnicity influences the duration of work absence owing to injury or illness both indirectly (by influencing workers' occupational characteristics) and directly (by acting independently of occupational factors).

Absenteeism↗
PubMed2005

Household computer and Internet access: The digital divide in a pediatric clinic population.

Past studies have noted a digital divide, or inequality in computer and Internet access related to socio-economic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access to computers and the Internet, and whether this access differed by socio-economic status or other demographic information. We conducted a phone survey of a population-based sample of parents with children ages 0 to 11 years old. Analyses assessed predictors of having home access to a computer, the Internet, and high-speed Internet service. Overall, 88.9% of all households owned a personal computer, and 81.4% of all households had Internet access. Among households with Internet access, 48.3% had high speed Internet at home. There were significant associations between home computer ownership or Internet access and parental income or education. There was no relationship these factors and high speed Internet access. Over 60% of families with annual household income of $10,000-$25,000, and nearly 70% of families with only a high-school education had Internet access at home. While income and education remain significant predictors of household computer and internet access, many patients and families at all economic levels have access, and might benefit from health promotion interventions using these modalities.

Computers↗
PubMed2004

Television, video, and computer game usage in children under 11 years of age.

OBJECTIVE: To conduct a population-based survey of television and other media usage in young children to determine (1) total media usage; (2) the proportion of children who have televisions in their bedrooms and who eat breakfast or dinner in front of the television; and (3) predictors of parental concern about the amount of television their child watches. STUDY DESIGN: Telephone survey administered to 1454 parents of children <11 years old derived from a diverse clinic population. RESULTS: The mean age of the index child was 5.05 years. Mean daily reported child media use was as follows: television (1.45 hours; SD, 1.5); videos (1.1 hours; SD, 1.30); and computer games (0.54 hours; SD, 0.96). Thirty percent of parents reported that their child ate breakfast or dinner in front of the television in the past week, and 22% were concerned about the amount of television that their child watched. In multivariate linear regression, eating breakfast or dinner in front of the television in the past week was associated with increased hours of television viewing (0.38 hours [0.21, 0.54]) and video (0.19 hours [0.04, 0.34]). Having a television in a child's bedroom was associated with increased hours of television (0.25 hours [0.07, 0.43]), video viewing (0.31 hours [0.16, 0.47]), and computer games (0.21 hours [0.10, 0.32]). In general, higher parental education was associated with decreased hours of television and video but not computer games. Older children were 2 to 3 times more likely than younger children to have a television in their bedroom and to have eaten a meal in front of it in the past week. More educated parents were less likely to report that their child had a television in their bedroom and more likely to be concerned about the amount of television their child viewed. CONCLUSIONS: Combined video and computer game usage exceeded television usage. Both children of low- and high-income parents are at risk for certain behaviors associated with television usage. Parents whose children watched more television were more likely to be concerned about the amount of television their child viewed.

Child↗
PubMed2004

Tinker, tailor, soldier, patient: work attributes and depression disparities among young adults.

Prior studies have consistently found the occurrence of depression to be higher among persons with lower socio-economic status (SES), but causal mechanisms for this relationship are often not well understood. For example, while depression has been shown to increase during spells of unemployment, little work has been done on job attributes that may be related to depression among employed people early in their careers. This study links the 1992 wave of the National Longitudinal Survey of Youth 1979 cohort-which included Depression symptom scores on the Center for Epidemiologic Studies Depression (CES-D) instrument-to the US Department of Labor's new occupational characteristics O*Net dataset. The resulting dataset includes information regarding depression, SES, and specific attributes of jobs held by the young adult respondents. Job attributes included measures of social status, interpersonal stressors, and physical conditions. Multivariate analysis revealed that for young men, higher job status is associated with lower CES-D scores. Higher scores on the opposition scale, which measures the extent to which employees are obliged to take a position opposed to others, is associated with higher CES-D scores. For young women, physically uncomfortable or dangerous jobs are associated with more depressive symptoms. Results are stratified by race/ethnicity. For Black men, unlike for White men or Latinos, job security is associated with fewer depressive symptoms; and for Latino men, but not for Black or White men, physically uncomfortable or dangerous jobs are associated with more depressive symptoms. For Black women, job status is associated with fewer depressive symptoms. We conclude that part of the SES-depression relationship may arise from the psychosocial aspects of jobs, which we have found to be significantly and meaningfully associated with depressive symptoms among employed young adults.

Adolescent↗