Traffic noise and blood pressure in low-socioeconomic status, African-American urban schoolchildren

The primary aim of this field study was to investigate the relationships among residential noise exposure at home and at school and blood pressure in low-socioeconomic status African-American children. Children were recruited from Boys and Girls Clubs in a mid-sized, Northeastern city. The sample consisted of 250 schoolchildren (128 boys and 122 girls) aged 6-14 years. Each child was interviewed prior to anthropometric and blood pressure measurement. An oscillometric monitor was used for measurement of resting blood pressure. Correlation analysis in the overall sample showed no significant relationship between noise exposure and children's blood pressure. No interactions were found between noise at home and at schools as well as orientation of bedroom and/or living room and noise at home with blood pressure. A sub-sample of children was also examined by adding the orientation of bedroom and living room as inclusion criteria (n = 128), and there was an interaction between noise exposure and age on systolic blood pressure. In younger children aged 6-10 years, a significant positive relation was found between noise levels at homes and systolic blood pressure, controlling for body mass index (B = 0.48, 95% C.I. = 0.07 -0.88, p = 0.02).

Childhood poverty and young adults' allostatic load: the mediating role of childhood cumulative risk exposure

Childhood poverty is linked to a host of physical and psychological disorders during childhood and later in life. In the study reported here, we showed that the proportion of childhood spent in poverty from birth to age 9 was linked to elevated allostatic load, a marker of chronic physiological stress, in 17-year-olds. Furthermore, this prospective longitudinal relationship was mediated by cumulative risk exposure at age 13. The greater the duration of early life spent in poverty, the greater the exposure to cumulative risk. This, in turn, leads to elevated allostatic load. Multiple psychological, biological, and neurological pathways likely account for the social patterning of psychological and physical disease.

Poverty and health: the mediating role of perceived discrimination

Social-class discrimination is evident in many societies around the world, but little is known about its impact on the poor or its role as an explanatory variable in the link between socioeconomic status and health. The current study tested the extent to which perceived discrimination explains socioeconomic gradients in physical health. Participants were 252 adolescents (51% male, 49% female; mean age = 17.51 years, SD = 1.03 years) who participated in Wave 3 of an ongoing longitudinal study focusing on the developmental consequences of rural poverty. Physical health was operationalized as allostatic load, a measure of cumulative wear and tear on the body caused by overactivation of physiological systems that respond to stress. Mediation analyses suggested that 13% of the effect of poverty on allostatic load is explained by perceived discrimination. The findings suggest that social-class discrimination is one important mechanism behind the influence of poverty on physical health.

Family income and childhood obesity in eight European cities: the mediating roles of neighborhood characteristics and physical activity

Utilizing data from the Large Analysis and Review of European Housing and Health Status (LARES) research program conducted by the WHO in eight European cities (Forli, Vilnius, Ferreira do Alentejo, Bonn, Geneva, Angers, Bratislava, Budapest), we examined whether the well-documented inverse correlation between family income and children's BMI might be explained, in part, by access to open green space and ensuing physical activity. We found that household income was inversely related to BMI among 1184 children, ages 6-18 years of age. Utilizing structural equation modeling with statistical controls for age and gender, we found evidence for two indirect paths between household income and BMI. One indirect relationship operates successively through open green space and physical activity. The second path operates through physical activity alone. The child's height and weight as well as level of physical activity were reported by their mother. Open green space was assessed by trained observers' ratings of the area surrounding the child's home. Limitations of the study and implications for better understanding of the ecological context of obesity are discussed.

Cumulative risk and adolescent's internalizing and externalizing problems: the mediating roles of maternal responsiveness and self-regulation

The purpose of the present study was to examine longitudinal associations among maternal responsiveness, self-regulation, and behavioral adjustment in adolescents. The authors used structural equation modeling to test a model that demonstrates that the effects of early cumulative risk on behavioral problems is mediated by maternal responsiveness and self-regulation. Furthermore, the authors examine the contributions of cumulative risk and maternal responsiveness on children's self-regulatory abilities. The study uses a 3-wave longitudinal design with multiple measures of risk and self-regulation from multiple observers. Data were collected from adolescents (N = 265, male = 140) and their parents at age 9, 13, and 17. Results suggest that the mediation hypothesis held true for externalizing, but not internalizing problems. Furthermore, cumulative risk and maternal responsiveness contributed uniquely to children's self-regulation abilities. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Manual or semi-automated edge detection of the maximal far wall common carotid intima-media thickness: a direct comparison

BACKGROUND

Automated edge detection is thought to be superior to manual edge detection in quantification of the far wall common carotid intima-media thickness (CIMT), yet published evidence making a direct comparison is not available.

METHODS

Data were used from the METEOR study, a randomized placebo-controlled trial among 984 individuals showing that rosuvastatin attenuated the rate of change of 2 year change in CIMT among low-risk individuals with subclinical atherosclerosis. For this post hoc analysis, CIMT images of the far wall of the common carotid artery were evaluated using manual and semi-automated edge detection and reproducibility, relation to cardiovascular risk factors, rates of change over time and effects of lipid-lowering therapy were assessed.

RESULTS

Reproducibility was high for both reading methods. Direction, magnitude and statistical significance of risk factor relations were similar across methods. Rate of change in CIMT in participants assigned to placebo was 0.0066 mm per year (SE: 0.0027) for manually and 0.0072 mm per year (SE: 0.0029) for semi-automatically read images. The effect of lipid-lowering therapy on CIMT changes was -0.0103 mm per year (SE: 0.0032) for manual reading and -0.0111 mm per year (SE: 0.0034) for semi-automated reading.

CONCLUSION

Manual and semi-automated readings of the maximal far wall of the common CIMT images both result in high reproducibility, show similar risk factor relations, rates of change and treatment effects. Hence, choices between semi-automated and manual reading software for CIMT studies likely should be based on logistical and cost considerations rather than differences in expected data quality when the choice is made to use far wall common CIMT measurements.

Childhood cumulative risk and obesity: the mediating role of self-regulatory ability

OBJECTIVES

We tested whether early childhood risk exposures are related to weight gain in adolescence and evaluate an underlying mechanism, self-regulatory behavior, for the risk-obesity link.

METHODS

Cumulative risk exposure to 9 sociodemographic (eg, poverty), physical (eg, substandard housing), and psychosocial (eg, family turmoil) stressors was assessed in 244 nine-year-old children. BMI was calculated at age 9 and then 4 years later. At age 9, children's ability to delay gratification as an index of self-regulatory behavior was assessed. Path analyses were then estimated to evaluate our mediational model (Cumulative risk → Self-regulation → BMI) over a 4-year period in a prospective, longitudinal design.

RESULTS

Nine-year-old children exposed to a greater accumulation of multiple risk factors show larger gains in adiposity over the next four year period, net of their initial BMI. These gains in BMI during early adolescence are largely accounted for by deteriorated self-regulatory abilities among children facing more cumulative risks.

CONCLUSIONS

Early childhood risk exposure leads to larger gains in BMI in adolescence. Given the importance of childhood adiposity to the development of obesity later in life, understanding the underlying mechanisms that link early experience to weight gain is an essential task. Deficiencies in self-regulation in response to chronic stress appears to be an important agent in the obesity epidemic.

Use of atorvastatin in systemic lupus erythematosus in children and adolescents

OBJECTIVE

Statins reduce atherosclerosis and cardiovascular morbidity in the general population, but their efficacy and safety in children and adolescents with systemic lupus erythematosus (SLE) are unknown. This study was undertaken to determine the 3-year efficacy and safety of atorvastatin in preventing subclinical atherosclerosis progression in pediatric-onset SLE.

METHODS

A total of 221 participants with pediatric SLE (ages 10-21 years) from 21 North American sites were enrolled in the Atherosclerosis Prevention in Pediatric Lupus Erythematosus study, a randomized double-blind, placebo-controlled clinical trial, between August 2003 and November 2006 with 36-month followup. Participants were randomized to receive atorvastatin (n=113) or placebo (n=108) at 10 or 20 mg/day depending on weight, in addition to usual care. The primary end point was progression of mean-mean common carotid intima-media thickening (CIMT) measured by ultrasound. Secondary end points included other segment/wall-specific CIMT measures, lipid profile, high-sensitivity C-reactive protein (hsCRP) level, and SLE disease activity and damage outcomes.

RESULTS

Progression of mean-mean common CIMT did not differ significantly between treatment groups (0.0010 mm/year for atorvastatin versus 0.0024 mm/year for placebo; P=0.24). The atorvastatin group achieved lower hsCRP (P=0.04), total cholesterol (P<0.001), and low-density lipoprotein (P<0.001) levels compared with placebo. In the placebo group, CIMT progressed significantly across all CIMT outcomes (0.0023-0.0144 mm/year; P<0.05). Serious adverse events and critical safety measures did not differ between groups.

CONCLUSION

Our results indicate that routine statin use over 3 years has no significant effect on subclinical atherosclerosis progression in young SLE patients; however, further analyses may suggest subgroups that would benefit from targeted statin therapy. Atorvastatin was well tolerated without safety concerns.

The effects of urban bus driving on blood pressure and musculoskeletal problems: a quasi-experimental study

OBJECTIVE

Work settings with high levels of stress are consistently associated with poor health outcomes. This study examines the longitudinal relationships between the number of hours of driving a bus in a city and blood pressure and musculoskeletal problems.

METHODS

A prospective longitudinal design coupled with multilevel random coefficient modeling was used to examine the relationship among exposure to a job with high level of stress, urban bus driving, blood pressure, and musculoskeletal problems. Baseline blood pressure and musculoskeletal symptoms of men and women (n = 88) were assessed before they began driving a bus in central Stockholm. The number of hours of driving per week, blood pressure, and musculoskeletal symptoms were tracked for a period of 5 years. Multilevel random coefficient modeling techniques were used to model how individual trajectories of health effects were affected by the number of hours of driving, after statistically controlling for baseline preworking health measures.

RESULTS

Controlling for sex and baseline health outcomes, the average number of hours of bus driving per week predicted higher diastolic blood pressure (B = 0.069, standard error = 0.034, p = .042) and more frequent musculoskeletal symptoms (B = 0.013, standard error = 0.003, p < .001).

CONCLUSIONS

The findings provide evidence for a positive association between the number of hours of bus driving and blood pressure and musculoskeletal problems. These findings are discussed in exposures to potentially toxic physical and psychosocial work-related factors.

Loosening the link between childhood poverty and adolescent smoking and obesity: the protective effects of social capital

Pervasive, lifelong inequalities in physical health begin in early childhood and are driven, in part, by social gradients in risk factors such as smoking and obesity. Yet not all low-income children have elevated physical-health risks as adults. The relation between income-to-needs ratio at age 9 and smoking prevalence and body fat (body mass index) at age 17 was examined in a sample of 196 rural adolescents. Income-to-needs ratio is the U.S. federal government's defined index of household income as a proportion of the poverty line. This is the first study to show that links between childhood poverty and subsequent physical-health outcomes can be loosened. At-risk youth in communities with a relatively rich array of social capital did not smoke more or have greater excess body fat compared with their more affluent counterparts.

Early childhood poverty, cumulative risk exposure, and body mass index trajectories through young adulthood

OBJECTIVES

We assessed whether cumulative risk exposure underlies the relation between early childhood poverty and body mass index (BMI) trajectories.

METHODS

We interviewed youths and their mothers in rural upstate New York (168 boys and 158 girls) from 1995 to 2006 when the youths were aged 9, 13, and 17 years. At each interview, we calculated their BMI-for-age percentile.

RESULTS

Early childhood poverty predicted BMI growth trajectories from ages 9 to 17 years (b = 3.64; SE = 1.39; P < .01). Early childhood poverty also predicted changes in cumulative risk (b = 0.31; SE = 0.08; P < .001). Cumulative risk, in turn, predicted BMI trajectories (b = 2.41; SE = 0.75; P < .01). Finally, after we controlled for cumulative risk, the effect of early childhood poverty on BMI trajectories was no longer significant, indicating that cumulative risk exposure mediated the relation between early childhood poverty and BMI trajectories (b = 2.01; SE = 0.94).

CONCLUSIONS

We show for the first time that early childhood poverty leads to accelerated weight gain over the course of childhood into early adulthood. Cumulative risk exposure during childhood accounts for much of this accelerated weight gain.

Associations between chronic community noise exposure and blood pressure at rest and during acute noise and non-noise stressors among urban school children in India

The present study builds on prior research that has examined the association between children's chronic exposure to community noise and resting blood pressure and blood pressure dysregulation during exposure to acute stressors. A novel contribution of the study is that it examines how chronic noise exposure relates to blood pressure responses during exposure to both noise and non-noise acute stressors. The acute noise stressor was recorded street noise and the non-noise stressor was mental arithmetic. The sample consisted of 189 3rd and 6th grade children (51.9% percent boys; 52.9% 3rd graders) from a noisy (n = 95) or relatively quiet (n = 94) public school in the city of Pune, India. There were no statistically significant differences between chronic noise levels and resting blood pressure levels. However, relative to quiet-school children, noisy-school children had significantly lower increases in blood pressure when exposed to either an acute noise or non-noise stressor. This finding suggests that chronic noise exposure may result in hypo-reactivity to a variety of stressors and not just habituation to noise stressors.

Relations of Parent-Youth Interactive Exchanges to Adolescent Socioemotional Development

This study examined the relations of parent-youth agreement and disagreement during a joint problem-solving task and multi-methodological indices of socioemotional outcomes in adolescents (Mean age = 13). One hundred and sixty seven parents and their adolescent children participated. Each parent-youth pair played the interactive game Jenga, and their interactions were analyzed for frequency of elaborations (agreement during three or more conversational turns) and negotiations (disagreement during three or more conversational turns). Elaborations during parent-youth interactions were related to less negative classroom behavior, better self-regulation, and more task persistence in youth. Findings are discussed in light of the importance of parent-youth interaction and youth autonomy in adolescent socioemotional development.

Intensive glucose control and macrovascular outcomes in type 2 diabetes

AIMS/HYPOTHESIS

Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes.

METHODS

A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified.

RESULTS

A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9% (HR 0.91, 95% CI 0.84-0.99), primarily because of a 15% reduced risk of myocardial infarction (HR 0.85, 95% CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95% CI 0.90-1.20) and 1.10 for cardiovascular death (95% CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95% CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95% CI 0.89-1.13, vs HR 0.84, 95% CI 0.74-0.94, respectively; interaction p = 0.04).

CONCLUSIONS/INTERPRETATION

Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.

Intensive lipid lowering may reduce progression of carotid atherosclerosis within 12 months of treatment: the METEOR study

BACKGROUND

In several statin trials, vascular event rates for treatment groups begin to separate 1 year after commencement of treatment. For atherosclerosis progression, the temporal sequence of the effect has not been defined. We used data from the Measuring Effects on intima media Thickness: an Evaluation Of Rosuvastatin (METEOR) trial to determine the earliest time point at which significant differences in atherosclerosis progression rates could be detected after initiation of statin therapy.

METHODS

The METEOR trial was a double-blind, randomized placebo-controlled trial that studied the effect of LDL-C lowering with 40 mg rosuvastatin on the rate of change of carotid intima media thickness (CIMT) measured by B-mode ultrasound amongst 984 low risk subjects. Ultrasound assessments were made at baseline and every 6 months up to 2 years.

RESULTS

Rosuvastatin treatment was associated with a 49% reduction in LDL-C-C, a 34% reduction in total cholesterol, an 8.0% increase in HDL-C and a 16% reduction in triglycerides (all P < 0.0001 compared with placebo). The difference in rate of mean maximum CIMT progression between the rosuvastatin and placebo groups (based on near and far wall measurements from both left and right common carotid and internal carotid segments and carotid bifurcation) was not statistically significant after 6 months (0.0023 mm year(-1) and 0.0106 mm year(-1), respectively P = 0.34). After 12 months, CIMT progression rates were significantly different between the groups: 0.0032 mm year(-1) and 0.0133 mm year(-1) in the rosuvastatin-treated and placebo-treated groups, respectively (P = 0.049). This divergence grew with further follow-up: -0.0009 mm year(-1) and 0.0131 mm year(-1) after 18 months (P < 0.001) and -0.0014 mm year(-1) and 0.0131 mm year(-1) after 24 months of treatment (P < 0.001). Results were stronger for the mean common CIMT progression (based on near and far wall measurements from both left and right common carotid segments).

CONCLUSION

Aggressive LDL-C lowering seems to exert its beneficial effect on atherosclerosis progression during the first 12 months of treatment. This parallels the timing of event reduction seen in clinical trials and suggests that the efficacy of lipid lowering treatment on CIMT progression can be evaluated in trials with a duration of 1 year, given sufficient sample size, high precision of measurements and a treatment effect comparable to that seen in METEOR.

Ultrasound protocols to measure carotid intima-media thickness: a post-hoc analysis of the OPAL study

OBJECTIVE

Ultrasound protocols to measure carotid intima-media thickness (CIMT) differ in the number of carotid walls, segments and angles measured. No published evidence is available to help decide which approach is best, i.e. the most reproducible and providing the largest CIMT progression rate measured with highest precision. We compared different ultrasound protocols in a post-hoc analysis in the 'Osteoporosis Prevention and Arterial effects of tiboLone' (OPAL) study, a 3-year randomized controlled trial among healthy postmenopausal women.

RESEARCH DESIGN AND METHODS

Based on combinations of 60 CIMT measurements per participant (two sides, two walls, three segments, five angles), 66 theoretical protocols were constructed. Each protocol was assessed and ranked on: (1) reproducibility (intra-class correlation (ICC), mean difference of duplicate scans) and (2) CIMT progression rate and its precision (standard error) in the placebo group.

RESULTS

Duplicate scans at baseline and end of study were available for 675 women (89% of 759 subjects). ICC ranged from 0.69 to 0.88. Mean difference in CIMT of duplicate scans and its standard deviation, ranged from 0.0010 to 0.0137 mm and from 0.0561 to 0.1770, respectively. CIMT rate of progression ranged from -0.0001 to 0.0113 mm/year. The protocols with highest reproducibility and highest CIMT progression-precision were mean common CIMT protocols measuring both near and far wall at > or = 2 angles. The mean maximum protocol measuring three segments at > or = 2 angles performed best, yet with lower estimates as for common CIMT protocols.

CONCLUSIONS

In healthy middle-aged subjects mean common CIMT protocols that include measurements at both near and far walls at multiple (> or = 2) angles provide highest reproducibility combined with largest estimates of CIMT progression measured with high precision and are to be recommended in this population.

Poverty and maternal responsiveness: The role of maternal stress and social resources

One of the main reasons poverty is bad for children's development is because it reduces maternal responsiveness. This study addresses a heretofore unanswered question: why do low-income children experience diminished maternal responsiveness compared with their more affluent counterparts? In addition, we examine this question among a largely neglected population, young adolescent ( M = 13.1 years), rural low- and middle-income, white children. These families all reside in small towns and rural areas in North America. The negative association between poverty and maternal responsiveness is mediated by the combination of heightened maternal stress and diminished social networks.

Income Health Inequalities Among Older Persons

Objective: We examine whether the pervasive income gradient in health among senior citizens can be explained in part by multiple risk exposure. Method: A representative sample of 457 older persons ( M = 74.29 years) living independently at home were assessed in a longitudinal study. Health was assessed with a standard self-report index. Risks included loss of a loved one, caregiver burden, low housing quality, and low social integration. Results: The prospective link between income and subsequent health 2 years later is largely explained by exposure to a confluence of multiple risk factors during the 2-year period. These findings incorporate controls for negative affectivity. Discussion: Low-income, older persons are significantly more likely to have lost a loved one or close friend, be burdened by extensive caregiving demands for someone else, be more socially isolated, and live in lower quality housing. These risk exposures, in turn, largely account for the prospective link between income and health.