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Biomedical subjects

S L Gortmaker

Publications and source records attributed to S L Gortmaker.

At least 55 records · Page 3Linked to original sources
PubMed1990

Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.

Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11,699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions--particularly mental health services--remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.

Adolescent↗
PubMed1990

Inactivity, diet, and the fattening of America.

Recent studies have documented an increasing prevalence of childhood and adolescent obesity in the United States. These increases will likely result in increased adult obesity because of the tracking of fatness from adolescence into adulthood and the tendency for adults in the United States to become obese as they age. We have identified television viewing as a strong risk factor for childhood and adolescent obesity. Television viewing is associated with both the onset of obesity and a decrease in the remission of obesity and acts by decreasing activity levels and possibly influencing diet. Logistic regressions also document associations between television viewing and obesity among adults. These relationships are greater than those estimated between measures of vigorous physical activity and obesity and indicate the importance of inactivity, to which television viewing contributes substantially. Population dietary intake data indicated no statistically significant change and perhaps some decrease in mean energy intake among children and youth during the same period that obesity was increasing. These data are consistent with the hypothesis that decreases in activity reduce lean body mass and lower energy requirements. We conclude that multiple intervention approaches involving diet, exercise, and restriction of television viewing and other sedentary activities all appear necessary to halt the fattening of America.

Adolescent↗
PubMed1988

A successful experiment to reduce unnecessary laboratory use in a community hospital.

A series of interventions at a 228-bed general hospital provided physicians with feedback at regular intervals concerning the amount of laboratory services employed in treating their patients. Case-mix-adjusted estimates of laboratory tests allowed each physician to compare use of laboratory tests with that of peers in the same department at the same hospital. Physicians with "excess" practice patterns ordered hundreds more laboratory tests than average each year. A multifaceted educational program included the following: 1) meetings were held concerning costs and unnecessary laboratory tests; 2) physicians were given descriptions of their practice patterns relative to their peers as part of both large and small departmental discussions; 3) the feedback was repeated a year later; 4) a consensus conference established guidelines for test ordering; and 5) a sample of patient records was examined for appropriateness of laboratory test ordering. A total of 37% of a sample of tests ordered during the baseline period by physicians with "excess" practice patterns was classified as inappropriate. The intervention resulted in a reduction of 1.8 tests per patient (P = 0.0005). Eight of the nine tests individually showed reductions in use. Charge data from the target hospital showed a statistically significant reduction in laboratory charges per patient in the quarter following program initiation (P = 0.02) and no evidence for change in a group of five comparison hospitals. There was no evidence for reductions in the ordering of essential tests. These results demonstrate a cost-effective approach to reducing unnecessary costs that can be implemented in hospitals with integrated data systems.

Clinical Laboratory Techniques↗
PubMed1987

Increasing pediatric obesity in the United States.

Data from four national surveys indicate pronounced increases in the prevalence of pediatric obesity in the United States. Obese children are defined as those with triceps skinfolds greater than or equal to the 85th percentile of children of the same age and sex in 1963 to 1970. Superobese children are those with skinfolds greater than or equal to the 95th percentile. Compared with skinfold data from the 1963 to 1965 National Health Examination Survey, cycle 2, skinfold data from the second National Health and Nutrition Examination Survey, conducted from 1976 to 1980, indicate a 54% increase in the prevalence of obesity among children 6 to 11 years old and a 98% increase in the prevalence of superobesity. Compared with skinfold data from the 1966 to 1970 National Health Examination Survey, cycle 3, skinfold data from the second National Health and Nutrition Examination Survey indicate a 39% increase in the prevalence of obesity among children 12 to 17 years old and a 64% increase in the prevalence of superobesity. Increases occurred among children of all ages and both sexes and for both blacks and whites. Blood pressure data from the four surveys suggest that the share of pediatric hypertension associated with obesity has increased. Such rapid increases in obesity indicate that environmental causes are likely responsible.

Adolescent↗
PubMed1987

Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.

The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonatal mortality rates did not increase in the target areas following initiation of RICP, indicating that deaths were not merely being postponed. Nine of ten individual sites showed reductions in infant mortality following program initiation. Birthweight-specific mortality data indicated that the decline was due mainly to reductions in neonatal mortality among low-birthweight infants. No reductions in the incidence of low birthweight were observed in the target areas. Substantial gaps in the delivery of prenatal care remained due to the continuing poverty of the population and the resultant lack of financial coverage for health services. We conclude that improved perinatal medical care can reduce infant mortality in poor rural areas to average levels experienced in the United States, and that the high rates still observed in some rural counties are unnecessary.

Black or African American↗
PubMed1985

Do we fatten our children at the television set? Obesity and television viewing in children and adolescents.

The association of television viewing and obesity in data collected during cycles II and III of the National Health Examination Survey was examined. Cycle II examined 6,965 children aged 6 to 11 years and cycle III examined 6,671 children aged 12 to 17 years. Included in the cycle III sample were 2,153 subjects previously studied during cycle II. These surveys, therefore, provided two cross-sectional samples and one prospective sample. In all three samples, significant associations of the time spent watching television and the prevalence of obesity were observed. In 12- to 17-year-old adolescents, the prevalence of obesity increased by 2% for each additional hour of television viewed. The associations persisted when controlled for prior obesity, region, season, population density, race, socioeconomic class, and a variety of other family variables. The consistency, temporal sequence, strength, and specificity of the associations suggest that television viewing may cause obesity in at least some children and adolescents. The potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis.

Adolescent↗
PubMed1984

Factors within the physical environment associated with childhood obesity.

The relationship of obesity to environmental factors such as season, region, and population density was examined in children studied during cycle II of the National Health Examination Survey. This survey selected 7119 children aged 6 to 11 yr old from a representative noninstitutionalized sample of the United States population. The prevalence of obesity (triceps skinfold more than the 85th percentile) was significantly more in the Northeast and Midwest than in the West and significantly more in large metropolitan areas than in areas with lower population densities. The prevalence of obesity was generally lowest in the summer and highest in the fall or winter. Each environmental variable was associated with 2- to 3-fold variations in the prevalence of obesity. The effect of region, population density, and season appeared independent of race and socioeconomic status. Similar relationships were found for superobesity (triceps skinfold more than the 95th percentile). These results emphasize that environmental variables significantly affect the prevalence of obesity and could help account for the wide variations in prevalence that have been previously published. Understanding the mechanisms by which the environment affects childhood obesity may improve the effectiveness of community level interventions.

Child↗
PubMed1982

Parental smoking and the risk of childhood asthma.

Data from two random population surveys are used to assess the relationship between parental smoking and the prevalence of asthma in children aged 0-17. Data from a 1977 Midwestern urbanized county indicate that, if mothers smoked, the prevalence of parent reported asthma increased from 5.0 per cent to 7.7 per cent (estimated relative risk of 1.5), and the prevalence of functionally impairing asthma increased from 1.1 per cent to 2.2 per cent (relative risk of 2.0). In a more rural Eastern county in 1980, a lower overall prevalence of asthma was noted. However, similar estimated relative risks of asthma (1.8) and functionally impairing asthma (2.4) were found to be associated with maternal smoking. Inconsistent relationships were found between the estimated prevalence of asthma and paternal smoking. When multivariate controls were introduced, the relationships between maternal smoking and asthma persisted. Estimated attributable risks indicate that between 18 per cent and 34 per cent of the asthma reported in these samples can be attributed to maternal smoking. Implications of these findings for primary care physicians are discussed.

Adolescent↗
PubMed1981

Medicaid and the health care of children in poverty and near poverty: some successes and failures.

Recent trends in access to and utilization of health services by children living in poverty, near poverty, and higher income households in the Flint, Michigan, metropolitan area are examined. During the period under study (1973-1977), there were substantial increases in the percentage of poor children enrolled in Medicaid. By 1977, however, 15 per cent of children in poverty in the city of Flint were still not enrolled; in suburban areas, this estimate was 30 per cent. Some correlates of non-enrollment are identified. These changes in Medicaid enrollment were accompanied by an attenuation of differences in the utilization of ambulatory medical services among income groups, although children on Medicaid in 1977 were still less likely to have a regular source of care, and less likely to have a pediatrician as a regular physician. Although dental visits were covered by Medicaid beginning in 1975, economic differentials in dental utilization appear to have widened over the period under study. A variety of barriers to the delivery of services under Medicaid in this community are noted, and the generalizability of these findings discussed.

Adolescent↗
PubMed1979

The effects of prenatal care upon the health of the newborn.

Data upon all births and infant deaths in New York City in 1968 are analyzed using methods for the analysis of multidimensional contingency tables. These methods provide estimates of the effect of variations in prenatal care upon the relative risks of low birth weight and neonatal and postneonatal mortality, controlling for a wide variety of factors which tend to "select" women into a program of prenatal care. Significant relationships between lack of prenatal care and infant mortality are estimated, but these occur mainly via the relationship of inadequate prenatal care to low birth weight. Furthermore, among white mothers who delivered on a private service, those receiving inadequate levels of prenatal care experienced only slightly increased risks of a low birth weight infant. In contrast, white mothers who delivered on a general service, and all black mothers, experienced substantially increased risks when receiving inadequate prenatal care. A variety of behavioral characteristics of mothers were not controlled in these analyses, and thus clear causal inferences concerning the efficacy of prenatal care cannot be drawn. These analyses do, however, identify a significant population of women at substantial risk.

Adult↗
PubMed1978

Elective induction and stimulation of labor and the health of the infant.

This study examines a large heterogeneous sample to determine whether elective induction and stimulation of labor have a beneficial or deleterious effect on the health of the infant. Previous studies have reached contradictory results, partly because of the small sample sizes employed. This study uses a multiple regression analysis of New York City birth certificate data from 1968. We find a small, but significant, negative effect on the newborn of both elective induction of labor and elective stimulation of labor. When hospital care context is allowed to vary, much larger negative effects were found within municipal hospitals and to a lesser extent on service wards of voluntary hospitals. Although 1968 findings cannot be applied to 1978, the implications are clear.

Apgar Score↗
PubMedDate not supplied

Assessing managed care for children with chronic conditions.

This paper reviews opportunities to monitor managed care for children and adolescents with chronic conditions and considers how well the Health Plan Employer Data and Information Set, version 3.0 (HEDIS 3.0), assesses care for these children. We propose four steps to strengthen the applicability of HEDIS to children with chronic conditions: (1) develop methods of identifying and monitoring groups of children with chronic conditions; (2) report HEDIS indicators for these children separately from those for other children; (3) develop and implement consumer and provider surveys that elicit information specific to these populations; and (4) develop specific structure, process, and outcomes indicators for children with chronic conditions.

Adolescent↗
PubMedDate not supplied

Assessment of non-response bias in a probability household survey of male same-gender sexual behavior.

OBJECTIVE: To assess non-participation bias in a survey of male sexual behavior. MATERIAL AND METHODS: A household survey was carried out in 1992-1993 using a probability sampling frame in Mexico City. Demographic variables were available for all eligible men. The extent of non-participation bias was estimated using a version of the Heckman method, which utilizes two equations, one to predict participation and the other to predict reports of same-gender sexual behavior. RESULTS: A total of 8,068 of the 13,713 eligible men completed a face-to-face questionnaire (response rate 59%); 173 men (2.1%) reported bisexual behavior in their lifetime, and 37 (0.4%) reported only male partners. Survey participation was predicted using demographic variables: 67% of the observations were correctly predicted by a probit regression model: 82% of participants and 53% of non-participants (pseudo-r2 = 0.13). Same-gender sexual behavior was predicted by variables indicating attachment to gay/bisexual social networks, history of sexually transmitted diseases, positive attitudes towards gay and bisexual males, and lack of support from male relatives. Ninety-seven per cent of the cases was correctly predicted by the probit model (pseudo-r2 = 0.14). The correlation between these two equations was not statistically significant. CONCLUSIONS: These results indicate that prevalence estimates of same-gender sexual behavior among Mexico City men were not biased by selective survey participation. Careful selection and training of household interviewers may have assisted in minimizing potential bias.

Adolescent↗