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Seetharaman S, Matson PA, Trent ME, McCartney Swamy A, Marcell AV. Association of Adolescents' Body Mass Index Classification With Preventive Clinical Care Receipt. J Adolesc Health 2023; 73:1046-1052. [PMID: 37690010 PMCID: PMC10841196 DOI: 10.1016/j.jadohealth.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To examine differences in screening and advising for modifiable risk behaviors during well-visits based on adolescents' body mass index categories. METHODS Retrospective analyses were conducted with the National Institute of Health's NEXT Generation Health Study data, a nationally representative cohort of 10th graders. In wave 1 (2010), adolescents were classified as being underweight (<4.99th percentile), normal-weight (5-84.99th percentile), overweight (85-94.99th percentile), or with obesity (≥95th percentile) based on the body mass index categories described by the Centers for Disease Control and Prevention. In wave 2 (2011), adolescents were asked by their provider about smoking, alcohol use, use of other drugs, sexual activity, nutrition, and exercise, and whether they were advised about risks associated with these behaviors. RESULTS The sample consisted of 1,639 eligible participants as follows: 57.8% females, 63.3% 16-year-olds, 47.8% non-Hispanic Whites, 41.5% living in the South, 75.4% with health insurance, and 29.8% with low family affluence. Screening rates for overweight compared to normal-weight males were 51% reduced for smoking, 46% for alcohol use, 47% for other drug use, 57% for nutrition, and 47% for exercise. Screening rates were 40% reduced for other drug use for males with obesity, and 89% reduced for alcohol use for underweight males compared to normal-weight males. Advice receipt for females with obesity compared to normal-weight females was 90% increased for nutrition and 78% increased for exercise. DISCUSSION Overweight male adolescents reported being less likely to be screened across almost all preventive service topics representing missed opportunities for care delivery.
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Affiliation(s)
- Sujatha Seetharaman
- Division of Pediatric Endocrinology, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island.
| | - Pamela A Matson
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria E Trent
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Annemarie McCartney Swamy
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arik V Marcell
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Comparative analysis of anthropometric indicators for diagnosing obesity and predicting cardiometabolic risk in Mexican adolescents. NUTR HOSP 2022; 39:513-519. [PMID: 35080416 DOI: 10.20960/nh.03897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION obesity is a cardiometabolic risk (CMR) factor in adolescents. It represents a public health problem that requires simple diagnostic strategies based on the determination of anthropometric indicators (AIs) such as body mass index (BMI), waist circumference (WC), conicity index (CONI), waist-to-height ratio (WHtR), and body fat percentage (BFP). The purpose of the current contribution was to analyze the utility of the aforementioned AIs for evaluating obesity as a CMR factor in Mexican adolescents. MATERIALS AND METHODS the design of the study is descriptive and cross-sectional. Nutritional status was established by using various AIs and as a CMR factor under the criteria of WHtR. Participating in the present investigation were 2,000 adolescents from 15 to 17 years of age, of which 1,079 (53.9 %) were female and 921 (46.1 %) were male. All were high school students in Tuxtla Gutiérrez, Chiapas, Mexico. RESULTS AND CONCLUSION the prevalence of obesity was influenced by gender. With the WHtR and BFP, male students exhibited a greater prevalence of obesity, while with the BMI and CONI, the percentage of obesity was similar between the two genders. BMI was significantly correlated with BFP, WC and WHtR, and was one of the AIs with the greatest area under the curve, showing a good capacity to predict cardiometabolic risk. BMI is a simple and adequate tool for diagnosing obesity and predicting CMR in adolescents.
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Reynolds GL, Fisher DG. The Role of the Medicaid Expansion in the Use of Preventive Health Care Services in California Men. Am J Mens Health 2021; 14:1557988320903193. [PMID: 31997707 PMCID: PMC6993173 DOI: 10.1177/1557988320903193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Men’s use of preventive care services may be constrained due to a number of factors including lack of health care insurance. California used the Medicaid expansion provisions of the Affordable Care Act (ACA) to enroll low-income men between the ages of 18 and 64 years in publicly funded health insurance. Most studies on the effect of the ACA on health care services have focused on racial/ethnic differences rather than gender. Data from the California Health Interview Survey for the 2015–2016 survey period were used to model the use of preventive health care services in the year prior to interview. Population weights were used in the analysis which was done using PROC SURVEY LOGISTIC in SAS software, version 9.4. The sample consisted of men between the ages of 18 and 64 years (N = 6,180). Of these 66% (n = 4,088) reporting receiving any preventive care services in the year prior to interview. The largest proportions of respondents fell into the youngest group aged 18–25 (17%) followed by the oldest group aged 60–64 (16.9%); 43% reported they were married, 57% had incomes at greater than 300% of the federal poverty level. There was no effect of race or ethnicity on receiving preventive care services. Having a chronic condition such as hypertension or diabetes was associated with a greater odds of receiving preventive care. Expanding Medicaid to include low-income men below the age of 65 is associated with increased use of preventive health care, especially among those with chronic conditions.
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Affiliation(s)
- Grace L Reynolds
- Department of Health Care Administration, California State University, Long Beach, CA, USA.,Center for Behavioral Research & Services, California State University, Long Beach, CA, USA
| | - Dennis G Fisher
- Center for Behavioral Research & Services, California State University, Long Beach, CA, USA.,Department of Psychology, California State University, Long Beach, CA, USA
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Association of anthropometric indicators to evaluate nutritional status and cardiometabolic risk in Mexican teenagers. NUTR HOSP 2020; 36:1049-1054. [PMID: 31475834 DOI: 10.20960/nh.02487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: anthropometric indicators (AIs) such as waist circumference (WC), body mass index (BMI), waist/hip index (WHpI), waist/height index (WHtI) and body fat percentage (BFP) are useful tools for the diagnosis of nutritional status (NS) in adolescents. Each of these parameters has advantages and disadvantages. The purpose of the present study was to analyze the association of these AIs (WC, BMI, WHpI, WHtI, and BFP) to evaluate nutritional status and estimate the cardiometabolic risk (CMR) in Mexican adolescents. Material and method: in a cross-sectional descriptive study, the NS was analyzed through various AIs and CMR with the WHtI criteria. Nine hundred and seventeen adolescents between 15 and 17 years old participated in the study, of whom 488 (52.9%) were female and 429 (47.1%) male, all students of middle school in Tuxtla Gutiérrez, Chiapas, Mexico. Results and conclusion: women presented a higher prevalence of obesity according to most indicators. The WHtI was the parameter that detected the highest prevalence of obesity (31%), correlating with the BMI and the BFP. Moreover, there was evidence of a significant relation between NS (assessed by all the anthropometric indicators) and CMR. The WHtI could be considered as an adequate tool for the diagnosis of obesity associated with CMR in adolescents.
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Breland JY, Wong MS, Frayne SM, Hoggatt KJ, Steers WN, Saechao F, Washington DL. Obesity and Health Care Experiences among Women and Men Veterans. Womens Health Issues 2019; 29 Suppl 1:S32-S38. [PMID: 31253240 DOI: 10.1016/j.whi.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. METHODS Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. RESULTS The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. CONCLUSIONS It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.
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Affiliation(s)
- Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California.
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - W Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Fay Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Haas CB, Phipps AI, Hajat A, Chubak J, Wernli KJ. Time to fecal immunochemical test completion for colorectal cancer screening. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:174-180. [PMID: 30986014 PMCID: PMC7170013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Fecal immunochemical tests (FITs) can efficiently screen for colorectal cancer (CRC), but little is known on the timing to their completion. We investigate the time to return of a FIT following an order and describe patient characteristics associated with FIT return. STUDY DESIGN Retrospective cohort study. METHODS We identified 63,478 members of Kaiser Permanente Washington, aged 50 to 74 years, who received a FIT order from 2011 through 2012. Patient characteristics were ascertained through administrative and electronic health record data sources. We compared time from FIT order to return by patient characteristics using Kaplan-Meier and Cox regression methods. RESULTS About half (53.7%) of members completed a FIT. Median time from order to return was 13 days (mean, 44.5 days; interquartile range, 6-42 days). There was higher completion of FITs among Asian patients (hazard ratio [HR], 1.43; 95% CI, 1.38-1.48), black patients (HR, 1.13; 95% CI, 1.08-1.19), and Hispanic patients (HR, 1.10; 95% CI, 1.04-1.16) compared with white patients; among patients with recent CRC testing (vs no testing in past 2 years; HR, 1.90; 95% CI, 1.86-1.95); and among patients with Medicare insurance (vs commercial; HR, 1.30; 95% CI, 1.24-1.37). Factors associated with decreased FIT completion included younger age (50-54 years vs 70-74 years; HR, 0.87; 95% CI, 0.82-0.92), obesity (vs normal body mass index; HR, 0.88; 95% CI, 0.86-0.91), and higher Charlson Comorbidity Index score (≥3 vs 0; HR, 0.82; 95% CI, 0.79-0.87). CONCLUSIONS Time to return of FIT varies by patient characteristics. We observed greater FIT completion among people of color, suggesting that racial disparities in CRC may not be due to patient completion of the test after an order is received.
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Affiliation(s)
- Cameron B Haas
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101.
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Eskelinen TJ, Kotsar A, Tammela TL, Murtola TJ. Components of metabolic syndrome and prognosis of renal cell cancer. Scand J Urol 2017; 51:435-441. [DOI: 10.1080/21681805.2017.1352616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Andres Kotsar
- Department of Urology, Tarto University Hospital, Tarto, Estonia
| | - Teuvo L.J. Tammela
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J. Murtola
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Lynch BA, Rutten LJF, Jacobson RM, Kumar S, Elrashidi MY, Wilson PM, Jacobson DJ, St. Sauver JL. Health Care Utilization by Body Mass Index in a Pediatric Population. Acad Pediatr 2015; 15:644-50. [PMID: 26443036 PMCID: PMC4760684 DOI: 10.1016/j.acap.2015.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We tested the hypothesis that the frequency of emergency department (ED) visits, outpatient clinic visits, and hospitalizations were higher among children with higher body mass index (BMI) categories, even after controlling for demographics, socioeconomic status, and presence of other chronic medical conditions. METHODS We obtained electronic height, weight, and utilization data for all residents of Olmsted County, Minnesota, aged 2 to 18 years on January 1, 2005 (n = 34,335), and calculated baseline BMI (kg/m(2)). At least 1 BMI measurement and permission to use medical record information was available for 19,771 children (58%); 19,528 with follow-up comprised the final cohort. BMIs were categorized into underweight/healthy weight (<85th percentile), overweight (85th to <95th percentile), and obese (≥95th percentile). Negative binomial models were used to compare the rate of utilization across BMI categories. Multivariable models were used to adjust for the effects of age, race, sex, socioeconomic status, and chronic medical conditions. RESULTS Compared to children with BMI <85th percentile, overweight and obese status were associated with increased ED visits (adjusted incident rate ratio [IRR] 1.16, 95% confidence interval [CI] 1.10, 1.23; and IRR 1.27, 95% CI 1.19, 1.35, respectively; P for trend <.0001), and outpatient clinic visits (IRR 1.05, 95% CI 1.02, 1.08; and IRR 1.07, 95% CI 1.04, 1.11, respectively; P for trend <.0001). No associations were observed between baseline BMI category and hospitalizations in the adjusted analyses. CONCLUSIONS Children who are overweight or obese utilize the ED and outpatient clinics more frequently than those who are underweight/healthy weight, but are not hospitalized more frequently.
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Affiliation(s)
- Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | | | - Patrick M Wilson
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Debra J Jacobson
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Department of Health Sciences Research, Mayo Clinic, 200 First St., Rochester, MN, 55905
| | - Jennifer L St. Sauver
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Department of Health Sciences Research, Mayo Clinic, 200 First St., Rochester, MN, 55905
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