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Biomedical subjects

Steven L Gortmaker

Publications and source records attributed to Steven L Gortmaker.

At least 19 recordsLinked to original sources
PubMed2006

Play Across Boston: a community initiative to reduce disparities in access to after-school physical activity programs for inner-city youths.

BACKGROUND: In 1999, the Centers for Disease Control and Prevention (CDC) funded Play Across Boston to address disparities in access to physical activity facilities and programs for Boston, Mass, inner-city youths. CONTEXT: Local stakeholders worked with the Harvard School of Public Health Prevention Research Center and Northeastern University's Center for the Study of Sport in Society to improve opportunities for youth physical activity through censuses of facilities and programs and dissemination of results. METHODS: Play Across Boston staff conducted a facility census among 230 public recreational complexes and a program census of 86% of 274 physical activity programs for Boston inner-city youths aged 5 to 18 years during nonschool hours for the 1999 to 2000 school year and summer of 2000. Comparison data were collected from three suburban communities: one low income, one medium income, and one high income. CONSEQUENCES: Although Boston has a substantial sports and recreational infrastructure, the ratio of youths to facilities in inner-city Boston was twice the ratio found in the medium- and high-income suburban comparison communities. The low-income suburban comparison community had the highest number of youths per recreational facility with 137 youths per facility, followed by Boston with 117 youths per facility. The ratio of youths to facilities differed among Boston neighborhoods. Boston youths participated less in school-year physical activities than youths in medium- and high-income communities, and less advantaged Boston neighborhoods had lower levels of participation than more advantaged Boston neighborhoods. Girls participated less than boys. INTERPRETATION: Play Across Boston successfully developed and implemented a rigorous needs assessment with local relevance and important implications for public health research on physical activity and the environment. Boston Mayor Thomas M. Menino called the Play Across Boston report a "playbook" for future sports and recreation planning by the city of Boston and its community partners.

Adolescent↗
PubMed2006

US state- and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis.

Although social capital has been linked to a variety of health outcomes, its association with obesity has yet to be elucidated. This study explored the relations between social capital measured at the US state and county levels and individual obesity and leisure-time physical inactivity. Individual-level data were drawn from the 2001 Behavioral Risk Factor Surveillance System survey, while data from other surveys and administrative sources were used to construct contextual measures. Two state-level social capital scales were derived from 10 indicators and two county-level scales from five indicators. In 2-level analyses of over 167,000 adults nested within 48 states plus the District of Columbia, residence in a state above the median on one or both state social capital scales (vs. neither scale) was associated with lower relative odds of obesity and physical inactivity, controlling for individual-level covariables and state-level estimates of mean household income, the Gini coefficient, and the percentage of Black residents. In 3-level analyses, the adjusted odds ratio (OR) for physical inactivity associated with residence in a county above the median on one or both county social capital scales was significantly below 1, while the association with obesity was not significant. Significantly weaker inverse ORs for the relations between state- and county-level social capital and obesity were observed among American Indians/Alaska Natives compared to Whites. Meanwhile, little support was found for mediation by social capital of the associations of urban sprawl and income inequality with obesity or physical inactivity. Overall, this study provides some evidence for the promotion of social capital as a potential strategy for addressing the burgeoning obesity epidemic.

Adult↗
PubMed2006

When children eat what they watch: impact of television viewing on dietary intake in youth.

OBJECTIVES: To test whether increased television viewing is associated with increased total energy intake and with increased consumption of foods commonly advertised on television, and to test whether increased consumption of these foods mediates the relationship between television viewing and total energy intake. DESIGN: Prospective observational study with baseline (fall 1995) and follow-up (spring 1997) measures of youth diet, physical activity, and television viewing. We used food advertising data to identify 6 food groups for study (sweet baked snacks, candy, fried potatoes, main courses commonly served as fast food, salty snacks, and sugar-sweetened beverages). SETTING AND PARTICIPANTS: Five public schools in 4 communities near Boston. The sample included 548 students (mean age at baseline, 11.70 years; 48.4% female; and 63.5% white). MAIN OUTCOME MEASURES: Change in total energy intake and intake of foods commonly advertised on television from baseline to follow-up. RESULTS: After adjusting for baseline covariates, each hour increase in television viewing was associated with an additional 167 kcal/d (95% confidence interval, 136-198 kcal/d; P<.001) and with increases in the consumption of foods commonly advertised on television. Including changes in intakes of these foods in regression models provided evidence of their mediating role, diminishing or rendering nonsignificant the associations between change in television viewing and change in total energy intake. CONCLUSIONS: Increases in television viewing are associated with increased calorie intake among youth. This association is mediated by increasing consumption of calorie-dense low-nutrient foods frequently advertised on television.

Advertising↗
PubMed2006

Quality of life for children and adolescents: impact of HIV infection and antiretroviral treatment.

BACKGROUND: HIV/AIDS mortality rates in the United States are declining; pediatric HIV has become a chronic disease, with quality of life (QoL) outcomes assuming greater importance. OBJECTIVES: To compare QoL among HIV-infected and uninfected children and to assess the impact of different antiretroviral regimens on QoL among HIV-infected children. METHODS: Perinatally exposed, HIV-infected (N = 1847) and uninfected (N = 712) children and adolescents were studied. Among infected children, 1283 were available for the antiretroviral regimen analysis. QoL domain scores were assessed for subjects 6 months to 4 years, 5 to 11 years, and 12 to 21 years of age, and the impact of infection status and alternative treatment regimens on QoL domains was evaluated. RESULTS: HIV infection was associated with significantly worse mean adjusted scores for functional status among children 6 months to 4 years of age and health perceptions, physical resilience, physical functioning, and social/role functioning among those 5 to 11 years of age. However, uninfected children 5 to 11 years of age reported significantly worse psychological functioning. HIV-infected children (5-11 years of age) and adolescents (12-21 years of age) receiving no antiretroviral treatment had worse health perceptions. Adolescents receiving no antiretroviral agents also had worse symptoms. When antiretroviral regimens were compared, adolescents receiving protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-containing therapy had worse symptoms, compared with those receiving protease inhibitor-containing therapy; otherwise, no significant differences were found. CONCLUSIONS: Generally parents of HIV-infected children 6 months to 4 years and 5 to 11 years of age generally reported lower mean QoL scores than did parents of uninfected children, although worse psychological functioning was reported for uninfected children. HIV-infected adolescents not receiving antiretroviral treatment had worse health perceptions and symptoms. We found no consistent QoL differences among children receiving different antiretroviral regimens.

Activities of Daily Living↗
PubMed2006

Estimating the energy gap among US children: a counterfactual approach.

OBJECTIVE: Our goal was to quantify the magnitude of energy imbalance responsible for the increase in body weight among US children during the periods 1988-1994 and 1999-2002. METHODS: We adopted a counterfactual approach to estimate weight gains in excess of normal growth and the implicit "energy gap"--the daily imbalance between energy intake and expenditure. On the basis of Centers for Disease Control and Prevention growth charts, we constructed weight, height, and BMI percentile distributions for cohorts 2 to 4 and 5 to 7 years of age in the 1988-1994 National Health and Nutrition Examination Survey (N = 5000). Under the counterfactual "normal-growth-only" scenario, we assumed that these percentile distributions remained the same as the cohort aged 10 years. Under this assumption, we projected the weight and height distributions for this cohort at 12 to 14 and 15 to 17 years of age on the basis of their baseline weight-for-age and stature-for-age percentiles. We compared these distributions with those for corresponding age groups in the 1999-2002 National Health and Nutrition Examination Survey (N = 3091) approximately 10 years after the 1988-1994 National Health and Nutrition Examination Survey. We calculated differences between the counterfactual and observed weight distributions and translated this difference into the estimated average energy gap, adjusting for increased total energy expenditure attributable to weight gain. In addition, we estimated the average excess weight accumulated among overweight adolescents in the 1999-2002 National Health and Nutrition Examination Survey, validating our counterfactual assumptions by analyzing longitudinal data from the National Longitudinal Survey of Youth and Bogalusa Heart Study. RESULTS: Compared with the counterfactual scenario, boys and girls who were aged 2 to 7 in the 1988-1994 National Health and Nutrition Examination Survey gained, on average, an excess of 0.43 kg/year over the 10-year period. Assuming that 3500 kcal leads to an average of 1-lb weight gain as fat, our results suggest that a reduction in the energy gap of 110-165 kcal/day could have prevented this increase. Among overweight adolescents aged 12 to 17 in 1999-2002, results indicate an average energy imbalance ranging from 678 to 1017 kcal/day because of an excess of 26.5 kg accumulated over 10 years. CONCLUSIONS: Quantifying the energy imbalance responsible for recent changes in weight distribution among children can provide salient targets for population intervention. Consistent behavioral changes averaging 110 to 165 kcal/day may be sufficient to counterbalance the energy gap. Changes in excess dietary intake (eg, eliminating one sugar-sweetened beverage at 150 kcal per can) may be easier to attain than increases in physical activity levels (eg, a 30-kg boy replacing sitting for 1.9 hours with 1.9 hours walking for an extra 150 kcal). Youth at higher levels of weight gain will likely need changes in multiple behaviors and environments to close the energy gap.

Adolescent↗
PubMed2005

Protease inhibitor combination therapy, severity of illness, and quality of life among children with perinatally acquired HIV-1 infection.

OBJECTIVES: This study examines quality of life (QOL) among school-aged children with perinatally acquired HIV infection and compares QOL outcomes between treatment groups that differ according to the use of protease inhibitor (PI) combination therapy (PI therapy). To gain insights into how PI therapy might influence QOL, associations between severity of illness and QOL were also investigated. METHODS: Cross-sectional data for 940 children, 5 to 18 years of age, who were enrolled in Pediatric AIDS Clinical Trials Group Late Outcomes Protocol 219 were used to examine domains of caregiver-reported QOL, as assessed with the General Health Assessment for Children, during 1999. The General Health Assessment for Children is an age-specific, modular, QOL assessment that was developed for the study with previously validated measures. QOL differences between treatment groups were estimated with linear and logistic regressions that controlled for sociodemographic characteristics (age, gender, race/ethnicity, maternal/caregiver education, and respondent) and severity-of-illness indicators related to receipt of PI therapy (AIDS status, log(10) CD4+ cell counts, and height-for-age z scores). RESULTS: The mean age of participants was 9.7 years. Most children were non-Hispanic black (54%) or Hispanic (31%), and 49% of the participants were female. At the 1999 study visit, approximately 14% of children had severe immune suppression (<15% CD4+ cells), whereas 62% of children had > or =25% CD4+ cells, ie, no immune suppression. Participants did exhibit some lag in growth, with mean height and weight z scores of -0.70 and -0.20, respectively. Twenty-eight percent of the children were reported to have met criteria for AIDS at study entry (1993-1999). When treatment groups were compared, children receiving PI therapy (72%) were older, had lower CD4+ cell percentages, and had lower height and weight z scores than did those receiving non-PI therapies. They were also more likely to have met criteria for AIDS at study entry. The most commonly used PIs were ritonavir (46%) and nelfinavir (63%). Health perceptions ratings for most children were at the upper end of the scale, whereas ratings for 25% of the children ranged over the lower 70% of scale scores. Almost one half of the children had at least some limitations in physical functioning, with more frequent limitations in energy-demanding activities (46%) than in basic activities of daily living (32%). The Behavior Problems Index was used to assess psychologic functioning. The mean total Behavior Problems Index score (9.34) and the proportion of children with extreme scores (23%) were consistent with values reported for chronically ill children and those at social and economic risk. One or more limitations in social/school functioning were reported for 58% of children. More than one third of the children (38%) experienced > or =1 physical symptoms that were at least moderately distressing. Health perceptions, physical functioning, psychologic functioning, social/school functioning, and overall HIV symptom scores did not differ between treatment groups. However, receipt of PI therapy was associated with an increased rate of diarrhea (28 vs 13%; adjusted odds ratio: 2.59; 95% confidence interval: 1.74-3.85). Severity of illness was associated with QOL in all domains except psychologic functioning. Higher log(10) CD4+ cell counts, higher height-for-age z scores, and absence of AIDS at study entry were independently associated with fewer social/school limitations and better HIV symptom scores. Health perceptions and physical functioning scores were associated with log(10) CD4+ cell counts and height z scores, respectively. CONCLUSIONS: QOL among children receiving PI therapy differed little from that among children receiving non-PI therapy, despite clinical indications of more advanced disease. Importantly, the study found no evidence of direct negative effects of PI therapy on QOL outcomes, other than an increased rate of diarrhea. Findings suggest that the effects of PI combination therapies to slow or to prevent disease progression and to increase CD4+ cell counts and height growth have the potential to improve QOL among children with HIV infection. However, many children do experience a constellation of functional impairments indicated by behavioral problems and clinical symptoms, with limitations in activities and in school performance. Comprehensive health services will continue to be required to minimize long-term illness and disability and to maximize children's potential as they move into adolescence and adulthood.

Adolescent↗
PubMed2005

The impact of a school-based obesity prevention trial on disordered weight-control behaviors in early adolescent girls.

OBJECTIVE: To assess the impact of an obesity prevention intervention on use of self-induced vomiting/laxatives (purging) and diet pills to control weight in girls in early adolescence. DESIGN: We matched and randomly assigned 10 middle schools to an intervention or a control condition in a randomized controlled trial. Longitudinal multivariable analyses using generalized estimating equations were conducted with data from 480 girls to examine the effects of the intervention on the risk of reporting a new case of purging or diet pill use to control weight at follow-up 21 months later, while controlling for ethnicity and school matched pairs. Girls who reported purging or using diet pills at baseline were excluded from analyses. SETTING: Middle schools. PARTICIPANTS: Four hundred eighty girls in early adolescence aged 10 to 14 years (mean age, 11.5 years). INTERVENTION: The Planet Health obesity prevention program was implemented during 2 school years and was designed to promote healthful nutrition and physical activity and to reduce television viewing. OUTCOME: Reduced risk of using self-induced vomiting/laxatives or diet pills to control weight in the past 30 days. RESULTS: After the intervention, we found 14 (6.2%) of 226 girls in control schools and 7 (2.8%) of 254 girls in intervention schools reported purging or using diet pills to control their weight (P = .003). In a multivariable generalized estimating equation model, girls in intervention schools were less than half as likely to report purging or using diet pills at follow-up compared with girls in control schools (odds ratio, 0.41; 95% confidence interval, 0.22-0.75). CONCLUSION: These findings provide promising evidence that school-based interventions may effectively integrate prevention of both obesity and disordered weight-control behaviors.

Adolescent↗
PubMed2005

Effects of a school-based obesity-prevention intervention on menarche (United States).

OBJECTIVE: Early menarche is a risk factor for breast cancer. Since body composition influences age at menarche we decided to estimate the effects of a school-based intervention for the prevention of obesity on the initiation of menses in young girls. METHODS: Ten schools were randomized to a modified curriculum or no curricular changes for 2 school-years. Data of 508 pre-menarcheal girls at baseline (age range: 10-13 years) were analyzed. RESULTS: Girls attending an intervention school experienced menarche less frequently than girls attending control schools during the intervention period (intervention schools = 54%, control schools = 59%; RR = 0.76; 95% CI [0.66, 0.87]). Attending an intervention school was also associated with lower increase in BMI (-0.3 kg/m2; p = 0.003), lower gains in triceps skinfold thickness (-1.5 mm; p = 0.007), decreased television viewing (-0.6 h/day; p<0.0001) and increased physical activity (3.1 MET-h/week; p = 0.032). Including these changes as predictors of menarche incidence attenuated the intervention effect (RR = 0.94; 95% CI [0.80, 1.10]). CONCLUSIONS: The intervention delayed menarche in this group of girls. The delay was produced by increased physical activity, reduced television viewing and changes in BMI and fat distribution. These findings may have implications for the primary prevention of breast cancer.

Adolescent↗
PubMed2005

Playground safety and access in Boston neighborhoods.

BACKGROUND: Youth physical activity is partly influenced by access to playgrounds and recreational opportunities. Playgrounds in disadvantaged areas may be less safe. METHODS: Investigators assessed safety at 154 playgrounds in Boston between July 2000 and July 2001. Playgrounds were geocoded and safety scores assigned to census block groups (CBGs). For each of Boston's 591 CBGs, investigators calculated the total number youth and proportions of black residents, adults without a high school degree, and youth living in poverty. Investigators assigned each CBG a safety score, and calculated distance from the CBG centroid to the nearest playground and nearest "safe" playground (top safety quartile). Statistical analyses were completed using SAS PROC GENMOD by October 2002. RESULTS: In bivariate analysis, playground safety was inversely associated with total CBG youth population (p =0.001) and proportions of black residents (p <0.001), youth in poverty (p =0.003) and residents with no high school degree (p <0.002). The proportion of black residents in the CBG was inversely associated with safety (p =0.013), independent of CBG educational attainment and numbers of youth. The average distance was 417 meters to the nearest playground and 1133 meters to the nearest "safe" playground. Distance to the nearest playground was inversely associated with the proportion of residents with no high school degree (p <0.0001) after controlling for numbers of youth and proportion of black residents. CBGs with more youth had greater distances to the safest playgrounds (p =0.04). CONCLUSIONS: In Boston, playground safety and access to playgrounds varied according to indicators of small-area socioeconomic and racial/ethnic composition.

Adolescent↗
PubMed2005

Clustering of fast-food restaurants around schools: a novel application of spatial statistics to the study of food environments.

OBJECTIVES: We examined the concentration of fast food restaurants in areas proximal to schools to characterize school neighborhood food environments. METHODS: We used geocoded databases of restaurant and school addresses to examine locational patterns of fast-food restaurants and kindergartens and primary and secondary schools in Chicago. We used the bivariate K function statistical method to quantify the degree of clustering (spatial dependence) of fast-food restaurants around school locations. RESULTS: The median distance from any school in Chicago to the nearest fast-food restaurant was 0.52 km, a distance that an adult can walk in little more than 5 minutes, and 78% of schools had at least 1 fast-food restaurant within 800 m. Fast-food restaurants were statistically significantly clustered in areas within a short walking distance from schools, with an estimated 3 to 4 times as many fast-food restaurants within 1.5 km from schools than would be expected if the restaurants were distributed throughout the city in a way unrelated to school locations. CONCLUSIONS: Fast-food restaurants are concentrated within a short walking distance from schools, exposing children to poor-quality food environments in their school neighborhoods.

Adolescent↗
PubMed2004

Diffusion of an integrated health education program in an urban school system: planet health.

OBJECTIVE: Assessed the feasibility, acceptability, and sustainability of Planet Health, an interdisciplinary, integrated health education curriculum implemented in six public middle schools. METHODS: Workshops on Planet Health implementation were attended by 129 teachers (language arts, math, science, and social studies) over three school years (1999-2000, 2000-2001, and 2001-2002). Questionnaires were administered post-implementation and in the fall and spring of each year. Outcomes were dose, acceptability, feasibility, and intent to continue use. RESULTS: The average number of lessons taught per teacher per year was 1.7 to 3.1, compared to a goal of 2 to 3. Each year, teachers reported high acceptability and perceived feasibility of the intervention, and the majority indicated they intended to continue using the curriculum. CONCLUSIONS: Planet Health was feasible and acceptable in a participatory research model involving a public school-university partnership, and it was also sustainable independent of the research effort.

Boston↗
PubMed2004

Youth recall and TriTrac accelerometer estimates of physical activity levels.

PURPOSE: To examine significance of missing data and describe physical activity patterns using recall and accelerometer measures among youth in a nonlaboratory setting. METHODS: Fifty-four middle-school students wore TriTrac-R3D monitors (TTM) and completed an interviewer-prompted 24-h recall during two, 5-d monitoring sessions. We coded 2860 30-min recall intervals to a standard MET compendium. Complete TTM data were gathered for 43 students. Ordinal multinomial models tested for bias in TTM estimates of activity levels due to: 1) exclusion of subjects with incomplete TTM data, and 2) exclusion of intervals within days due to missing TTM data. RESULTS: Students with complete monitor data had an average 12.5 +/- 0.9 monitored hours per day over 5.5 +/- 2.1 d. Compared with students with incomplete monitoring data, they reported similar proportions of recall 30-min intervals at sedentary (68% vs 69%), light (14% vs 15%), moderate (11% vs 10%), and vigorous (7% vs 6%) intensity levels (P = 0.63). The proportion of recall intervals (within days) with and without simultaneous monitoring data did not differ by activity intensity (P = 0.64) across sedentary (69% vs 67%), light (14% vs 12%), moderate (11% vs 10%), and vigorous (6% vs 9%) categories. Recalls overestimated percent time per day in moderate and vigorous activity relative to TTM (22.8% vs 8.9%, P < 0.0001). Boys reported higher percent of time than girls in vigorous activity (10.9% vs 3.9%, P < 0.05). Girls reported more time than boys (9.5% vs 6.4%, P < 0.05) in light activities. No significant sex differences were observed using TTM. CONCLUSIONS: Missing TTM data did not bias estimates of activity levels. Self-reported activity measures overestimated moderate and vigorous activity relative to the TTM and varied by sex.

Adolescent↗
PubMed2004

Effects of fast-food consumption on energy intake and diet quality among children in a national household survey.

BACKGROUND: Fast food has become a prominent feature of the diet of children in the United States and, increasingly, throughout the world. However, few studies have examined the effects of fast-food consumption on any nutrition or health-related outcome. The aim of this study was to test the hypothesis that fast-food consumption adversely affects dietary factors linked to obesity risk. METHODS: This study included 6212 children and adolescents 4 to 19 years old in the United States participating in the nationally representative Continuing Survey of Food Intake by Individuals conducted from 1994 to 1996 and the Supplemental Children's Survey conducted in 1998. We examined the associations between fast-food consumption and measures of dietary quality using between-subject comparisons involving the whole cohort and within-subject comparisons involving 2080 individuals who ate fast food on one but not both survey days. RESULTS: On a typical day, 30.3% of the total sample reported consuming fast food. Fast-food consumption was highly prevalent in both genders, all racial/ethnic groups, and all regions of the country. Controlling for socioeconomic and demographic variables, increased fast-food consumption was independently associated with male gender, older age, higher household incomes, non-Hispanic black race/ethnicity, and residing in the South. Children who ate fast food, compared with those who did not, consumed more total energy (187 kcal; 95% confidence interval [CI]: 109-265), more energy per gram of food (0.29 kcal/g; 95% CI: 0.25-0.33), more total fat (9 g; 95% CI: 5.0-13.0), more total carbohydrate (24 g; 95% CI: 12.6-35.4), more added sugars (26 g; 95% CI: 18.2-34.6), more sugar-sweetened beverages (228 g; 95% CI: 184-272), less fiber (-1.1 g; 95% CI: -1.8 to -0.4), less milk (-65 g; 95% CI: -95 to -30), and fewer fruits and nonstarchy vegetables (-45 g; 95% CI: -58.6 to -31.4). Very similar results were observed by using within-subject analyses in which subjects served as their own controls: that is, children ate more total energy and had poorer diet quality on days with, compared with without, fast food. CONCLUSION: Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.

Adolescent↗
PubMed2003

Impact of television viewing patterns on fruit and vegetable consumption among adolescents.

BACKGROUND: National data indicate that children and youth do not meet Healthy People 2010 objectives for fruit and vegetable intake. Television viewing is hypothesized as a contributing factor because of its documented role in encouraging consumption of highly advertised foods that may lead to the replacement of fruits and vegetables. METHODS: A sample of 548 ethnically diverse students (average age: 11.7 +/- 0.8 years) from public schools in 4 Massachusetts communities were studied prospectively over a 19-month period from October 1995 to May 1997. We examined the associations between baseline and change in hours of television and video viewing per day (the predictor variables) and change in energy-adjusted intake of fruits and vegetables by using linear regression analyses to control for potentially confounding variables and the clustering of observations within schools. FINDINGS: For each additional hour of television viewed per day, fruit and vegetable servings per day decreased (-0.14) after adjustment for anthropometric, demographic, dietary variables (including baseline percent energy from fat, sit-down dinner frequency, and baseline energy-adjusted fruit and vegetable intake), and physical activity. Baseline hours of television viewed per day was also independently associated with change in fruit and vegetable servings (-0.16). CONCLUSIONS: Television viewing is inversely associated with intake of fruit and vegetables among adolescents. These associations may be a result of the replacement of fruits and vegetables in youths' diets by foods highly advertised on television.

Adolescent↗
PubMed2003

Sexual behavior patterns and HIV risks in bisexual men compared to exclusively heterosexual and homosexual men.

OBJECTIVE: To compare patterns of sexual behavior among bisexual, heterosexual and homosexual men. MATERIAL AND METHODS: A household probability survey was carried out in Mexico City in 1992-1993 using the national health surveys sampling frame. Information from 8,068 men was obtained; however, the main analysis of this paper refers only to men sexually active in the previous 5 years. RESULTS: Bisexuals reported more prevalent anal intercourse with women (16% vs. 3%, p = 0.01), and more sexual encounters with female sex workers than exclusive heterosexuals (10% vs. 4%; p = 0.04). Bisexuals used condoms more often with sex workers than did heterosexuals (p = 0.01). Most of the bisexuals (79%) did not engage in anal receptive or insertive intercourse with males in the previous year, practicing instead oral insertive sex or only masturbation; 35% of homosexuals did not report practicing anal sex. Bisexuals who engaged in anal intercourse had less anal receptive behavior than homosexuals (13% vs. 60%, p < 0.01); of these, due to condom use, only 7% of bisexuals and 18% of homosexuals had unprotected anal receptive sex in the last intercourse with a male. CONCLUSIONS: Bisexuals practice less risky sexual behavior with males than exclusive homosexuals. This finding may imply that bisexual men in Mexico are an ineffective epidemiological bridge for HIV transmission. The English version of this paper is available too at:http://www.insp.mx/salud/index.html.

Adolescent↗
PubMed2002

The prevalence of pain in pediatric human immunodeficiency virus/acquired immunodeficiency syndrome as reported by participants in the Pediatric Late Outcomes Study (PACTG 219).

OBJECTIVES: As the life expectancy of children with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increases, quality-of-life outcomes are of increasing concern. The prevalence of pain in adults with AIDS ranges from 40% to 60%, depending on stage of illness. There is limited research concerning pain in HIV-infected children and youth. DESIGN: The General Health Assessment for Children was administered to caregivers of HIV-infected children and youth enrolled in the Pediatric Late Outcomes Study (PACTG 219), a prospective cohort study. Pain is assessed over the previous month with 7 questions. For the purpose of this analysis, we defined pain as the presence of pain of at least moderate intensity. Participants were observed from January 1, 1996, to December 31, 1999. RESULTS: A total of 985 HIV-positive participants had a baseline pain evaluation in 1995. The prevalence of pain remained relatively constant during each year of observation, averaging 20%. Lower CD4+ T-lymphocyte percentage, female gender, and an HIV/AIDS-related diagnosis were highly associated with an increased risk of reported pain. Pain was also independently associated with increased risk of death. After adjusting for CD4 percentage, use of combination therapy including protease inhibitors, comorbid diagnoses, and other sociodemographic characteristics, individuals reporting pain were over 5 times more likely to die than those not reporting pain (hazard ratio = 5.07; 95% confidence interval = 3.23-7.95). CONCLUSIONS: Pain is a frequently encountered symptom in children and youth with HIV disease and is also associated with increased mortality. These findings emphasize the importance of pain management in this population.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Television viewing and initiation of smoking among youth.

BACKGROUND: Smoking is the leading preventable cause of death in the United States, and the risk of disease increases the earlier in life smoking begins. The prevalence of smoking among US adolescents has increased since 1991. Despite bans on television tobacco advertising, smoking on television remains widespread. OBJECTIVE: To determine whether youth with greater exposure to television viewing exhibit higher rates of smoking initiation. METHODS: We used the National Longitudinal Survey of Youth, Child Cohort to examine longitudinally the association of television viewing in 1990 among youth ages 10 to 15 years with smoking initiation from 1990-1992. Television viewing was based on the average of youth and parent reports. We used multiple logistic regression, taking into account sampling weights, and controlled for ethnicity; maternal education, IQ, and work; household structure; number of children; household poverty; child gender; and child aptitude test scores. RESULTS: Among these youth, smoking increased from 4.8% in 1990 to 12.3% in 1992. Controlling for baseline characteristics, youth who watched 5 or more hours of TV per day were 5.99 times more likely to initiate smoking behaviors (95% confidence interval: 1.39-25.71) than those youth who watched <2 hours. Similarly, youth who watched >4 to 5 hours per day were 5.24 times more likely to initiate smoking than youth who watched <2 hours (95% confidence interval: 1.19-23.10). CONCLUSIONS: Television viewing is associated in a dose-response relationship with the initiation of youth smoking. Television viewing should be included in adolescent risk behavior research. Interventions to reduce television viewing may also reduce youth smoking initiation.

Adolescent↗