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A multivariate analysis of health-related practices: a nine-year mortality follow-up of the Alameda County Study.

Associations between several common health-related practices and a variety of health outcomes have been reported. However, the independent associations between each of these practices and mortality from all causes have not been assessed. In the present report, a multiple logistic analysis of seven potentially health-related practices (individually and in a summary index) and mortality from all causes is conducted, using data from the Human Population Laboratory Study of a random sample of 6928 adults living in Alameda County, California in 1965 and a subsequent nine-year mortality follow-up. Many covariables such as physical health status and socioeconomic status are simultaneously analyzed. The health-related practices examined are: 1) never smoking; 2) regular physical activity; 3) low alcohol consumption; 4) average weight status; 5) sleeping seven to eight hours/night; 6) not skipping breakfast; and 7) not snacking between meals. The analysis reveals that five of the practices are associated with lower mortality from all causes. Neither eating breakfast nor not snacking have significant independent associations with lower mortality. After covariable adjustment, respondents who reported few low-risk practices have a relative risk of 2.3 (p less than 0.001) when compared with those who had many low-risk practices. Mortality risks for possible combinations of health-related practices are discussed.

Adult↗

Traumatic pneumomediastinum in a child secondary to corn chip perforation of the esophagus.

Esophageal perforations, while an infrequent form of trauma in the pediatric population, are of concern because of their life-threatening complications. If not recognized and treated promptly, esophageal injuries can result in mediastinitis and death. An unusual case is presented, describing traumatic esophageal perforation in a child resulting from laceration by an ingested corn chip. A study is reported investigating the rigidity of three types of these popular snack chips. Stress testing and statistical analysis of the resultant measurement data indicated that the three brands of chips were equally rigid. The mean force of compression required to fracture the chips was approximately three pounds, a force great enough to damage the fragile structures of the upper aerodigestive system. Physicians and parents alike should be aware of the possible dangers of this type of snack food to avert the possibility of esophageal injury with its resultant morbidity and potential mortality.

Child↗

Eating habits, smoking and toothbrushing in relation to dental caries: a 3-year study in Swedish female teenagers.

OBJECTIVES: The aims of the present study were to describe eating, toothbrushing and smoking habits in a cohort of Swedish female adolescents, and to relate the findings to dental caries increment. DESIGN: The research took the form of a longitudinal study. SUBJECTS AND METHODS: The study sample consisted of a cohort of 162 girls under regular dental care, aged 12 years at baseline, who were followed for 3 years, from the sixth to the ninth grade. Eating, oral cleaning and smoking habits were self-reported three times per year through a questionnaire, and caries data at baseline and after 3 years were collected from dental records. RESULTS: The results showed significantly (P < 0.05) impaired eating habits during the study period and that adherence to regular main meals diminished. In the eighth grade, one-third of the girls skipped breakfast before school and only 50% had their free school lunch daily. The omission of breakfast and irregular main meals, as well as smoking were significantly associated with caries (decayed, missed and filled surfaces) increment in the eighth grade (odds ratio = 4.1-4.9, P < 0.05). Snacks, light meals, soft drinks and sweets were already frequently consumed at baseline and continued to be so over the years. Although > 95% of subjects reported that they brushed their teeth at least once a day, approximately 20% did not do it every evening, and this figure remained stable over the study period. However, snacks, soft drinks and sweets, and toothbrushing habits had no significant influence on caries development. CONCLUSION: Dietary advice for caries prevention in adolescent girls should focus on the importance of retaining regular main meals, and especially, not skipping breakfast.

Adolescent↗

Food intake at age 8. 2. Frequency, company and place of meals.

In a sample of 141 healthy 8 year old children, over 95% had three main meals on each of the 4 days of the food record. Two-thirds had an afternoon snack and nearly one-half a morning snack on each of the 4 days, but only one-quarter had supper on each day. Seventy-one per cent of all meals were eaten at home with the family, 20% at school with friends, and less than 1% of meals were eaten at a restaurant or fast food outlet. These data show that amongst children of primary school age, take away sources of food make a very small contribution to the diet, and that eating habits at home are of greatest importance to the child's diet.

Child↗

Does amygdaloid corticotropin-releasing hormone (CRH) mediate anxiety-like behaviors? Dissociation of anxiogenic effects and CRH release.

The brain corticotropin-releasing hormone (CRH) circuits are activated by stressful stimuli, contributing to behavioral and emotional responses. The present study assessed anxiety-like responses and in vivo neurochemical alterations at the central nucleus of the amygdala (CeA) evoked by exposure to an unfamiliar (anxiogenic) environment. Also, the impact of anxiolytic treatments and those that affect CRH were assessed in this paradigm. Novel environment (new cage) markedly suppressed ingestion of a palatable snack. This effect was dose-dependently antagonized by diazepam and was utilized as an index of anxiety in the rodent. Although exposure to a novel environment also stimulated the in vivo release of CRH and glutamate at the CeA, various CRH antagonists (e.g. alphah-CRH, Calpha-MeCRH, CP-154,526, antisauvagine-30, preproTRH178-199) did not attenuate the stressor-elicited behavioral suppression, although Calpha-MeCRH was found to attenuate the freezing response elicited by contextual stimuli that were associated with previously administered footshock. Moreover, central infusion of CRH failed to suppress snack consumption in the home cage. Although diazepam had potent anxiolytic effects in this paradigm, this treatment did not prevent the stressor-associated release of CRH and glutamate at the CeA. Thus, while neural circuits involving CRH and/or glutamatergic receptors at the CeA may be activated by an unfamiliar environment, the data challenge the view that activation of these receptors is necessary for the expression of anxiety-like behavioral responses. Rather than provoking anxiety, these systems might serve to draw attention to events or cues of biological significance, including those posing a threat to survival.

Amygdala↗

Caries experience in the primary dentition of Tanzanian and Finnish 3-7-year-old children.

Caries experience of primary teeth in relation to age, sex, ethnic group, socioeconomic status and frequency of consuming sweet snacks and drinks was studied among groups of Tanzanian and Finnish 3-7-yr-olds, a total of 1118 children. In all age groups the Tanzanian children had higher mean dmft scores than Finnish children did. In the Finnish group the mean dmft score was higher at age 7 than at age 3, while in the Tanzanian group no statistically significant difference in dmft scores was found between age groups. In both groups maxillary incisors and molars were the main teeth affected by caries. Frequent consumption of sweet snacks and drinks increased the risk for caries in Tanzanian but not in Finnish children. High socioeconomic status decreased the risk for caries in Finnish children but among Tanzanian children high SES was not associated significantly with the risk of developing caries. According to these results, caries experience in Tanzanian urban nursery school children was significantly higher than in Finnish children of the same age, the differences being especially high among the youngest age groups.

Age Factors↗

Comparative study of oral health status between Scottish and Japanese schoolchildren aged 6-11 years.

This study was carried out to examine and compare the differences in oral health status between Scottish (Fife) and Japanese (Motoyoshi) primary schoolchildren, and also to analyse some factors concerned with the differences found. It was observed that caries experience is higher in Motoyoshi than in Fife, despite Fife schoolchildren having poorer oral cleanliness and consuming snacks more frequently. However, Fife children had more fissure sealants and brushed their teeth more frequently with fluoridated dentifrice than did Motoyoshi children. The sugar content of snacks consumed by Motoyoshi children was higher than that of the Scots. Gingivitis (PMA positive rate) was higher in Fife than in Motoyoshi, and it was also noted that Fife children were less independent than Motoyoshi children in their daily behaviour.

Attitude to Health↗

Oral self-care behaviours in older dentate adults.

Defining oral self-care as activities undertaken by individuals to maintain or promote dental health, this paper examines the distribution of oral self-care behaviours in a sample of dentate adults, age 50 and over, living in Ontario, Canada (n = 713). Results are presented separately for two older cohorts, respondents ages 50-64 and those 65 and older, and for females and males. Six oral self-care behaviours were examined: toothbrushing, flossing, use of an interdental device, extra fluoride use, frequency of between meal snacks and ingestion of cariogenic foods. High rates of self-care occurred only for toothbrushing. Age groups differed significantly for use of interdental devices, consumption of cariogenic foods and snacking between meals while gender differences were found for toothbrushing, flossing and consuming sweet foods. The need to target older adults and especially older males for oral hygiene information and instruction in order to counteract possible misleading beliefs learned before the advent of current dental hygiene practices is apparent from these data.

Age Factors↗

Dental caries in relation to diet, saliva and cariogenic microorganisms in Tanzanians of selected age groups.

The relationship between diet and dental caries in a Tanzanian population was studied. Mutans streptococci, lactobacilli, yeasts, salivary flow rate as well as buffer effect were also analyzed. A random sample of 12-, 35-44- and 65- to 74- year olds was drawn from Msongola (rural) and Ukombozi (urban), Dar-es-Salaam. The mean of two 24-h recalls was used for the assessment of food intake. The percentage of those with at least one carious tooth ranged from 30% in the 12-year-olds to 80% in the oldest age group. The mean number of decayed teeth (DT) increased significantly with age (P = 0.000) but was not significantly associated with the area of residence. DT increased significantly (P = 0.048) with the number of snacks per day and was also associated with dietary sucrose (P = 0.025), total carbohydrates (P = 0.002) and fiber (P = 0.002). Among salivary variables lactobacilli (P = 0.000) correlated positively with DT. Our study did not reveal any strong association between total energy intake and dental caries in rural or urban populations in Tanzania but snacking and sucrose intake were significantly associated with caries, in particular in the urban area.

Adult↗

Teaching dental undergraduates behaviour change skills.

This paper describes an active learning-based education tool which enables dental students to learn preventive techniques relevant to patient dental health behaviour. 2 studies were conducted involving 33, 2nd year (study 1) and 9, 3rd year (study 2) undergraduate dental students. In study 1, snacking behaviour and its antecedents were analysed from detailed 3-day diet diaries completed by the students. Study 2 entailed the students changing one aspect of their sugar/diet behaviour using self-management techniques. It is concluded that dental students can successfully (a) identify antecedents to sugar snacking behaviours on several levels, i.e., cognitive, emotional and situational, (b) set goals and use behaviour change techniques to modify these behaviours, and (c) appreciate that this experience is relevant to similar preventive techniques that they will use in clinical practice. Training in the application of these skills to their own maladaptive behaviours provides a strong educational tool based on psycho-educational theories.

Behavior Therapy↗

Oral health behaviour and its determinants amongst Iranian dental students.

OBJECTIVES: To study the oral health behaviour (OHB) of Iranian senior dental students in relation to their gender, background characteristics, knowledge of preventive care, and attitudes towards preventive dentistry. MATERIALS AND METHODS: Using a cluster random sampling approach, a questionnaire survey was conducted with 327 senior dental students in seven dental schools. The questionnaire covered age, gender, parents' employment in dentistry, previous academic education in dental hygiene, oral self-care, most recent dental check-up, knowledge of preventive dentistry and attitudes towards it. Attending a dental check-up by a dentist or a classmate within the last year was defined as preventive care use. Chi-square test and logistic regression models were used for statistical analyses. RESULTS: Women reported significantly higher frequencies of tooth brushing (P < 0.001), fluoridated toothpaste use (P = 0.001) and flossing (P < 0.001) compared with men. Respondents who had been previously educated as dental hygienists had lower frequencies of eating sugary snacks (P < 0.001) and paid more attention to preventive care (P = 0.03) than others. Those with more extensive knowledge of preventive care reported higher frequencies of using fluoridated toothpaste (P = 0.05). Reported frequencies of brushing were higher amongst those with more positive attitudes (P = 0.03). In logistic regression models, having at least one parent employed as a dentist was significantly associated with higher frequencies of eating sugary snacks (P = 0.047, OR = 0.3) and more frequent preventive care use (P = 0.048, OR = 2.9). CONCLUSION: Education and training in preventive measures should be effective enough to overcome background characteristics. There is room for improving the OHB of Iranian dental students.

Adult↗

Longitudinal study of caries, cariogenic bacteria and diet in children just before and after starting school.

Fifty 5-yr-old preschool children living in Akranes, a small community in West Iceland known to have a high caries prevalence, were investigated with respect to caries, salivary counts of mutans streptococci and lactobacilli, and consumption of cariogenic foods. Fifteen months later, after being in school for half a year, 43 of the 50 children were reexamined and investigated as before. Mean dmfs scores rose from 7.1 to 9.0, but the scores including initial caries rose from 9.7 to 15.3. Mutans streptococci were carried by 84% of children on both occasions with a mean count 2.1 and 3.6 x 10(5) cfu/ml. Lactobacillus carriage increased from 29 to 38% and the mean count from 5.1 to 13 x 10(3) cfu/ml at 6 yr. The frequency of consumption of sugar-containing foods increased from 4.2 to 5.2 intakes per day and between-meal snacks rose from 3.0 to 3.7 per day. Children classified as "misusing" sugar were 59% at 5 yr and 83% at 6 yr. The mean caries score at 6 yr for children "misusing" sugar was 10.7 but only 2.0 for those not misusing sugar. Thus the deterioration in dental health appears, in these children, to be associated with the increased consumption of sweets and other cariogenic between-meal snacks after starting school.

Child↗

Greek immigrant children in southern Sweden in comparison with Greek and Swedish children. II. Meal pattern and food habits.

Greek immigrant children (GI) belonging to the second generation of immigrants in Sweden have been compared with Swedish children (S) and Greek children in Greece (G) regarding meal pattern and food habits. Interviews were performed in the homes. Meal pattern and frequency of consumption of various food items were studied by 24-hour recalls, and the food frequency interview method. The meal pattern and the distribution of meals and snacks during the day did not show large differences between the groups. In the GI and G groups it was common to start the day with milk and sugar. The same habit was reported before going to bed. It was common in the GI and G groups to have a prepared meal (dinner) relatively late in the evening. Of the S children only 55% had dinner. GI children had a less frequent intake of vegetables compared to S and G children. GI and G children were heavy consumers of sweets and snacks. In conclusion, the Greek immigrant group had food habits similar to those of Greek rural children with few distinctive exceptions. Greek immigrant families had no difficulties in preparing Greek food.

Child↗

Community organization in a school health education program to reduce sodium consumption.

This paper describes the important role of community organization in providing the enabling and reinforcing factors necessary for students to adopt dietary behavior changes recommended in a school health education program for cardiovascular health. The "Hold the Salt!" program was designed to teach sixth grade students and their families about the link between high sodium diets early in life and increased risk for cardiovascular disease, and to significantly reduce pupils' intake of high-sodium snacks. The program consists of four educational components: a classroom cafeteria curriculum unit built around a board game; parent outreach; health provider reinforcement; and community support. The program was tested in an experimental group (n = 55) of urban, black, sixth grade students, whose knowledge and behavior changes were compared to a control group (n = 23) with similar demographic statistics. Data collected before and after the school program showed a 20% increase in knowledge about sodium and health (p less than .01) and a 33% decrease in reported high-sodium snack consumption (p less than .05) in the experimental group compared to no significant knowledge or reported behavior changes in the control group. The program was piloted for two years in Baltimore City elementary schools, then adopted by the Maryland State Dept. of Education for dissemination as part of the Home Economics curriculum in all of the state's middle schools.

Child↗

Food-related beliefs, eating behavior, and classroom food practices of middle school teachers.

This study examined classroom food practices and eating behavior of middle school teachers from 16 schools in a metropolitan area, located in the upper Midwest. In winter 1999-2000, teachers in sixth, seventh, and eighth grade were surveyed (response rate = 70%; n = 490/701). Questions addressed teachers' classroom food practices, eating behavior while at school, personal health, and attitudes about the school food environment. Use of food as an incentive/reward for students was a common classroom practice in middle schools, and most foods did not support development of health eating patterns by young adolescents. Candy was the most frequently used food item, reported by 73% of teachers, followed by cookies/doughnuts (37%), sweetened drinks (35%), and pizza (28%). Many middle school teachers did not role model healthy eating behavior at school. Prevalent use of vending was a particular concern, with beverage and snack vending use reported by 62% and 35% of teachers, respectively. Most vending items purchased were sweetened drinks (57%) and high-fat or high-sugar snacks (85%). Low perceived personal health, high-fat scores, and low support for the school food environment were some of the significant correlates of teachers' eating behavior. School and health professionals should continue to advocate for schoolwide policies and programs that support students and teachers if the goal of an integrated healthy school food environment is to be realized.

Adolescent↗

Competitive foods and beverages available for purchase in secondary schools--selected sites, United States, 2004.

School Health Profiles is conducted biennially to assess characteristics of school health programs. State and local departments of education and health select either all public secondary schools within their jurisdictions or a systematic, equal-probability sample of public secondary schools to participate in School Health Profiles. At each school, the principal and lead health education teacher were sent questionnaires to be self-administered and returned to the state or local agency conducting the survey. In 2004, a total of 27 states and 11 large urban school districts obtained weighted data from their survey of principals. The findings in this report indicate that the majority of secondary schools in 27 states and 11 large urban school districts allow students to purchase snack foods or beverages from vending machines or at the school store, canteen, or snack bar. The types of competitive foods and beverages available for purchase varied across states and large urban school districts. Overall, fruits or vegetables were less likely to be available for purchase than the other types of foods or beverages. Bottled water and soft drinks, sports drinks, or fruit drinks that are not 100% juice were most likely to be available for purchase.

Carbonated Beverages↗

Quality of diets consumed by older rural adults.

Older adults residing in rural communities are at risk for low dietary quality because of a variety of social, physical and environmental circumstances. Minority elders are at additional risk because of poorer health status and lower socioeconomic status. This study evaluated the food group intake of 130 older (>70 years) African American (34%), European American (36%), and Native American (30%) residents of two rural communities in central North Carolina. An interviewer-administered food frequency questionnaire was used to measure dietary intake. Food items were classified into food groups similar to the United States Department of Agriculture (USDA) Food Guide Pyramid and the National Cancer Institutes 5 A Day for Better Health program. None of the survey participants met minimum intake recommendations and most over-consumed fats, oils, sweets and snacks. African Americans and Native Americans consumed fewer servings of meats,fruits and vegetables, and fats, oils, sweets and snacks than European Americans. African American men consumed the fewest servings of fruits and vegetables of all gender/ethnic groups. Consumption of fats, oils and sweets was greatest among those 85 years and older and was more common among denture users. National strategies to educate the public about the importance of consuming a varied diet based on the recommendations presented in national nutrition education campaigns may not be reaching older adults in rural communities, particularly minority group members.

Black or African American↗

Aging, nutrient choice, activity, and behavioral responses to nutrients.

We directly measured nutrient consumption, activity patterns, and behavior in young volunteers and healthy elderly volunteers (N = 86) living in an identical environment. Compared to the young subjects, the elderly adults consumed fewer calories and less carbohydrate and fat, but not less protein, after adjustment for differences in body weight. Males of both ages consumed more protein than females after adjustment for body weight. All subjects snacked predominantly on carbohydrate-rich foods. The elderly subjects, however, consumed significantly fewer snacks than the young. Patterns of mood and activity also differed between age groups: the elderly volunteers were more active and alert than the young, especially early in the day, as measured by activity monitors and self-report questionnaires. We also examined the behavioral effects of high-protein and high-carbohydrate meals on these subjects because of the effects such meals can have on brain serotonin levels. The subjects ingested isocaloric carbohydrate- or protein-rich breakfasts and dinners and then participated in a series of behavioral tasks. Significant interactions between the type of meal consumed (protein versus carbohydrate) and the time at which they were ingested (breakfast versus dinner were observed. A protein meal consumed at breakfast induced more fatigue and sleepiness than an isocaloric carbohydrate meal; this was reversed in the evening when a carbohydrate meal induced more fatigue. Elderly subjects were less sensitive to sleepiness induced by carbohydrate in the evening. Overall, the young and old adults exhibited significant differences in calorie and carbohydrate intakes and also mood and activity, even when they chose their foods from an identical selection of food items and followed the same basic daily routines while living in a controlled study environment.

Adult↗