Search

Evidence suggests that autistic adults have higher odds of developing several co-occurring conditions, but less is known about disparities by race and ethnicity in this population. Using 2008-2012 Medicaid Analytic eXtract (MAX) data, we (i) identify the prevalence of co-occurring conditions among the population of autistic adult Medicaid beneficiaries compared to a matched sample of those without an autism spectrum disorder (ASD) diagnosis, (ii) conduct logistic regression to estimate odds ratios for these health conditions predicted by an autism diagnosis, and (iii) estimate odds of having these health conditions as predicted by racial/ethnic group among the autistic population only. Overall, autistic adults did not have higher prevalence of some major health conditions (cardiovascular conditions, stroke, cancer, cardiovascular disease), but they did have higher odds of others (nutrition conditions, epilepsy, disorders of the central nervous system). Analysis by racial/ethnic group, however, shows that Black, Hispanic, and Asian autistic beneficiaries had higher odds of diabetes, hospitalized cardiovascular diseases, and hypertension, among other conditions. Policymakers should be aware that racial disparities found in the general population persist in the autistic population and should work to implement systems and programs to improve screening and preventive care for minority autistic populations. LAY SUMMARY: Autistic adults may have several co-occurring physical and mental health conditions, which could differ by racial/ethnic group. We find that, compared to the general Medicaid population, autistic adult Medicaid beneficiaries have elevated odds of some health conditions, like epilepsy and nutrition conditions, as well as some psychiatric conditions, such as anxiety and attention disorders. We also find that many of the same health disparities by racial/ethnic group in the general population persist among the autistic adult Medicaid population. For example, Black, Hispanic, and Asian Medicaid autistic beneficiaries have higher odds of diabetes, and Black and Hispanic autistic beneficiaries have higher odds of obesity and nutrition conditions than white autistic beneficiaries.

We investigated intergenerational associations of adolescent mothers' and grandmothers' anthropometrics and schooling with adolescent mothers' offspring's anthropometrics in Ethiopia, India, Peru, and Vietnam. We examined birthweight (n = 283), birthweight Z-score (BWZ), conditional growth in weight-for-age Z-score (cWAZ, residuals from a regression of WAZ at last survey round on BWZ, sex, and age), and height-for-age Z-score (HAZ) of children born to older cohort adolescent girls in the Young Lives study. Our key independent variables were adolescent mothers' body size: HAZ and body-mass-index-for-age Z-score (BMIZ) at age 8, conditional HAZ (cHAZ, residuals from a regression of HAZ at the end of a growth period on prior HAZ, age, and sex), conditional BMIZ growth (cBMIZ, calculated analogously), and grandmaternal BMIZ, HAZ, and schooling. We adjusted for child, maternal, and household characteristics. Adolescent mothers' cHAZ (ages 8-15) predicted birthweight (β = 130 g, 95% confidence interval (CI) 31-228), BWZ (β = 0.31, CI 0.09-0.53), and cWAZ (β = 0.28, CI 0.04-0.51). Adolescent mothers' BMIZ at age 8 predicted birthweight (β = 79 g, CI 16-43) and BWZ (β = 0.22, CI 0.08-0.36). Adolescent mothers' cBMIZ (ages 12-15) predicted child cWAZ and HAZ. Grandmothers' schooling predicted grandchild birthweight (β = 22 g, CI 1-44) and BWZ (β = 0.05, CI 0.01-0.10).

Evidence on the associations of birth weight and prepubertal nutritional status with menarcheal age for low- and middle-income countries is limited. We investigated these relationships using the Young Lives younger cohort for 2001 Indian, Peruvian, and Vietnamese girls born in 2001-2002. Girls were followed at approximately ages 1, 5, 8, and 12 years. Weibull survival models estimated hazards of earlier menarche on the basis of birth weight Z-scores (BWZ), and age-8 BMI-for-age Z-scores (BMIZ) and height-for-age Z-scores (HAZ). Estimates controlled for potential individual-, mother-, and household-level confounders and for changes in anthropometry between 1 and 8 years. In adjusted models, BWZ predicted later age at menarche (hazard ratio (HR) = 0.90, 95% CI: 0.83-0.97). Conversely, HAZ (HR = 1.66, 95% CI 1.5-1.83) and BMIZ at 8 years (HR = 1.28, 95% CI: 1.18-1.38) predicted earlier menarche. Changes in HAZ and BMIZ between 1 and 8 years were not associated with earlier menarche. Associations were consistent across countries, though with variation in estimated magnitudes. Maternal height and age were associated with later menarche. This evidence points to consistently robust and opposite associations of birth weight versus prepubertal attained height and body mass index with menarcheal age in three diverse settings with regard to nutrition, ethnicity, and socioeconomic status.

There has been little examination of: (1) associations of early-life nutrition and adolescent cognitive skills, (2) if they vary by gender, (3) if they differ by diverse contexts, and (4) contributions of post-infancy growth to adolescent cognitive attainment. We use Young Lives data on 7687 children from Ethiopia, India, Peru, and Vietnam to undertake ordinary least squares estimates of associations between age-1 height-for-age z-score (HAZ) and age-15 cognitive outcomes (math, reading, vocabulary), controlling for child and household factors. Age-1 HAZ is positively associated with cognitive scores in all countries. Child gender-specific estimates for these coefficients either do not differ (math, reading) or favor girls (vocabulary). Augmenting models to include growth in HAZ between ages 1 and 15 years that was not predicted by HAZ at age 1 reveals that such improvements are associated with higher cognitive scores, but that sex-specific coefficients for this predictor favor boys in India and Peru. The results suggest that nutritional indicators at age 1 have gender-neutral associations with math and reading and favor girls for vocabulary achievement at age 15, but unpredicted improvements in HAZ by adolescence are associated with higher cognitive scores for boys than for girls. This evidence enriches our understanding of relationships between children’s nutritional trajectories during childhood and adolescent cognitive development, and how these associations vary by gender in some contexts to the possible disadvantage of girls.

Rapid development in Latin America has been accompanied by lifestyle shifts, including changes in time use and social environments. Overweight/obesity has also emerged as a public health challenge. We examined whether lifestyle changes and sexual maturity-related indicators (early pubertal development and having a child) predict increases in adiposity among Peruvian youth. Using longitudinal data from Young Lives, we examined changes in adiposity between ages 8 and 15 years old for the younger cohort and ages 15 and 22 years old for the older cohort. Boys and girls in both cohorts demonstrated substantial increases in age-adjusted adiposity measures, but predictors were different for boys versus girls. For boys, increases in time spent in work and domestic chores predicted increases in adiposity body mass index and BMI-for-age Z-score and increases in time spent sleeping were associated with decreases in adiposity (waist circumference and waist-to-height ratio). For girls, sexual maturity-related indicators (early menarche and childbearing) predicted increases in adiposity, regardless of time use. Potential mechanisms for these results may include diet, physical activity, wealth, and urban-rural residence. Time use among youth was associated with diet quality and physical activity, but in different ways for boys versus girls. Strategies for dealing with rising overweight and obesity should incorporate sex-based specificities.

As part of the nutritional transition, undernutrition is globally declining while changes brought by economic development have ushered in increases in overweight and its related economic costs and health consequences around the world. We examine trajectories in stunting and overweight from age one year to mid-adolescence and from mid-childhood to early adulthood among two cohorts from Ethiopia, India, Peru and Vietnam using data from the Young Lives study. We examine descriptive data and then model trajectories in stunting and overweight status over age. Group-based trajectory analysis with five ages of overweight and stunting for each country-cohort reveals (1) trajectories of catch-up growth for a subset of study children between the ages of 12 and 19 in the older cohort in Ethiopia (20.1% of the cohort), India (20.5%), Peru (16.9%), and Vietnam (14.0%); (2) trajectories of increasing probabilities of stunting as children age from 12 to 22 in the older cohort in India (22.2%) and Peru (30.7%); (3) trajectories of early (childhood) increases in overweight probabilities (younger cohort: India, 3.4%, Peru, 19.4%, and Vietnam, 8.1%), and of later (adolescence) increases in overweight probabilities (older cohort: Ethiopia, 0.5%, India, 6.3%, Peru, 40.9%, and Vietnam, 9.4%). Multinomial logit prediction of membership in trajectory categories reveals that higher wealth quartiles and maternal schooling are protective against high stunting probability trajectory group membership, but higher wealth and urban residence predict high overweight probability trajectory group membership. This evidence suggests a window of opportunity for interventions to reduce stunting and to avert overweight development in adolescence, in addition to the often-emphasized first 1,000 days after conception. A life-course approach to policies and programs to target both undernutrition and overweight should be considered.

Extend analyses of maternal mental health and infant growth in low- and middle-income countries (LMICs) to children through age eight years, and broaden analyses to cognitive and psychosocial outcomes.Community-based longitudinal cohort study in four LMICs (Ethiopia, India, Peru and Vietnam). Surveys and anthropometric assessments were carried out when the children were approximately ages 1, 5 and 8 years. Risk of maternal common mental disorders (rCMDs) was assessed with the Self-Reporting Questionnaire (SRQ)-20 (score ≥8).Rural and urban as well as low- and middle-income communities.7722 mothers and their children.Child stunting and underweight (Z score ≤2 of height and weight for age), and20th centile for: cognitive development (Peabody Picture Vocabulary Test), and the psychosocial outcomes self pride and life satisfaction.A high rate of rCMD, stunting and underweight was seen in the cohorts. After adjusting for confounders, significant associations were found between maternal rCMDs and growth variables in the first year of life, with persistence to age 8 years in India and Vietnam, but not in the other countries. India and Vietnam also showed significant associations between rCMDs and lower cognitive development. After adjustment, rCMD was associated with low life satisfaction in Ethiopia but not in the other cohorts.Associations of maternal rCMD in the first year of life with child outcomes varied across the study cohorts and, in some cases, persisted across the first 8 years of life of the child, and included growth, cognitive development and psychosocial domains.

Purpose We aimed to estimate group-based trajectories of body mass index (BMI) in a longitudinal cohort of young women and determine the association between sexual identity and BMI trajectory group, adjusting for obesity risk factors. Methods We analyzed data from females in waves I–IV of the National Longitudinal Study of Adolescent to Adult Health. Sexual identity was categorized as heterosexual, mostly heterosexual, bisexual, or lesbian (homosexual/mostly homosexual). We conducted group-based trajectory modeling of BMI with a censored normal distribution and a cubic relationship with age to identify three BMI trajectory groups. Multinomial logit regressions predicted the risk of trajectory membership associated with sexual identity, adjusting for background characteristics. Results At wave I, the mean (n = 7,801) age was 15.9 years (95% confidence interval: 15.6–16.1). Subjects were 16.3% African-American; and 80.0% heterosexual, 15.9% mostly heterosexual, 2.5% bisexual, and 1.7% lesbian. Group-based trajectory modeling identified three BMI trajectory groups characterized as (1) minimal obesity (62.2%), (2) developing obesity (29.9%), and (3) progressive obesity (8.0%). In multinomial logit regressions adjusted for age, race, parental obesity and education, sexual abuse, household income, screen time, depressive symptoms, and rural residence, lesbian women had a nearly two-fold higher relative risk of being in the developing obesity trajectory group (relative risk ratio = 1.91, 95% confidence interval: 1.10–3.32) relative to the minimal obesity group, compared with heterosexual women. Conclusions Lesbian women were at increased risk of membership in the developing obesity trajectory group compared with heterosexual women. Adjusting for obesity risk factors had minimal impact on the point estimates for this association.

Background: Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy. Objective: We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y. Design: We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y. Results: The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80–0.84) and positively associated with mathematics achievement (effect-size range: 0.05–0.10), reading comprehension (0.02–0.10), and receptive vocabulary (0.04–0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering. Conclusions: Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school–age children also merit consideration.

Using a multinomial logit model with data from the Survey of Income and Program Participation, this paper tests whether the implementation of the Family and Medical Leave Act (FMLA) is associated with an increase in return to work at part-time status among first-time mothers working full-time during their pregnancy. I find a statistically significant trend of increasingly higher odds of returning to work at part-time status relative to return at full-time status, beginning in 1993 (the year in which the FMLA is implemented). Furthermore, an additional week of either state or federal leave is significantly associated with a higher odds of return at part-time status. This article provides evidence that job protection and leave legislation may help facilitate higher levels of labor force participation among women with small children, through more flexible work arrangements.

Recent research has demonstrated some growth recovery among children stunted in infancy. Less is known about key age ranges for such growth recovery, and what factors are correlates with this growth. This study characterized child growth up to age 1 year, and from ages 1 to 5 and 5 to 8 years controlling for initial height-for-age z-score (HAZ), and identified key distal household and community factors associated with these growth measures using longitudinal data on 7266 children in the Young Lives (YL) study in Ethiopia, India, Peru and Vietnam. HAZ at about age 1 year and age in months predicted much of the variation in HAZ at age 5 years, but 40–71% was not predicted. Similarly, HAZ at age 5 years and age in months did not predict 26–47% of variation in HAZ at 8 years. Multiple regression analysis suggests that parental schooling, consumption, and mothers' height are key correlates of HAZ at about age 1 and also are associated with unpredicted change in HAZ from ages 1 to 5 and 5 to 8 years, given initial HAZ. These results underline the importance of a child's starting point in infancy in determining his or her growth, point to key distal household and community factors that may determine early growth in early life and subsequent growth recovery and growth failure, and indicate that these factors vary some by country, urban/rural designation, and child sex.