Prevalence of hearing loss among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey

CONTEXT

Hearing loss in children influences the development of communication and behavioral skills, but few studies in the United States have used pure-tone audiometry to derive hearing loss prevalence estimates for children.

OBJECTIVE

To describe the prevalence of hearing loss among US children by sociodemographic characteristics, reported hearing loss, and audiometric screening factors.

DESIGN

National population-based cross-sectional survey with an in-person interview and audiometric testing at 0.5 to 8 kHz.

SETTING/PARTICIPANTS

A total of 6166 children aged 6 to 19 years completed audiometry in the mobile examination center of the Third National Health and Nutrition Examination Survey conducted between 1988 and 1994.

MAIN OUTCOME MEASURE

Hearing loss, defined as audiometric threshold values of at least 16-dB hearing level based on a low or high pure-tone average.

RESULTS

A total of 14.9% of children had low-frequency or high-frequency hearing loss of at least 16-dB hearing level, 7.1% had low-frequency hearing loss of at least 16-dB hearing level, and 12.7% had high-frequency hearing loss of at least 16-dB hearing level. Most hearing loss was unilateral and slight in severity (16- to 25-dB hearing level). Of those with measured hearing loss, 10.8% were reported to have current hearing loss during the interview.

CONCLUSIONS

This analysis indicates that 14.9% of US children have low-frequency or high-frequency hearing loss of at least 16-dB hearing level in 1 or both ears. Among children in elementary, middle, and high school, audiometric screening should include low-frequency and high-frequency testing to detect hearing loss.

Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey, 1988-1994, United States

OBJECTIVE

This analysis estimates the first nationally representative prevalence of noise-induced hearing threshold shifts (NITS) among US children. Historically, NITS has not been considered a common cause of childhood hearing problems. Among children, NITS can be a progressive problem with continued exposure to excessive noise, which can lead to high-frequency sound discrimination difficulties (eg, speech consonants and whistles).

METHODS

The Third National Health and Nutrition Examination Survey (NHANES III) was conducted from 1988 to 1994. NHANES III is a national population-based cross-sectional survey with a household interview, audiometric testing at 0.5 to 8 kHz, and compliance testing. A total of 5249 children aged 6 to 19 years completed audiometry and compliance testing for both ears in NHANES III. The criteria used to assess NITS included audiometry indicating a noise notch in at least 1 ear.

RESULTS

Of US children 6 to 19 years old, 12.5% (approximately 5.2 million) are estimated to have NITS in 1 or both ears. In the majority of the children meeting NITS criteria, only 1 ear and only 1 frequency are affected. In this analysis, all children identified with NITS passed compliance testing, which essentially rules out middle ear disorders such as conductive hearing loss. The prevalence estimate of NITS differed by sociodemographics, including age and sex.

CONCLUSIONS

These findings suggest that children are being exposed to excessive amounts of hazardous levels of noise, and children's hearing is vulnerable to these exposures. These data support the need for research on appropriate hearing conservation methods and for NITS screening programs among school-aged children. Public health interventions such as education, training, audiometric testing, exposure assessment, hearing protection, and noise control when feasible are all components of occupational hearing conservation that could be adapted to children's needs with children-specific research.

Serum selenium levels in the US population: Third National Health and Nutrition Examination Survey, 1988-1994

The published literature on serum selenium levels in the US population describes studies on small samples that may not be representative of the US population. This analysis provides the first nationally representative serum selenium levels in the US population by age group, sex, race-ethnicity, poverty income ratio (PIR), geographic region, and urban status. The Third National Health and Nutrition Examination Survey (NHANES III) is a national population-based cross-sectional survey with an in-person interview and serum selenium measurements. For the 18,597 persons for whom serum selenium values wereavailable in NHANES III, the mean concentration was 1.58 nmol/L and the median concentration was 1.56 nmol/L. Mean serum selenium levels differed by age group, sex, race ethnicity, PIR, and geographic region. The US population has slight differences in serum selenium levels by demographic factors.

Serum dioxins, polychlorinated biphenyls, and endometriosis: a case-control study in Atlanta

Endometriosis among women of reproductive age can result in pain and infertility. The objectives of this study were to test if there is a relation between endometriosis and serum dioxin concentrations as expressed by total toxic equivalence and serum total polychlorinated biphenyl concentrations among women patients at one Atlanta reproductive medicine clinic during 1998-1999; a secondary objective was to provide exposure data for individual congeners of these chemicals and 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (p,p'-DDE) in women in Atlanta. Laparoscopy including biopsy and visualization of the peritoneal cavity, ovaries, outside of the fallopian tubes and uterus confirmed all endometriosis cases (n=60) and confirmed 30 controls without endometriosis. Other controls had an infertile partner (n=27) or ovulation problems (n=7) with no signs or symptoms of endometriosis. All serum samples were analyzed at the U.S. Centers for Disease Control and Prevention in 2003. Statistical analyses included Fisher's exact chi-square tests and logistic regression. Models were presented for the full study sample and for the subset that included all cases (n=60) and only controls (n=30) with surgical confirmation of disease-free status. Serum concentrations (lipid-adjusted and non lipid-adjusted) of analyzed exposure measures were low and similar for cases and controls and did not explain endometriosis in the study population.

Learning from patient and site perspectives to develop better digital health trials: Recommendations from the Clinical Trials Transformation Initiative

In order to harness the potential of digital health technologies to enhance the quality of clinical research, it is critical to first understand how to engage patients and research sites when planning and conducting digital health trials. To pave the way for the more effective use of digital health technologies in trials, the Clinical Trials Transformation Initiative has developed the first comprehensive, evidence-based set of recommendations for incorporating patient and site perspectives in digital health trials. While directed primarily at sponsors, these recommendations are expected to be valuable for all stakeholders including investigators.

Differences in notifiable infectious disease morbidity among adult women--United States, 1992-1994

By 1990, all 50 states were using the Centers for Disease Control and Prevention (CDC) National Electronic Telecommunications System for Surveillance to report individual case data that included demographic information (without personal identifiers) about most notifiable diseases. This analysis of National Notifiable Diseases Surveillance System (NNDSS) data is useful for evaluating the distribution of reported notifiable infectious diseases among adult women by age and race. The number of cases of the 48 nationally notifiable infectious diseases reported among adult women (i.e., women > or = 15 years of age) were compiled for 1992-1994. These data were then analyzed by age and race, and rates per 100,000 adult women were calculated. During 1992-1994, the 10 most commonly reported nationally notifiable diseases among adult women in the United States were, in descending order of frequency, gonorrhea, primary/secondary syphilis, acquired immunodeficiency syndrome (AIDS), salmonellosis, tuberculosis, hepatitis A, hepatitis B, shigellosis, Lyme disease, and hepatitis C/non-A non-B. Gonorrhea was the most commonly reported notifiable infectious disease for women of all ages, except those ages > or = 55 years, and for women of all races, except Asian/Pacific Islanders. Tuberculosis was the most commonly reported infectious disease among women of Asian/Pacific Island descent. Analysis of NNDSS data provides information about the relative reported burden of diseases among women of all ages and different races. This information may be used for targeting research, prevention, and control efforts.

Environmental public health surveillance: possible estuary-associated syndrome

Public health surveillance involves the collection, analysis, and dissemination of data for use in public health practice. A surveillance system includes the capacity to collect and analyze data as well as the ability to disseminate the data to public health agencies that can undertake effective prevention and control activities. An emerging issue in environmental public health surveillance involves human exposure to the toxins produced by microorganisms present in oceans and estuaries. One of these organisms is Pfiesteria piscicida Steidinger & Burkholder, a dinoflagellate found in estuaries along the Atlantic and gulf coasts of the United States. There have been reports of both human illness associated with occupational exposures to concentrated laboratory cultures of P. piscicida and massive fill kills associated with the presence of the organism in rivers and estuaries. These reports, and anecdotal reports from people who worked on rivers where the organism has been found, generated concern that environmental exposures to P. piscicida, similar organisms, or perhaps a toxin or toxins produced by the organism(s), could cause adverse human health effects. To begin to evaluate the public health burden associated with P. piscicida, investigators from the National Center for Environmental Health at Centers for Disease Control and Prevention and health agencies from states along the Atlantic coast collaborated to develop a passive surveillance system for collecting, classifying, and tracking public inquiries about the organism. Specifically, the group developed exposure and symptom criteria and developed data collection and reporting capabilities to capture the human health parameters collectively referred to as possible estuary-associated syndrome (PEAS). The surveillance system was implemented in six states (Delaware, Florida, Maryland, North Carolina, South Carolina, Virginia) beginning in June 1998. From 1 June 1998 through 30 June 2001, the six state health agencies participating in the PEAS surveillance system received 3,859 calls: 3,768 callers requested information and 91 callers reported symptoms. Five individuals have been identified as meeting PEAS criteria.

Body weight dissatisfaction among Israeli Jewish and Arab women with normal or overweight-obese body mass index, Israeli INHIS-1, 2003-2004

INTRODUCTION

In Israel, 58.9% of Jewish and Arab Israeli women aged 25 to 64 years are overweight or obese (body mass index >or=25 kg/m(2)). The objective of this analysis is to describe body weight dissatisfaction differences between Jewish and Arab Israeli women with normal or overweight-obese body mass index.

METHODS

This analysis included 1,393 Jewish and Arab women who participated in the Israeli National Health Interview Survey, 2003-2004. The survey covered a random sample of the Israeli general population aged 21 years or older. All variables were based on self-report. Body weight dissatisfaction was a multiple-choice question in the survey that offered the following responses: very satisfied, satisfied, reasonably satisfied, not satisfied, or very unsatisfied. Univariate and multivariate analyses were conducted.

RESULTS

Overall, 39.1% of Jewish women reported body weight dissatisfaction, compared with 29.1% of Arab women. Older overweight-obese Arab women had a lower prevalence of body weight dissatisfaction than Jewish women of the same age group, which indicates cultural differences in body weight dissatisfaction among older overweight-obese women. However, cultural differences do not appear to influence body weight dissatisfaction among younger Jewish and Arab women of normal weight.

CONCLUSION

This study suggests that Jewish and Arab women differ in their perceptions of body weight. Interventions tailored to each group are needed to promote healthy dietary and physical activity behaviors.

Article Commentary: Indicators to Measure Success of Smoke-free Policies

The health consequences of involuntary exposure to tobacco smoke are well documented. The past decade provides several examples of successful smoke-free policies that are directly related to improving public health. The objective of this communication is to identify indicators that demonstrate the success of smoke-free policies. Indicators are identified from smoke-free policy evaluations conducted by countries such as the United States, New Zealand, and Israel. Indicators were identified that demonstrate the success of smoke-free policies in the areas of compliance, indoor air quality, bio-monitoring, medical tests, and health behaviors. As smoke-free policies continue to be implemented, indicator evaluation activities should be considered from the start.