[Household smoking and stunting for children under five years]

Associations of Knowledge, Attitude, and Practices toward Anemia with Anemia Prevalence and Height-for-Age Z-Score among Indonesian Adolescent Girls

BACKGROUND

Crucial gaps persist in knowledge, attitude, and practice (KAP) of adolescent girls that affect anemia and linear growth failure.

OBJECTIVE

To understand the role of KAP as a risk factor of anemia and linear growth problem in adolescent girls.

METHODS

We conducted a cross-sectional survey of 335 adolescent girls selected by clustered random sampling. The KAP questionnaire had 18 variables consisting of 9 knowledge, 3 attitude, and 6 practice components. Twelve variables addressed nutrition, dietary diversity, and health environments related to both anemia and stunting. The questionnaire was adapted from the 2014 Food and Agriculture Organization nutrition-related KAP guidelines for anemia. Dietary practice was evaluated from 2-day 24-hour recalls and a semi-quantitative food-frequency questionnaire. Associations between KAP and anemia, and height-for-age z-score (HAZ), were analyzed using multivariate logistic and linear regression models, respectively.

RESULTS

The mean hemoglobin (Hb) level was 119.7 g/L, with 44% of the adolescent girls being anemic (Hb < 120 g/L) and mean height was 151.0 cm with 25% being stunted (HAZ < -2 standard deviation [SD]). The median KAP score was 7 and ranged from 3 to 10. Low to moderate KAP scores were not significantly associated with being anemic (adjusted odds ratio [AOR] = 1.26; P = .43), however 1-point KAP score increment was associated with an increase of HAZ by 0.037 SD (P = .012).

CONCLUSIONS

The KAP related to diet and healthy environments was not associated with anemia prevalence, but was positively associated with increased HAZ among adolescent girls. Strategy to reduce anemia risk in this population should combine KAP improvement with other known effective nutrition interventions.

Household Exposure to Secondhand Smoke among Chinese Children: Status, Determinants, and Co-Exposures

Smoking prevalence stays high among adults in China, which also makes children exposed to secondhand smoke (SHS) in their households. This study aimed to investigate the status of SHS exposure among Chinese children, identify the influencing factors, and determine "co-exposure" to tobacco and other smokes in households. A total of 41,439 children aged 6-17 years were recruited from 30 provinces in Mainland China through the first Chinese Environmental Exposure-Related Human Activity Model Survey for Children (CEERHAPS-C). Information regarding children's demographics, socioeconomic status, and exposures to SHS and solid fuel smoke (SFS) in households was collected using a comprehensive questionnaire. Factors that affected exposures to household smokes were identified using multivariable logistic regressions. The overall prevalence of household SHS exposure was 41.7%, and the average duration was 14.7 ± 14.6 min/day among the exposed participants. Prevalence of household SHS exposure increased among children in older age groups and with parents in lower education levels. Among SHS-exposed children, 34% had co-exposure to SFS, and they had a significantly higher risk of co-exposure than non-SHS exposed children (odds ratio = 1.12, 95% confidence interval: 1.061, 1.162). The prevalence of household SHS exposure remains high among school-age children, suggesting the need to develop and implement smoking-free home programs.

Skipping breakfast and associated factors among Brazilian adolescents

ABSTRACT Objective To analyze the prevalence and factors associated with breakfast skipping among adolescents. Methods Cross-sectional study, with adolescents aged 10-17 years, evaluated between 2009 and 2011, belonging to a cohort study in the Central-West region of Brazil. Breakfast skipping was considered as not having breakfast every day. Demographic, socioeconomic, and lifestyle factors were evaluated through a questionnaire. Anthropometric assessment included measurement of weight and height, which were used to classify weight status using body mass index. Poisson regression was used to assess the association of breakfast skipping with demographic and socioeconomic variables, lifestyle factors, and weight status. Results Among 1,716 Brazilian adolescents evaluated, 36.2% reported not consuming breakfast every day, with the highest prevalence among girls (p=0.03). After adjusting for age and economic class, breakfast skipping was associated with not consuming breakfast with parents and morning shift at school, in both genders, and with obesity only in boys. Lifestyle factors such as alcohol consumption, physical activity, diet quality, and smoking were not associated with skipping breakfast. Conclusion The omission of breakfast was observed in more than a third of adolescents, being associated with demographic and lifestyle factors. In the public health perspective, the importance of encouraging the consumption of this meal is highlighted, with actions involving the school environment and the family.

The Impact of Secondhand Smoke Exposure on Children with Cystic Fibrosis: A Review

Secondhand smoke exposure (SHSe) has multiple adverse effects on lung function and growth, nutrition, and immune function in children; it is increasingly being recognized as an important modifier of disease severity for children with chronic diseases such as cystic fibrosis (CF). This review examines what is known regarding the prevalence of SHSe in CF, with the majority of reviewed studies utilizing parental-reporting of SHSe without an objective biomarker of exposure. A wide range of SHSe is reported in children with CF, but under-reporting is common in studies involving both reported and measured SHSe. Additionally, the impact of SHSe on respiratory and nutritional health is discussed, with potential decreases in long-term lung function, linear growth, and weight gain noted in CF children with SHSe. Immunologic function in children with CF and SHSe remains unknown. The impact of SHSe on cystic fibrosis transmembrane conductance regulator (CFTR) function is also examined, as reduced CFTR function may be a pathophysiologic consequence of SHSe in CF and could modulate therapeutic interventions. Finally, potential interventions for ongoing SHSe are delineated along with recommended future areas of study.

Effect of the exposure to maternal smoking during pregnancy and childhood on the body mass index until adolescence

OBJECTIVE

Investigate the effect of exposure to smoking during pregnancy and early childhood on changes in the body mass index (BMI) from birth to adolescence.

METHODS

A population-based cohort of children (0-5 years old) from Cuiabá, Midwest Brazil, was assessed in 1999-2000 (n = 2,405). Between 2009 and 2011, the cohort was re-evaluated. Information about birth weight was obtained from medical records, and exposure to smoking during pregnancy and childhood was assessed at the first interview. Linear mixed effects models were used to estimate the association between exposure to maternal smoking during pregnancy and preschool age, and the body mass index of children at birth, childhood and adolescence.

RESULTS

Only 11.3% of the mothers reported smoking during pregnancy, but most of them (78.2%) also smoked during early childhood. Among mothers who smoked only during pregnancy (n = 59), 97.7% had smoked only in the first trimester. The changes in body mass index at birth and in childhood were similar for children exposed and those not exposed to maternal smoking. However, from childhood to adolescence the rate of change in the body mass index was higher among those exposed only during pregnancy than among those who were not exposed.

CONCLUSIONS

Exposure to smoking only during pregnancy, especially in the first trimester, seems to affect changes in the body mass index until adolescence, supporting guidelines that recommend women of childbearing age to stop smoking.

Effects of social mobility from childhood to adolescence on BMI

OBJECTIVE

Little is known about the contribution of childhood socio-economic position (SEP) and social mobility to weight change. The present study evaluated the effect of family SEP during the pre-school years and social mobility on BMI between birth and adolescence.

DESIGN

Longitudinal. The SEP of each child's family was classified according to an asset-based wealth index as low, medium or high. Four different categories of childhood-adolescence SEP groups were created in order to examine social mobility: low-medium/high, medium-medium, medium-high and high-high/medium. For each of these categories, BMI was tracked from birth to adolescence. Linear mixed-effects models were used to analyse the data.

SETTING

Cuiabá-MT, Brazil.

SUBJECTS

A population-based cohort of children born between 1994 and 1999 was assessed between 1999 and 2000, and again between 2009 and 2011.

RESULTS

A total of 1716 adolescents were followed from childhood to adolescence (71·4 % of baseline). The prevalence of overweight/obesity was 20·4 % in childhood and 27·7 % in adolescence. A higher SEP in childhood was associated with a greater prevalence of overweight in adolescence. Expressive upward social mobility occurred, mainly in the lowest SEP group. There was a greater rate of change in BMI between birth and adolescence among children with a higher SEP in childhood and children who remained in the higher SEP from childhood to adolescence.

CONCLUSION

Individuals from a higher SEP in childhood and those who remained in the higher social classes showed greater rate of change in BMI. Thus, initial SEP was the major determinant of changes in BMI.

Effect of tobacco smoke exposure during pregnancy and preschool age on growth from birth to adolescence: a cohort study

BACKGROUND

There is strong evidence of an association between maternal smoking during pregnancy and restriction of intrauterine growth, but the effects of this exposure on postnatal linear growth are not well defined. Furthermore, few studies have investigated the role of tobacco smoke exposure also after pregnancy on linear growth until adolescence. In this study we investigated the effect of maternal smoking exposure during pregnancy and preschool age on linear growth from birth to adolescence.

METHODS

We evaluated a cohort of children born between 1994 and 1999 in Cuiabá, Brazil, who attended primary health clinics for vaccination between the years 1999 and 2000 (at preschool age) and followed-up after approximately ten years. Individuals were located in public and private schools throughout the country using the national school census. Height/length was measured, and length at birth was collected at maternity departments. Stature in childhood and adolescence was assessed using the height-for-age index sex-specific expressed as z-score from curves published by the World Health Organization. Linear mixed effects models were used to estimate the association between exposure to maternal smoking, during pregnancy and preschool age, and height of children assessed at birth, preschool and school age, adjusted for age of the children.

RESULTS

We evaluated 2405 children in 1999-2000, length at birth was obtained from 2394 (99.5%), and 1716 at follow-up (71.4% of baseline), 50.7% of the adolescents were male. The z-score of height-for-age was lower among adolescents exposed to maternal smoking both during pregnancy and childhood (p < 0.01). Adjusting for age, sex, maternal height, maternal schooling, socioeconomic position at preschool age, and breastfeeding, children exposed to maternal smoking both during pregnancy and preschool age showed persistent lower height-for-age since birth to adolescence (coefficient: -0.32, p < 0.001) compared to non-exposed. Paternal smoking at preschool age was not associated with growth after adjustment for confounders.

CONCLUSION

Exposure to maternal smoking not only during pregnancy, but also at early childhood, showed long-term negative effect on height of children until adolescence.

O censo escolar como estratégia de busca de crianças e adolescentes em estudos epidemiológicos

Alternativas de baixo custo que possibilitem o acompanhamento de grupos populacionais constituem estratégias importantes na condução de estudos de coorte. Este trabalho apresenta os procedimentos para o uso do censo escolar como instrumento de busca de crianças e adolescentes em estudos de seguimento. O estudo foi realizado entre os estudantes adolescentes que frequentaram os postos de saúde de Cuiabá, Estado de Mato Grosso, Brasil, para vacinação em 1999. Foram localizados 86,8% de adolescentes com o uso do censo escolar e 0,2% pelo Sistema de Informações sobre Mortalidade. Dentre os adolescentes localizados, foram entrevistados 1.716, representando uma taxa de seguimento de 71,4%. Neste estudo, o censo escolar mostrou ser um método efetivo na busca de estudantes.

Tabagismo no domicílio e desnutrição em lactentes

OBJETIVO:Verificar o efeito da exposição à fumaça do tabaco sobre o crescimento de lactentes. MÉTODOS: Foi realizado um estudo transversal, de base populacional, com crianças atendidas nos postos de saúde de Cuiabá (MT) para imunização. Foram sorteados 10 postos e entrevistados os responsáveis por, aproximadamente, 200 crianças em cada posto. Neste estudo foram analisadas crianças menores de dois anos, perfazendo um total de 1.437 participantes. Peso e estatura foram medidos no momento da vacinação. Para análise multivariada foram construídos dois modelos, tendo como resposta as variáveis contínuas, peso para idade e comprimento para idade, os quais utilizaram a modelagem hierárquica. RESULTADOS:Aprevalência de baixo comprimento foi de 4,7% e de baixo peso foi de 3,0%. Do total de crianças estudadas, 35,8% eram expostas à fumaça do cigarro dos moradores. Após ajustes para variáveis sócio-demográficas e para as variáveis biológicas da criança, apenas o tabagismo da mãe mostrou efeito independente sobre o estado nutricional da criança, sendo que o tabagismo gestacional manteve-se associado ao indicador comprimento para idade (β =-0,226; p=0,02) e o tabagismo atual da mãe, ao indicador peso para idade (β=-0,235; p=0,02). O tabagismo do pai e dos demais moradores do domicílio não se mostrou associado a nenhum dos desfechos estudados. CONCLUSÃO:O tabagismo gestacional mostrou efeito independente sobre o indicador comprimento para idade e o tabagismo atual da mãe ao indicador peso para idade dos lactentes.

Fatores associados à experimentação do cigarro em adolescentes

OBJETIVO: Analisar a prevalência e os fatores associados à experimentação do cigarro em adolescentes. MÉTODOS: Estudo transversal, utilizando-se questionário específico, onde foram entrevistados 2.883 estudantes do ensino fundamental e do 1º ano do ensino médio, de escolas localizadas na zona urbana da cidade de Cuiabá (MT). Estimou-se a prevalência e foram analisados os principais fatores relacionados à experimentação do cigarro. Após isso, obteve-se um modelo logístico hierarquizado descrevendo as chances da experimentação do cigarro relacionada com as variáveis investigadas. RESULTADOS: A prevalência da experimentação do cigarro foi de 30,2%. No modelo final de análise, as principais variáveis relacionadas com a experimentação do cigarro foram menor nível de escolaridade da mãe (OR = 2,44; IC95%: 1,72-3,47); menor nível socioeconômico (OR = 1,39; IC95%: 1,01-1,93); estudar na escola pública (OR = 1,56; IC95%: 1,22-2,00); estar no 1º ano do ensino médio (OR = 3,45; IC95%: 2,63-4,54); estudar no período noturno (OR = 2,44; 1,85-3,22); ter pais separados (OR = 1,23; IC95%: 1,02-1,49); já ter sido reprovado na escola (OR = 2,17; IC95%: 1,78-2,70); ter amigos fumantes (OR = 3,75; IC95%: 2,99-4,70); ter irmãos fumantes (OR = 2,44; IC95%: 1,82-3,27); e ser mais velho (17-19 anos) (OR = 2,44; IC95%: 1,39-4,17). CONCLUSÕES: Foi alta proporção de adolescentes que experimentaram o cigarro. Após ajuste para variáveis de confusão os fatores mais fortemente associados à experimentação do cigarro foram nível de escolaridade da mãe, idade do adolescente, estudar no período noturno, já ter sido reprovado na escola e ter amigos e irmãos fumantes. Medidas preventivas devem ser direcionadas aos adolescentes, dentro das instituições escolares, como forma de controle do tabagismo.

Does cigarette use influence adiposity or height in adolescence?

PURPOSE

To study the effect of cigarette use on height and adiposity in adolescents.

METHODS

Data on cigarette use were collected every 3 months for 5 years from adolescents initially 12-13 years of age. Height, weight, and triceps skinfold thickness were measured in survey cycles 1, 12, and 19. Multivariate linear regression models were fitted to estimate the association between cigarette use and the anthropometric measures in a dataset that pooled data over two time periods, from survey cycles 1-12 and from survey cycles 12-19.

RESULTS

Data were available for 451 boys and 478 girls. Seven percent of boys and 14% of girls smoked > or =30 cigarettes per month on average during the first time period; 9% of boys and 18% of girls smoked > or =30 cigarettes per month on average during the second time period. In boys, a 100-cigarette per month increment in cigarette use over the preceding 2.5 years was independently associated with lower body mass index (-0.4 kg/m(2)) and shorter height (-0.7 cm). In girls, cigarette use was not associated with height or adiposity.

CONCLUSIONS

While there was no relation in girls, cigarette use appears to decrease body mass index and height in boys. Young girls may be less likely to take up cigarette smoking if tobacco control messages emphasize that cigarette use may not be associated with reduced weight in adolescent females.