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Introduction: Behavioral and mental health conditions present significant challenges in the United States where access to care is limited. Family medicine physicians play a crucial role in addressing these challenges, often serving as frontline clinicians for behavioral and mental health conditions. Methods: This study examined the current behavioral and mental health system in a predominantly rural 10-county region in the Southeastern United States through gap analysis in addition to a survey of preparedness and barriers among family medicine physicians in the region. Results: Gap analysis results indicated that (1) stigma and lack of accessible education about behavioral and mental health, (2) fragmented resources, (3) inaccessible care, and (4) workforce shortage and burnout were primary drivers of poor outcomes in the region. Survey results indicated that physicians feel prepared to treat anxiety and depression but feel less prepared to manage bipolar disorder, schizophrenia, and substance use disorders. Respondents disagreed that there are adequate local resources and referral options for patients with behavioral and mental health conditions. Lack of timely access, distance, cost/insurance status, were all cited by respondents as barriers to appropriate care. Conclusion and Recommendations: Findings underscore the importance of supporting family medicine physicians to enhance behavioral and mental healthcare outcomes. Behavioral health integration in primary care settings is a promising strategy to improve care accessibility and clinician preparedness. Bridging gaps in health care outcomes requires collaborative efforts, enhanced training, and policy advocacy within the family medicine community to ensure comprehensive and equitable behavioral and mental healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community. Methods: The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors. Results: There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001). Conclusions: Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of a uniform, reduced, default dispense quantity for new opioid analgesic prescriptions on the quantity of opioids prescribed in dentistry practices. Methods We conducted a cluster-randomized controlled trial within a health system in the Bronx, NY, USA. We randomly assigned three dentistry sites to a 10-tablet default, a 5-tablet default, or no change (control). The primary outcome was the quantity of opioid analgesics prescribed in the new prescription. Secondary outcomes were opioid analgesic reorders and health service utilization within 30 days after the new prescription. We analyzed outcomes from 6 months before implementation through 18 months after implementation. Results Overall, 6,309 patients received a new prescription. Compared with the control site, patients at the 10-tablet-default site had a significantly larger change in prescriptions for 10 tablets or fewer (38.7 percentage points; confidence interval [CI]: 11.5 to 66.0), lower number of tablets prescribed (–3.3 tablets; CI: –5.9 to –0.7), and lower morphine milligram equivalents (MME) prescribed (–14.1 MME; CI: –27.8 to –0.4), which persisted in the 30 days after the new prescription despite a higher percentage of reorders (3.3 percentage points; CI: 0.2 to 6.4). Compared with the control site, patients at the 5-tablet-default site did not have a significant difference in any outcomes except for a significantly higher percentage of reorders (2.6 percentage points; CI: 0.2 to 4.9). Conclusions Our findings further support the efficacy of strategies that lower default dispense quantities, although they indicate that caution is warranted in the selection of the default. Trial registration ClinicalTrials.org ID: NCT03030469. [ABSTRACT FROM AUTHOR]

Background: Beginning in 2019, stepped-wedge designs (SWDs) were being used in the investigation of interventions to reduce opioid-related deaths in communities across the United States. However, these interventions are competing with external factors such as newly initiated public policies limiting opioid prescriptions, media awareness campaigns, and the COVID-19 pandemic. Furthermore, control communities may prematurely adopt components of the intervention as they become available. The presence of time-varying external factors that impact study outcomes is a well-known limitation of SWDs; common approaches to adjusting for them make use of a mixed effects modeling framework. However, these models have several shortcomings when external factors differentially impact intervention and control clusters.Methods: We discuss limitations of commonly used mixed effects models in the context of proposed SWDs to investigate interventions intended to reduce opioid-related mortality, and propose extensions of these models to address these limitations. We conduct an extensive simulation study of anticipated data from SWD trials targeting the current opioid epidemic in order to examine the performance of these models in the presence of external factors. We consider confounding by time, premature adoption of intervention components, and time-varying effect modification- in which external factors differentially impact intervention and control clusters.Results: In the presence of confounding by time, commonly used mixed effects models yield unbiased intervention effect estimates, but can have inflated Type 1 error and result in under coverage of confidence intervals. These models yield biased intervention effect estimates when premature intervention adoption or effect modification are present. In such scenarios, models incorporating fixed intervention-by-time interactions with an unstructured covariance for intervention-by-cluster-by-time random effects result in unbiased intervention effect estimates, reach nominal confidence interval coverage, and preserve Type 1 error.Conclusions: Mixed effects models can adjust for different combinations of external factors through correct specification of fixed and random time effects. Since model choice has considerable impact on validity of results and study power, careful consideration must be given to how these external factors impact study endpoints and what estimands are most appropriate in the presence of such factors. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking has emerged as a leading cause of mortality among people with hepatitis C virus (HCV). People who inject drugs (PWID) represent the largest group of adults infected with HCV in the US. However, cigarette smoking remains virtually unexplored among this population. This study aimed at (1) determining prevalence and correlates of cigarette smoking among HCV-infected PWID enrolled in opiate agonist treatment programs; (2) exploring the association of smoking with HCV treatment outcomes including adherence, treatment completion and sustained virologic response (SVR); and 3) exploring whether cigarette smoking decreased after HCV treatment.Methods: Participants were 150 HCV-infected PWID enrolled in a randomized clinical trial primarily designed to test three intensive models of HCV care. Assessments included sociodemographics, presence of chronic health and psychiatric comorbidities, prior and current drug use, quality of life, and HCV treatment outcomes.Results: The majority of the patients (84%) were current cigarette smokers at baseline. There was a high prevalence of psychiatric and medical comorbidities in the overall sample of PWID. Alcohol and cocaine use were identified as correlates of cigarette smoking. Smoking status did not influence HCV treatment outcomes including adherence, treatment completion and SVR. HCV treatment was not associated with decreased cigarette smoking.Conclusions: The present study showed high prevalence of cigarette smoking among this population as well as identified correlates of smoking, namely alcohol and cocaine use. Cigarette smoking was not associated with HCV treatment outcomes. Given the detrimental effects that cigarette smoking and other co-occurring, substance use behaviors have on HCV-infected individuals' health, it is imperative that clinicians treating HCV also target smoking, especially among PWID. The high prevalence of cigarette smoking among PWID will contribute to growing morbidity and mortality among this population even if cured of HCV. Tailored smoking cessation interventions for PWID along with HCV treatment may need to be put into clinical practice.Trial Registration: NCT01857245 . Registered May 20, 2013. [ABSTRACT FROM AUTHOR]

Background: The United States has persistently high rates of preterm birth and low birthweight and is characterized by significant racial disparities in these rates. Innovative group prenatal care models, such as CenteringPregnancy, have been proposed as a potential approach to improve the rates of preterm birth and low birthweight and to reduce disparities in these pregnancy outcomes.Objective: This study aimed to test whether participation in group prenatal care would reduce the rates of preterm birth and low birthweight compared with individual prenatal care and whether group prenatal care would reduce the racial disparity in these rates between Black and White patients.Study Design: This was a randomized controlled trial among medically low-risk pregnant patients at a single study site. Eligible patients were stratified by self-identified race and ethnicity and randomly allocated 1:1 between group and individual prenatal care. The primary outcomes were preterm birth at <37 weeks of gestation and low birthweight of <2500 g. The primary analysis was performed according to the intent-to-treat principle. The secondary analyses were performed according to the as-treated principle using modified intent-to-treat and per-compliance approaches. The analysis of effect modification by race and ethnicity was planned.Results: A total of 2350 participants were enrolled, with 1176 assigned to group prenatal care and 1174 assigned to individual prenatal care. The study population included 952 Black (40.5%), 502 Hispanic (21.4%), 863 White (36.8%), and 31 "other races or ethnicity" (1.3%) participants. Group prenatal care did not reduce the rate of preterm birth (10.4% vs 8.7%; odds ratio, 1.22; 95% confidence interval, 0.92-1.63; P=.17) or low birthweight (9.6% vs 8.9%; odds ratio, 1.08; 95% confidence interval, 0.80-1.45; P=.62) compared with individual prenatal care. In subgroup analysis, greater attendance in prenatal care was associated with lower rates of preterm birth and low birthweight. This effect was most noticeable for the rates of low birthweight for Black participants in group care: intent to treat (51/409 [12.5%]), modified intent to treat (36/313 [11.5%]), and per compliance (20/240 [8.3%]). Although the rates of low birthweight were significantly higher for Black participants than White participants seen in individual care (adjusted odds ratio, 2.00; 95% confidence interval, 1.14-3.50), the difference was not significant for Black participants in group care compared with their White counterparts (adjusted odds ratio, 1.58; 95% confidence interval, 0.74-3.34).Conclusion: There was no difference in the overall rates of preterm birth or low birthweight between group and individual prenatal care. With increased participation in group prenatal care, lower rates of preterm birth and low birthweight for Black participants were observed. The role of group care models in reducing racial disparities in these birth outcomes requires further study. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the percentage of body fat (%BF)-BMI relationship, identify %BF levels corresponding to adult BMI cut points, and examine %BF-BMI agreement in a diverse Hispanic/Latino population.Methods: %BF by bioelectrical impedance analysis was corrected against %BF by (18) O dilution in 434 participants of the ancillary Hispanic Community Health Study/Study of Latinos. Corrected %BF was regressed against 1/BMI in the parent study (n = 15,261), fitting models for each age group, by sex, and Hispanic/Latino background; predicted %BF was then computed for each BMI cut point.Results: Bioelectrical impedance analysis underestimated %BF by 8.7 ± 0.3% in women and 4.6 ± 0.3% in men (P < 0.0001). The %BF-BMI relationship was nonlinear and linear for 1/BMI. Sex- and age-specific regression parameters between %BF and 1/BMI were consistent across Hispanic/Latino backgrounds (P > 0.05). The precision of the %BF-1/BMI association weakened with increasing age in men but not women. The proportion of participants classified as nonobese by BMI but as having obesity by %BF was generally higher among women and older adults (16.4% in women vs. 12.0% in men aged 50-74 years).Conclusions: %BF was linearly related to 1/BMI with consistent relationship across Hispanic/Latino backgrounds. BMI cut points consistently underestimated the proportion of Hispanics/Latinos with excess adiposity. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND HealthCorps provides school wellness programming using curricula to promote changes in nutrition, mental health, and physical activity behaviors. The research objective was to evaluate effects of implementing its curricula on nutrition, mental health, and physical activity knowledge and behavior. METHODS Pre- and postsurvey data were collected (N = 2255) during the 2012-2013 academic year from 14 New York City public high schools. An 18-item knowledge questionnaire addressed 3 domains; 26 behavioral items were analyzed by factor analysis to identify 6 behavior domains, breakfast being a seventh 1-item domain. We examined the effects stratified by sex, applying mixed-effects models to take into account clustering effects of schools and participants adjusted for age. RESULTS The HealthCorps program significantly increased all 3 knowledge domains (p < .05), and significantly changed several key behavioral domains. Boys significantly increased fruits/vegetables intake (p = .03). Girls increased acceptance of new fruits/vegetables (p = .03) and breakfast consumption (p = .04), and decreased sugar-sweetened beverages and energy dense food intake (p = .03). The associations between knowledge and behavior were stronger in boys than girls. CONCLUSION The HealthCorps program significantly increased participants' knowledge on nutrition, mental health, and physical activity. It also improved several key behavioral domains, which are targets of the 2010 Dietary Guidelines to address obesity in youth. [ABSTRACT FROM AUTHOR]

Background: Obesity is a risk factor for several cancers in postmenopausal women. We attempted to determine cutoffs of adiposity measures in relation to risk of obesity-related cancers among postmenopausal women and to examine the effects of hormone therapy (HT) use on the cutoffs, neither of which has been broadly studied. Methods: We used data from the Women's Health Initiative cohort (n=144,701) and applied Cox-proportional hazards regressions to each combination of 17 cancer types and 6 anthropometric measures (weight, body mass index [BMI], weight to height ratio, waist circumference, waist to hip ratio [WHR], and waist to height ratio). Interactions between the anthropometric measures and HT use were also examined. Cutoffs were determined by applying a grid search followed by a two-fold cross validation method. Survival ROC analysis of 5- and 10-year incidence followed. Results: Breast, colorectal, colon, endometrium, kidney, and all cancers combined were significantly positively associated with all six anthropometric measures, whereas lung cancer among ever smokers was significantly inversely associated with all measures except WHR. The derived cutoffs of each obesity measure varied across cancers (e.g., BMI cutoffs for breast and endometrium cancers were 30 kg/m2 and 34 kg/m2, respectively), and also depended on HT use. The Youden indices of the cutoffs for predicting 5- and 10-year cancer incidence were higher among HT never users. Conclusion: Using a panel of different anthropometric measures, we derived optimal cut-offs categorizing populations into high- and low-risk groups, which differed by cancer type and HT use. Although the discrimination abilities of these risk categories were generally poor, the results of this study could serve as a starting point from which to determine adiposity cutoffs for inclusion in risk prediction models for specific cancer types. [ABSTRACT FROM AUTHOR]

To examine the relationship between obesity and functional impairment and the influence of comorbidity, joint pain, and mental health on this association, we used US adult respondents (N = 430,912) to the 2007 Behavioral Risk Factor Surveillance Survey (BRFSS-07). Functional impairment was indicated if a respondent was either (i) limited in any way or in any activities because of physical, mental, or emotional problems, or (ii) had any health problem that required using special equipment such as a cane, wheelchair, special bed, or special telephone. Approximately 62.8% of respondents were overweight or obese and 20.3% were functionally impaired. The unadjusted relationship between obesity and functional impairment revealed a classical J-shaped pattern with odds ratios (95% confidence interval) compared to the normal weight group: 1.63 (1.54-1.73), 1.22 (1.20-1.25), 1.77 (1.73-1.81), 2.43 (2.36-2.51), and 4.12 (3.97-4.27) for underweight, overweight, obesity class I, II, and III, respectively. Although inclusion of different combinations of sociodemographic and medical covariates substantially attenuated the unadjusted association, the collective inclusion of all covariates in a single model did not eliminate the significant J-shaped association resulting in the following corresponding adjusted odds ratios: 1.19 (1.13-1.25), 1.01 (0.99-1.04), 1.23 (1.19-1.27), 1.38 (1.32-1.44), and 1.92 (1.82-2.02). The attenuation was mostly influenced by medical comorbidity. In conclusion, functional impairment is associated with obesity, primarily due to medical comorbidity conditions. The significant residual association highlights the importance of sustainable obesity prevention and treatment at both the individual and public level as functional impairment can create burdens at individual, familial, and societal levels. [ABSTRACT FROM AUTHOR]

Objective To estimate the projected population of US adults aged 18 years or older with lifetime experience of doctor-diagnosed depressive disorder from 2005–2050. Methods Based on nationally representative survey data from the year 2006 Behavioral Risk Factor Surveillance Survey (BRFSS), prevalence estimates of doctor-diagnosed depression (minor or major, and dysthymia) were weighted to incorporate the complex sampling design and increase generalizability of the findings. The weighted prevalence data by age and sex in 2006 were then used to estimate the projected adult population with lifetime experience of depressive disorder based on the sex-specific US Census national population projections from year 2005–2050. Results In year 2006 the (weighted) prevalence of lifetime experience of depressive disorder was 15.7% among 188,292 respondents aged 18 years or older. Female prevalence was 20.6%, which was about twice as high as the prevalence among males (11%). From year 2005–2050, the total number of US adults with depressive disorder will increase from 33.9 million to 45.8 million, a 35% increase. The increase is projected to be greater in the elderly population aged ≥65 years (3.8–8.2, a 117% increase) than in the young population aged <65 years (30.1–37.7, a 25% increase). Conclusions By year 2050, approximately 46 million US adults aged 18 years or older will be diagnosed with a depressive disorder. The increase will be more pronounced in adults aged 65 or older. Prevention, detection, and treatment of depressive disorders might attenuate the magnitude of this estimate. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The relationship among body mass index (BMI kg/m²), smoking status, and overall mortality remains controversial. To assess this relationship in a representative sample of older women, we used data from the Panel Study of Income Dynamics (PS ID). The PSID (begun in 1968) is a prospective longitudinal cohort study designed to examine economic and demographic behavior. Respondents were 1355 women age >50 when they initially completed the.:Self-Administered health Questionnaire in 1990+ Data collected included self-reported height and weight, years of completed education, smoking status (never versus ever), and responses to four health-related questions (e.g+, retired due to ill health, difficulty eating).. Respondents were followed, including the date of death if respondent died, through 1994. Cox proportional hazard regression revealed a U shaped relationship irrespective of whether smoking was included in the model. The base of the curve was fairly wide, suggesting that a broad range of BMI is well tolerated by older women. The minimum mortality (estimated from fitted proportional hazard models) for both the smoking and nonsmoking models occurred at a BMI of approximately 34. When interactions between smoking status and BMI terms were added to the model, the interactions were not jointly significant (p = 0.071). More- over an exploratory plot of the BMI-mortality curve among never smokers (n = 800) revealed a curve that moved away from being U-shaped toward being more monotonically decreasing. It is concluded that these data suggest that there is no evidence that the U-shaped BMI-mortality relationship observed is caused by confounding by smoking status. [ABSTRACT FROM AUTHOR]

Background: People who inject drugs (PWID) constitute 60% of the approximately 5 million people in the U.S. infected with hepatitis C virus (HCV). Treatment of PWID is complex due to addiction, mental illness, poverty, homelessness, lack of positive social support, poor adherence-related skills, low motivation and knowledge, and poor access to and trust in the health care system. New direct-acting antiviral medications are available for HCV with high cure rates and few side effects. The life expectancy and economic benefits of new HCV treatments will not be realized unless we determine optimal models of care for the majority of HCV-infected patients. The purpose of this study is to evaluate the effectiveness of directly observed therapy and group treatment compared with self-administered individual treatment in a large, urban opioid agonist therapy clinic setting in the Bronx, New York.Methods/design: In this randomized controlled trial 150 PWID with chronic HCV were recruited from opioid agonist treatment (OAT) clinics and randomized to one of three models of onsite HCV treatment in OAT: 1) modified directly observed therapy; 2) group treatment; or 3) control - self-administered individual treatment. Participants were age 18 or older, HCV genotype 1, English or Spanish speaking, treatment naïve (or treatment experienced after 12/3/14), willing to receive HCV treatment onsite, receiving methadone or buprenorphine at the medication window at least once per week, and able to provide informed consent. Outcomes of interest include adherence (as measured by self-report and electronic blister packs), HCV treatment completion, sustained virologic response, drug resistance, and cost-effectiveness.Discussion: This paper describes the design and rationale of a randomized controlled trial comparing three models of care for HCV therapy delivered in an opioid agonist treatment program. Our trial will be critical to rigorously identify models of care that result in high adherence and cure rates. Use of blister pack technology will help us determine the role of adherence in successful cure of HCV. Moreover, the trial methodology outlined here can serve as a template for the development of future programs and studies among HCV-infected drug users receiving opioid agonist therapy, as well as the cost-effectiveness of such programs.Trial Registration: This trial was registered with ClinicalTrials.gov ( NCT01857245 ). Trial registration was obtained prospectively on May 20th, 2013. [ABSTRACT FROM AUTHOR]

Importance: Hepatitis C virus (HCV) reinfection after curative treatment remains a concern for people who inject drugs., Objective: To assess the incidence of HCV reinfection and associated risk factors., Design, Setting, and Participants: This cohort study is a secondary analysis of a randomized clinical trial that was conducted across opioid treatment programs and community health centers in the US between September 2016 and August 2018. The current analyses were performed in March 2022. People who inject drugs who achieved sustained virologic response (SVR) were followed for up to 42 months., Exposure: Patients were randomly assigned to receive modified directly observed therapy or patient navigation., Main Outcomes and Measures: The primary outcome was rate of HCV reinfection. Change in reinfection rates over time was assessed using a Poisson regression model., Results: A total of 415 participants (mean [SD] age, 44.7 [11.5] years; 302 male [72.8%]) achieved a SVR and had 1 or more post-SVR assessments for HCV RNA. Overall, 302 (72.8%) reported recent injection drug use, 192 (46.3%) were living in unstable housing, and 313 (75.4%) had received recent methadone or buprenorphine for opioid use disorder. The overall reinfection rate was 11.4 per 100 person-years at risk (95% CI, 8.7-14.7 per 100 person-years at risk) over 518 person-years of follow-up. Reinfection rates varied significantly across sites, ranging from 2.9 per 100 person-years at risk (95% CI, 0.1-16.3 per 100 person-years) to 25.2 per 100 person-years at risk (95% CI, 15.6-38.5 per 100 person-years at risk) (P = .006). There was a significant decrease in incident reinfection with increasing post-SVR follow-up (weeks 0-24, 15.5 per 100 person-years; 95% CI, 10.3-22.3 per 100 person-years; weeks 73-144, 4.3 per 100 person-years; 95% CI, 0.9-12.5 per 100 person-years; P = .008). Reinfection rates were lower for participants aged 40 years or older than for younger participants (adjusted incidence rate ratio, 0.32; 95% CI, 0.18-0.57) and for participants for whom methamphetamine was not detected in urinary drug screening compared with participants for whom methamphetamine was detected (adjusted incidence rate ratio, 0.41; 95% CI, 0.21-0.82). Participants who reported injection drug use within the preceding 3 months had higher risk of reinfection than those who did not have recent injection drug use (adjusted incidence rate ratio, 3.33; 95% CI, 1.86-5.97)., Conclusions and Relevance: In this cohort study of people who injected drugs and were treated for HCV infection in community settings, reinfection was high in the period immediately after SVR but decreased significantly over time. These findings highlight the importance of early intervention to prevent reinfection., Trial Registration: ClinicalTrials.gov Identifier: NCT02824640.

Transitional care programs (TCPs), where hospital care team members repeatedly follow up with discharged patients, aim to reduce post-discharge hospital or emergency department (ED) utilization and healthcare costs. We examined the effectiveness of TCPs at reducing healthcare costs, hospital readmissions, and ED visits. Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement (BPCI) program adjudicated claims files and electronic health records from Greenville Memorial Hospital, Greenville, SC, were accessed. Data on post-discharge 30- and 90-day ED visits and readmissions, total costs, and episodes with costs over BPCI target prices were extracted from November 2017 to July 2020 and compared between the "TCP-Graduates" (N = 85) and "Did Not Graduate" (DNG) (N = 1310) groups. As compared to the DNG group, the TCP-Graduates group had significantly fewer 30-day (7.1% vs. 14.9%, p = 0.046) and 90-day (15.5% vs. 26.3%, p = 0.025) readmissions, episodes with total costs over target prices (25.9% vs. 36.6%, p = 0.031), and lower total cost/episode (USD 22,439 vs. USD 28,633, p = 0.018), but differences in 30-day (9.4% vs. 11.2%, p = 0.607) and 90-day (20.0% vs. 21.9%, p = 0.680) ED visits were not significant. TCP was associated with reduced post-discharge hospital readmissions, total care costs, and episodes exceeding target prices. Further studies with rigorous designs and individual-level data should test these findings.

Background: Inpatient pediatric central line-associated bloodstream infections (CLABSIs) cause morbidity and increased health care use. Minimal information exists for ambulatory CLABSIs despite ambulatory central line (CL) use in children. In this study, we identified ambulatory pediatric CLABSI incidence density, risk factors, and outcomes., Methods: Retrospective cohort with nested case-control study at 5 sites from 2010 through 2015. Electronic queries were used to identify potential cases on the basis of administrative and laboratory data. Chart review was used to confirm ambulatory CL use and adjudicated CLABSIs. Bivariate followed by multivariable backward logistic regression was used to identify ambulatory CLABSI risk factors., Results: Queries identified 4600 potentially at-risk children; 1658 (36%) had ambulatory CLs. In total, 247 (15%) patients experienced 466 ambulatory CLABSIs with an incidence density of 0.97 CLABSIs per 1000 CL days. Incidence density was highest among patients with tunneled externalized catheters versus peripherally inserted central catheters and totally implanted devices: 2.58 CLABSIs per 1000 CL days versus 1.46 vs 0.23, respectively ( P < .001). In a multivariable model, clinic visit (odds ratio [OR] 2.8; 95% confidence interval [CI]: 1.4-5.5) and low albumin (OR 2.3; 95% CI: 1.2-4.3) were positively associated with CLABSI, and prophylactic antimicrobial agents for underlying conditions within the preceding 30 days (OR 0.22; 95% CI: 0.12-0.40) and operating room CL placement (OR 0.36; 95% CI: 0.16-0.79) were inversely associated with CLABSI. A total of 396 patients (85%) were hospitalized because of ambulatory CLABSI with an 8-day median length of stay (interquartile range 5-13)., Conclusions: Ambulatory pediatric CLABSI incidence density is appreciable and associated with health care use. CL type, patients with low albumin, prophylactic antimicrobial agents, and placement setting may be targets for reduction efforts., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background: Among adolescents, physical inactivity and unhealthy dietary habits are associated with being obese. We know little about how those are associated with trying to lose weight., Methods: We analyzed the 2013 Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance data (N = 13,583) to examine how obesity and trying to lose weight are associated with: (1) <5 physically active days per week with ≥60 minutes physical activity; (2) playing with video computer games ≥3 hours per day on average; (3) no participation in any sports team in the past year; and (4) drinking soda ≥2 times per day. We applied survey logistic regression adjusting for age and Hispanic ethnicity, stratified by sex., Results: Both being obese (13.7%) and trying to lose weight (47.7%) are significantly associated with physical inactivity. Soda drinking was associated with being obese (odds ratio [OR] = 1.34, p = .003 for boys and OR = 1.36, p = .014 for girls); it was inversely associated trying to lose weight among girls (OR = 0.72, p < .001) but not among boys (OR = 1.13, p = .174)., Conclusion: Obesity was associated with physical inactivity and drinking soda in both sexes. Only girls appeared to avoid drinking soda as a strategy for losing weight. Trying to lose weight was associated with a higher likelihood of physically inactive behaviors both sexes. High schools need to develop collaborative strategies for reducing adolescent obesity and supporting students who are trying to lose weight that address physical inactivity and soda intake., (© 2020, American School Health Association.)

Objectives: The scaling of structural components to body size is well studied in mammals, although comparable human observations in a large and diverse sample are lacking. The current study aimed to fill this gap by examining the scaling relationships between total body (TB) and regional bone and skeletal muscle (SM) mass with body size, as defined by stature, in a nationally representative sample of the US population., Methods: Subjects were 17,126 non-Hispanic (NH) white, NH black, and Mexican American men and women, aged ≥18 years, evaluated in the National Health and Nutrition Examination Survey who had TB and regional bone mineral (BMin) and lean soft tissue (LST) mass measured by dual-energy X-ray absorptiometry. BMin and appendicular LST served as surrogate bone and SM mass measures, respectively. The allometric model, BMin or LST = α(height) β , in a logarithmic form was used to generate scaling exponents., Results: The findings were similar across all gender and race groups: body mass scaled to height with powers of ~2.0 (mean β ± SE, 1.94 ± 0.08-2.29 ± 0.09) while TB and appendicular BMin and appendicular LST scaled to height with consistently larger powers than those for body mass (eg, all P < .05 in NH white men and women); the largest BMin and LST scaling powers to height were observed in the lower extremities., Conclusions: Bone and SM mass, notably those of the lower extremities, increase as proportions of body mass with greater adult height. Metabolic and biomechanical implications emerge from these observations, the first of their kind in a representative adult US population sample., (© 2019 Wiley Periodicals, Inc.)

The mechanisms linking short stature with an increase in cardiovascular and cerebrovascular disease risk remain elusive. This study tested the hypothesis that significant associations are present between height and blood pressure in a representative sample of the US adult population.Participants were 12,988 men and women from a multiethnic sample (age ≥ 18 years) evaluated in the 1999 to 2006 National Health and Nutrition Examination Survey who were not taking antihypertensive medications and who had complete height, weight, % body fat, and systolic and diastolic arterial blood pressure (SBP and DBP) measurements; mean arterial blood pressure and pulse pressure (MBP and PP) were calculated. Multiple regression models for men and women were developed with each blood pressure as dependent variable and height, age, race/ethnicity, body mass index, % body fat, socioeconomic status, activity level, and smoking history as potential independent variables.Greater height was associated with significantly lower SBP and PP, and higher DBP (all P < .001) in combined race/ethnic-sex group models beginning in the 4th decade. Predicted blood pressure differences between people who are short and tall increased thereafter with greater age except for MBP. Socioeconomic status, activity level, and smoking history did not consistently contribute to blood pressure prediction models.Height-associated blood pressure effects were present in US adults who appeared in the 4th decade and increased in magnitude with greater age thereafter. These observations, in the largest and most diverse population sample evaluated to date, provide support for postulated mechanisms linking adult stature with cardiovascular and cerebrovascular disease risk., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Children in the United States (US) are frequently exposed to advertisements for high-fat, high-sugar (HFHS) foods, which is linked to greater demand for and consumption of those foods. Restricting advertisements for HFHS foods may be a viable obesity prevention strategy-however, public support for policy change is unclear., Methods: A secondary analysis of the 2012 Annenberg National Health Communication Survey was conducted. Respondents (N = 1838) were 53.2% female, mean age 50.0 ± 16.5 years. Race/ethnic composition was 76.8% white, 7.4% black, 9.2% Hispanic, and 6.6% other. The percentage of respondents supporting and opposing the regulation was calculated and logistic regression models identified predictors of support. Potential predictors included sociodemographic variables, attitudes towards other health regulations (e.g., smoking bans in public places), and various health behaviors (e.g., fruit and vegetable intake)., Results: A total of 56.3% of respondents supported or strongly supported advertisement restrictions, while only 8.2% strongly opposed. Approximately 20% had no opinion. Greatest support was found among respondents who supported smoking bans in public settings (OR = 4.3), who supported banning trans fats in restaurants (OR = 1.7), and who were older (OR = 1.7)., Conclusion: The US adult population appears to have an appetite for restricting HFHS advertising to children, with more than half the populace supporting such a policy in 2012. This may be an opportune time to implement and rigorously evaluate such childhood obesity prevention strategies.

Background: Few interventions targeting severely obese minority youth have been implemented in community-based settings. We evaluate a 9-month multicomponent, community-based program for obese, inner-city adolescents., Methods: Of 5250 estimated eligible adolescents, 349 were recruited; they had a mean age of 15 ± 2 years, mean BMI %ile 98.9 ± 1.5, and comprised 52% African American and 44% Hispanic. Longitudinal trends of anthropometric measures were compared 1 year before enrollment (T-12), at baseline (T0) and after program completion (T9). Dietary and physical activity behaviors were compared at T0 and T9. Anthropometric changes were compared at T9 and 18 months (T18) in completers and noncompleters., Results: A majority of participants were severely obese (67%) and expressed low readiness to change behaviors (82%). For intervals T-12 to T0 versus T0 to T9, there were significant decreases in rates of gain in BMI (0.13 vs. 0.04, p < 0.01), BMI percentile (0.0002 vs. -0.0001, p < 0.01), percent overweight (0.001 vs. -0.001, p < 0.01), and BMI z-score (0.003 vs. -0.003, p < 0.01). Significant increases in vegetable and fruit consumption and in vigorous physical activity participation were observed. From T9 to T18, except for a significant increase in BMI (38.3 ± 7.4 vs. 39.0 ± 7.5, p < 0.01) in completers, all other anthropometric measures remained unchanged in completers and noncompleters., Conclusions: We demonstrate modest clinical improvements and increased healthy lifestyle behaviors in predominantly severely obese, difficult-to-reach, ethnic minority adolescents attending a community-based weight management program. The loss of clinical improvements 9 months after program completion implies that extending the duration of such a program may prevent long-term weight regain in severely obese adolescents.

Background: Prospective studies in Western and Asian populations suggest that height is a risk factor for various cancers. However, few studies have explored potential confounding or effect modification of the association by other factors., Methods: We examined the association between height measured at enrollment in 144,701 women participating in the Women's Health Initiative and risk of all cancers combined and cancer at 19 specific sites. Over a median follow-up of 12.0 years, 20,928 incident cancers were identified. We used Cox proportional hazards models to estimate HR and 95% confidence intervals (CI) per 10 cm increase in height, with adjustment for established risk factors. We also examined potential effect modification of the association with all cancer and specific cancers., Results: Height was significantly positively associated with risk of all cancers (HR = 1.13; 95% CI, 1.11-1.16), as well as with cancers of the thyroid, rectum, kidney, endometrium, colorectum, colon, ovary, and breast, and with multiple myeloma and melanoma (range of HRs: 1.13 for breast cancer to 1.29 for multiple myeloma and thyroid cancer). These associations were generally insensitive to adjustment for confounders, and there was little evidence of effect modification., Conclusions: This study confirms the positive association of height with risk of all cancers and a substantial number of cancer sites., Impact: Identification of single-nucleotide polymorphisms associated both with height and with increased cancer risk may help elucidate the association., (©2013 AACR)

Studies of the relationship between anthropometric indices of obesity and colorectal cancer risk in women have shown only weak and inconsistent associations. Given the limitations of such indices, we used dual-energy X-ray absorptiometry (DXA)-derived measures of body fat obtained in the Women's Health Initiative to examine the association between body fat and risk of incident colorectal cancer. We compared these risk estimates with those obtained using conventional anthropometric measurements (body mass index and waist circumference). After exclusions, the study population consisted of 11,124 postmenopausal women with DXA measurements at baseline and no history of colorectal cancer. After a median follow-up period of 12.9 years, 169 incident colorectal cancer cases were ascertained. Cox's proportional hazards models were used to estimate hazard ratios and 95 % confidence intervals for the exposures of interest. Neither DXA-derived body fat measures nor anthropometric measures showed significant associations with risk. In view of the limited number of cases, we cannot rule out the existence of weak associations of these measures with risk of colorectal cancer.

Background: To date, there is no consensus regarding adult cutoffs of percentage of body fat or estimated cutoffs on the basis of nationally representative samples with rigorous body-composition measurements., Objective: We developed cutoffs of percentage of body fat on the basis of the relation between dual-energy x-ray absorptiometry-measured fat mass and BMI (in kg/m(2)) stratified by sex, age, and race-ethnicity by using 1999-2004 NHANES data., Design: A simple regression (percentage of body fat = β(0) + β(1) × 1 ÷ BMI) was fit for each combination of sex (men and women), 3 age groups (18-29, 30-49, and 50-84 y of age), and 3 race-ethnicity groups (non-Hispanic whites, non-Hispanic blacks, and Mexican Americans). Model fitting included a consideration of complex survey design and multiple imputations. Cutoffs of percentage of body fat were computed that corresponded to BMI cutoffs of 18.5, 25, 30, 35, and 40 on the basis of estimated prediction equations., Results: R(2) ranged from 0.54 to 0.72 for men (n = 6544) and 0.58 to 0.79 for women (n = 6362). In men, the percentage of body fat that corresponded to a BMI of 18.5, 25, 30, 35, and 40 across age and racial-ethnic groups ranged from 12.2% to 19.0%, 22.6% to 28.0%, 27.5% to 32.3%, 31.0% to 35.3%, and 33.6% to 37.6%, respectively; the corresponding ranges in women were from 24.6% to 32.3%, 35.0% to 40.2%, 39.9% to 44.1%, 43.4% to 47.1%, and 46.1% to 49.4%, respectively. The oldest age group had the highest cutoffs of percentage of body fat. Non-Hispanic blacks had the lowest cutoffs of percentage of body fat. Cutoffs of percentage of body fat were higher in women than in men., Conclusions: Cutoffs of percentage of body fat that correspond to the current US BMI cutoffs are a function of sex, age, and race-ethnicity. These factors should be taken into account when considering the appropriateness of levels of percentage of body fat.

Purpose: Racial disparities in treating pain with opioids are widely reported; however, differences in use of recommended strategies to reduce the risk of opioid misuse by race/ethnicity have not been evaluated., Methods: In a retrospective cohort of black and white patients with chronic noncancer pain prescribed opioid analgesics for at least 3 months, we assessed physicians' use of 3 opioid risk reduction strategies: (1) urine drug testing, (2) regular office visits (at least 1 visit per 6 months on opioids and within 30 days of an opioid change), and (3) restricted early opioid refills (receipt of a refill >1 week early less than twice). Nonlinear mixed effect regression models accounted for clustering within physician and adjusted additively for demographics, substance abuse, mental health and medical comorbidities, health care factors, and practice site., Results: Of the 1,612 patients studied, 62.1% were black. Black patients were more likely than white patients to receive urine drug testing (10.4% vs 4.1%), regular office visits (56.4% vs 39.0%), and restricted early refills (79.4% vs 72.0%) (P <.001 for each). In fully adjusted models, black patients had significantly higher odds than their white counterparts of receiving regular office visits (odds ratio = 1.51; 95% confidence interval, 1.06-2.14) and restricted early refills (odds ratio = 1.55; 95% confidence interval, 1.03-2.32), but not urine drug testing (odds ratio = 1.41; 95% confidence interval, 0.78-2.54)., Conclusions: In this cohort of primary care patients receiving opioid analgesics on a long-term basis, use of risk reduction strategies was very limited overall; however, black patients were more likely than white patients to receive 2 of 3 guideline-recommended strategies. These data raise questions about lax monitoring, especially for white patients taking opioids long term.

Objective: To estimate fruit and vegetable (FV) intake levels of US adult population and evaluate the association between FV intake and BMI status after controlling for confounding demographic, socioeconomic and lifestyle factors. We also sought to identify moderating factors., Methods: We used 2007 Behavior Risk Factors Surveillance System (N > 400,000) data. FV intake was dichotomized as ≥5 servings (FV5+) versus <5 servings/ day. BMI status was categorized as normal, overweight, and obese. Identification of moderators was performed by testing interactions between BMI status and other variables using bivariate analyses followed by multiple logistic regression analysis incorporating complex survey sampling design features., Results: Only 24.6% of US adults consumed ≥5 servings per day and less than 4% consumed 9 or more servings. Overweight (% FV5+ = 23.9%) and obese (21.9%) groups consumed significantly less FV than the normal-weight (27.4%) group (p < 0.0001). This inverse association remained significant even after controlling for potential confounding factors. Multivariate analysis identified five significant moderators (p < 0.0001) after controlling for all evaluated variables: race, sex, smoking status, health coverage, and physical activity. Notably, physically inactive obese males tended to consume the least FV (% FV5+ = 14.7%)., Conclusion: Current US population FV intake level is below recommended levels. The inverse association between FV intake and obesity was significant and was moderated by demographic, socioeconomic status, and lifestyle factors. These factors should be considered when developing policies and interventions to increase FV intake., (Copyright © 2011 S. Karger AG, Basel.)

Despite research and clinical significance, limited information is available on the relations between skeletal muscle (SM) and age in adults, specifically among Hispanics, African Americans (AA), and Asians. The aim was to investigate possible sex and ethnic SM differences in adults over an age range of 60 years. Subjects were 468 male and 1280 female adults (> or =18 years). SM was estimated based on DXA-measured appendicular lean-soft tissue using a previously reported prediction equation. Locally weighted regression smoothing lines were fit to examine SM trends and to localize age cutoffs; piecewise multiple linear regression models were then applied, controlling for weight and height, to identify age cutoffs for sex-specific changes in SM among the ethnic groups. The age of 27 years was identified for women and men as the cut-off after which SM starts to show a negative association with age. Both sexes had a similar ethnic pattern for expected mean SM at the age cutoff, with AA presenting the highest SM values, followed by Whites, Hispanics, and Asians. After the age cutoffs, the lowering of SM differed by ethnicity and sex: AA women showed the greatest SM lowering whereas Hispanic women had the least. Hispanic men tended to show a higher negative association of SM with age followed by AA and Whites. To conclude, significant sex and ethnic differences exist in the magnitude of negative associations of SM with age >27 years. Further studies using a longitudinal design are needed to explore the associations of ethnicity-related decline of SM with health risks., (2009 Wiley-Liss, Inc.)

Using population-based survey data from the 2003 Behavioral Risk Factor Surveillance Survey (BRFSS), we estimated the population prevalence of self-reported, doctor-diagnosed arthritis in the US from 2005 to 2050. Projected arthritis-prevalence data were estimated in 5-year increments along sex- and age-specific categories by multiplying the 2003 BRFSS arthritis prevalence data by the sex-stratified US Census projections. During this 45-year period, we estimate that the total number of US adults aged 20 years or older with arthritis will increase from 60 million to 96 million, a 1.6-fold increase. The increase is projected to be greater in those aged 65 years or older (a 2.3-fold increase) than for those aged 20 to 65 (a 1.3-fold increase). Given increases in the prevalence of known arthritis risk factors (e.g., obesity, Hispanic origin) our projections might underestimate the prevalence of arthritis in the coming years.

Objective: This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists., Method: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (> or =60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months., Results: First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety., Conclusions: Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.

Context: Increased physical activity is recommended for adults with arthritis., Objective: The objective of this study was to update and compare recent physical activity prevalence estimates of US adults with self-reported doctor-diagnosed arthritis., Design: The authors studied the 2001 and 2003 Behavioral Risk Factor Surveillance Survey (BRFSS), an annual random-digit telephone survey conducted by state health departments., Setting: The authors conducted a population-based sample from 50 states and the District of Columbia., Participants: The study included a total of 52,311 adults, 18 years or older, reporting doctor-diagnosed arthritis in 2001, and 82,839 reporting doctor-diagnosed arthritis in 2003., Main Outcome Measures: Reported level of physical activity was classified into 3 categories: physically inactive, insufficiently active, and meeting public health recommendations., Results: Between 2001 and 2003, the prevalence of physical inactivity decreased by 1.1% (23.8% versus 22.7%), the prevalence of insufficient levels of physical activity increased by 0.2% (38% versus 38.2%), and the prevalence of meeting physical activity recommendations increased by 0.9% (38.3% versus 39.2%). Compared with 2001 estimates, the prevalence of meeting physical activity recommendations increased by 6.2% (54.8% versus 61%) among those aged 18 to 24 years, 3.5% (36.4% versus 39.9%) among never smokers, 3% (49.4% versus 52.4%) among those aged 25 to 34 years, 2.4% (29.9% versus 32.3%) among obese adults, and among those aged 55 to 64 years (36.9% versus 39.3). Prevalence of inactivity increased by 3.2% among Hispanics (30.4% versus 33.6%) and 2.9% among those with 8 or fewer years of education (47.6% versus 50.5%)., Conclusions: Prevalence estimates of the 3 levels of physical activity among adults with arthritis changed very little. Given the established benefits of physical activity for arthritis, public health efforts to promote increased activity should continue to be developed and refined.

Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources., Design: Cluster randomised controlled trial., Setting: Five healthcare organisations in the United States and 60 affiliated practices., Patients: 405 patients, aged > or = 18 years, starting or changing treatment for depression., Intervention: Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist., Main Outcome Measures: Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (> or = 50% decrease in scores) and remission (score of < 0.5)., Results: At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003)., Conclusion: Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression.

Objective: To estimate the prevalence of US adults with self-reported, doctor-diagnosed arthritis (without specifying the type of rheumatic disease) who are meeting the US Surgeon General's recommendations for physical activity., Methods: Using population-based survey data from the 2001 Behavioral Risk Factor Surveillance Survey, we classified respondents according to their arthritis status and their level of physical activity (i.e., physically inactive, insufficiently active, or meeting recommendations). Prevalence data were weighted to take account of the complex sampling design, and were broken down by a variety of demographic characteristics such as race, education, and body weight., Results: Nearly one-quarter (23%) of US adults reported having doctor-diagnosed arthritis. Among adults with arthritis, 23.8% were physically inactive, 38% reported insufficient levels of physical activity, and 38.3% reported meeting the recommendations for physical activity. The highest prevalence of inactivity in adults with arthritis was found among those subjects with fewer than 8 years of formal education (47.6%), those with 9-11 years of education (35.5%), those who were African American (35.4%), those whose age was > or =65 years (31.1%), and those who were Hispanic (30.4%)., Conclusion: Despite the benefits of physical activity, more than 60% of adults with arthritis do not meet the physical activity recommendations. Efforts should be made to ensure that adults with arthritis are made aware of the benefits of physical activity, and that interventions are prescribed to assist these individuals in becoming more physically active.

When data are available on multiple individuals measured at multiple time points that may vary in number or inter-measurement interval, hierarchical linear models (HLM) may be an ideal option. The present paper offers an applied tutorial on the use of HLM for developing growth curves depicting natural changes over time. We illustrate these methods with an example of body mass index (BMI; kg/m(2)) among overweight and obese adults. We modelled among-person variation in BMI growth curves as a function of subjects' baseline characteristics. Specifically, growth curves were modelled with two-level observations, where the first level was each time point of measurement within each individual and the second level was each individual. Four longitudinal databases with measured weight and height met the inclusion criteria and were pooled for analysis: the Framingham Heart Study (FHS); the Multiple Risk Factor Intervention Trial (MRFIT); the National Health and Nutritional Examination Survey I (NHANES-I) and its follow-up study; and the Tecumseh Mortality Follow-up Study (TMFS). Results indicated that significant quadratic patterns of the BMI growth trajectory depend primarily upon a combination of age and baseline BMI. Specifically, BMI tends to increase with time for younger people with relatively moderate obesity (25 BMI <30) but decrease for older people regardless of degree of obesity. The gradients of these changes are inversely related to baseline BMI and do not substantially depend on gender., (Copyright 2003 John Wiley & Sons, Ltd.)

Background: Limited research has been done to explore differences between ethnic groups, including Hispanic Americans (HAs), in the association between percentage body fat (PBF) and body mass index (BMI; in kg/m(2)); the numbers of HAs are increasing in the US population., Objective: We investigated whether the relation between PBF and BMI in adult HAs differed from that of African Americans (AAs) and European Americans (EAs)., Design: We used a multiple regression model in which PBF measured with dual energy X-ray absorptiometry was predicted by the reciprocal of BMI (1/BMI; in m(2)/kg) in a sample of 487 men (n(EA) = 192, n(AA) = 148, and n(HA) = 147) and 933 women (n(EA) = 448, n(AA) = 304, and n(HA) = 181)., Results: For men, our results showed no significant differences between HAs and EAs, AAs and EAs, or HAs and AAs in the slope of the line relating 1/BMI to PBF. In women, there were significant differences in PBF as predicted by BMI between HAs and EAs (P < 0.002) and AAs and HAs (P = 0.020), but not between AAs and EAs. When PBF was estimated on the basis of predicting equations, the trend of the predicted PBF value in women differed according to ethnic group and BMI category. At a BMI < 30, HAs tended to have more body fat than did EAs and AAs, and at a BMI > 35, EAs tended to have more body fat than did the other groups., Conclusions: Our results show that the relation between PBF and BMI in HA women differs from that of EA and AA women.