- Email: [email protected]
Hyperactivity Disorder in Youth: Diagnostic Criteria, Community-Based Prevalence, and Treatment Throughout the Years
678
Abstracts / Annals of Epidemiology 22 (2012) 661e680
Methods: The data form CDC Linked Death and Infant Birth Data, from 1995 through 2002 for term babies. Other data from MaxMind and NOAA website; The variables from the NCHS file used were maternal age, race, birth weight, gestation, plurality, prenatal care, maternal education, marital status, and maternal smoking and alcohol usage. Logistical regression was performed with LBW as the dependent variable with all the other variables as confounding and where independent variables latitude and/or temperature with respect to race using STATA 9.0 SE. Results: About 25 million records from over 32 million births were used for analysis. It was noted average annual temperature>55 F and lower latitude had a higher probability of LBW; Odds ratio (OR) 1.23, P < 0.0005; 95% CL1.22-1.23). Greatest impact of LBW was for NHW and lowest for H, OR 1.22 vs 1.003. Conclusion: 1. LBW at birth is inversely related to higher environmental temperature during pregnancy. 2. Global warming in the future may have impact on LBW.
P79-S. School-Based Policies and Practices for the Prevention of Attention-Deficit/Hyperactivity Disorder: a Policy Analysis S.N. Visser, R. Perou. Centers for Disease Control and Prevention, Atlanta, GA Purpose: To compare school-based policy and practice alternatives for the prevention of childhood attention-deficit/hyperactivity disorder (ADHD), supported by the use of national survey data. Methods: The policy analytic steps of Patton and Sawicki (1993) were used to evaluate three evidence-based policy alternatives for the prevention of ADHD: 1) case management of health services, 2) daily physical education or recess, and 3) a do-nothing, status quo alternative. In addition to the conceptual analysis, data from CDC's 2006 School Health Policy and Practice Survey and 2007 National Survey of Children's Health were used to evaluate the cross-sectional association between state-based rates of ADHD and the three policy alternatives. The policy alternatives were evaluated based on evaluation criteria that were selected a priori: prevention effectiveness, cost, and cost distribution across sectors. Using the odds ratios from the quantitative analyses, telescopic forecasting was used as a crude means of projecting policy impact on ADHD prevalence over time. Results: Of the policy alternatives, case management of health services outscored the other two policy alternatives on all evaluation criteria, except cost distribution. However, due to the potentially substantial cost savings within the health sector, inordinate educational costs may be acceptable. Conclusion: Involving state school officials in feasibility discussions of the expansion of case management of health services within schools may produce a measurable payoff for ADHD prevention.
P80-S. Attention-Deficit/Hyperactivity Disorder in Youth: Diagnostic Criteria, Community-Based Prevalence, and Treatment Throughout the Years S.N. Visser, J.R. Holbrook, M.L. Danielson. Centers for Disease Control and Prevention, Atlanta, GA Purpose: To visually depict published population-based prevalence estimates for attention-deficit/hyperactivity disorder (ADHD), alongside milestones associated with diagnostic criteria evolution and FDA-approval of medication treatments. Methods: Textual review and secondary analysis of resources from a systematic evidence review were used to create a bar chart of ADHD prevalence estimates (%), overlaid with a line graph of parent-reported prevalence estimates from national surveys, and bound by periods in which specific ADHD diagnostic criteria were used, including those of the Diagnostic and Statistical Manual of Mental Disorders. Undergirding these data, a timeline depicts the date (year) of FDA-approval for medications used for ADHD treatment in children, beginning with the use of Benzedrine in 1936. Results: Consistent with previous reports, population-based prevalence estimates varied widely across time; variation is likely attributable to differences in the application of diagnostic criteria, demographic sample characteristics and, potentially, sample differences in etiologic factor exposures. During a period of stability in the diagnostic criteria, a clear upward trend in national rates of parent-reported ADHD was observed. Perhaps relatedly, the number of FDA-approved ADHD medications increased markedly in the 1990s, with the introduction of long-acting formulations.
Conclusion: A historical view into the descriptive epidemiology of ADHD provides a robust context for discussions of recently published increases in ADHD prevalence over time.
P81. Race and Ethnic Disparities in Preterm Births in Infants Conceived by in Vitro Fertilization in the United States X. Xiong, G. Pridjian, R.P. Dickey. Tulane University School of Public Health and Tropical Medicine, New Orleans, LA Purpose: To examine racial and ethnic differences in preterm births in infants conceived by in vitro fertilization (IVF). Methods: We conducted a retrospective cohort study of 56,465 singleton and 23,748 twin pregnancies resulting from fresh non-donor IVF cycles using 2006-2008 data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS). Results: Rates of very early preterm, early preterm, and preterm birth varied across the racial and ethnic groups in both singleton and twin pregnancies. In singletons, with white women as referent, after adjustment of confounding variables, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) of very early preterm birth, early preterm birth, and preterm birth in black women were 4.5 (3.3-6.0), 3.7 (2.9-4.6), and 2.0 (1.8-2.4). Hispanic women had a significantly lower rate of preterm births as compared to black women and similar or slightly higher rates as compared to white women. Native American women were not at an increased risk of any types of preterm births; and Asian women were at a reduced risk of preterm twin births [adjusted OR: 0.8 (0.7-0.9)]. Conclusion: There exist notable racial and ethnic disparities in preterm births in infants conceived by IVF, with the highest rate in black women.
Speaker Abstracts Session Title: Translating Epidemiologic Research Into Policy: What the Implications for Our Profession? R.C. Brownson, O. Carter-Pokras, V.M. Mays. Washington University in St. Louis, University of Maryland, and UCLA Overview: Epidemiology underlies sound public health practice, yet the process of translating epidemiologic research into policy, law, and regulation may be complex, uncertain, and daunting. The goal of this session is to review the lessons that can be gleaned from eight case studies, with particular attention on training and the role of the profession. The presentation will consist of epidemiologists who have worked in the policy arena. A set of eight case studies has been developed across a wide range of public health issues (i.e., food policy, regulation of secondhand smoke, blood alcohol limits for drivers, prevention of child obesity, HIV prevention in lower and middle income countries, veterans' compensation, cancer screening, and health disparities). Objectives:
1. Review and synthesize common lessons across the case studies; 2. Identify gaps and opportunities in the training of epidemiologists; and 3. Discuss the debates in the profession regarding the appropriate role of epidemiologists in the policy process. Moderator: Ross Brownson
Session Title: Environmental Epidemiology & Population Benefits Haiti: The Challenges for Epidemiology Kenneth A. Mundt Ph.D.. ENVIRON International Corporation Overview: Epidemiological methods are rooted in Snow's investigation of the London cholera epidemic of 1854, yet the world's worst cholera
Abstracts / Annals of Epidemiology 22 (2012) 661e680
Methods: The data form CDC Linked Death and Infant Birth Data, from 1995 through 2002 for term babies. Other data from MaxMind and NOAA website; The variables from the NCHS file used were maternal age, race, birth weight, gestation, plurality, prenatal care, maternal education, marital status, and maternal smoking and alcohol usage. Logistical regression was performed with LBW as the dependent variable with all the other variables as confounding and where independent variables latitude and/or temperature with respect to race using STATA 9.0 SE. Results: About 25 million records from over 32 million births were used for analysis. It was noted average annual temperature>55 F and lower latitude had a higher probability of LBW; Odds ratio (OR) 1.23, P < 0.0005; 95% CL1.22-1.23). Greatest impact of LBW was for NHW and lowest for H, OR 1.22 vs 1.003. Conclusion: 1. LBW at birth is inversely related to higher environmental temperature during pregnancy. 2. Global warming in the future may have impact on LBW.
P79-S. School-Based Policies and Practices for the Prevention of Attention-Deficit/Hyperactivity Disorder: a Policy Analysis S.N. Visser, R. Perou. Centers for Disease Control and Prevention, Atlanta, GA Purpose: To compare school-based policy and practice alternatives for the prevention of childhood attention-deficit/hyperactivity disorder (ADHD), supported by the use of national survey data. Methods: The policy analytic steps of Patton and Sawicki (1993) were used to evaluate three evidence-based policy alternatives for the prevention of ADHD: 1) case management of health services, 2) daily physical education or recess, and 3) a do-nothing, status quo alternative. In addition to the conceptual analysis, data from CDC's 2006 School Health Policy and Practice Survey and 2007 National Survey of Children's Health were used to evaluate the cross-sectional association between state-based rates of ADHD and the three policy alternatives. The policy alternatives were evaluated based on evaluation criteria that were selected a priori: prevention effectiveness, cost, and cost distribution across sectors. Using the odds ratios from the quantitative analyses, telescopic forecasting was used as a crude means of projecting policy impact on ADHD prevalence over time. Results: Of the policy alternatives, case management of health services outscored the other two policy alternatives on all evaluation criteria, except cost distribution. However, due to the potentially substantial cost savings within the health sector, inordinate educational costs may be acceptable. Conclusion: Involving state school officials in feasibility discussions of the expansion of case management of health services within schools may produce a measurable payoff for ADHD prevention.
P80-S. Attention-Deficit/Hyperactivity Disorder in Youth: Diagnostic Criteria, Community-Based Prevalence, and Treatment Throughout the Years S.N. Visser, J.R. Holbrook, M.L. Danielson. Centers for Disease Control and Prevention, Atlanta, GA Purpose: To visually depict published population-based prevalence estimates for attention-deficit/hyperactivity disorder (ADHD), alongside milestones associated with diagnostic criteria evolution and FDA-approval of medication treatments. Methods: Textual review and secondary analysis of resources from a systematic evidence review were used to create a bar chart of ADHD prevalence estimates (%), overlaid with a line graph of parent-reported prevalence estimates from national surveys, and bound by periods in which specific ADHD diagnostic criteria were used, including those of the Diagnostic and Statistical Manual of Mental Disorders. Undergirding these data, a timeline depicts the date (year) of FDA-approval for medications used for ADHD treatment in children, beginning with the use of Benzedrine in 1936. Results: Consistent with previous reports, population-based prevalence estimates varied widely across time; variation is likely attributable to differences in the application of diagnostic criteria, demographic sample characteristics and, potentially, sample differences in etiologic factor exposures. During a period of stability in the diagnostic criteria, a clear upward trend in national rates of parent-reported ADHD was observed. Perhaps relatedly, the number of FDA-approved ADHD medications increased markedly in the 1990s, with the introduction of long-acting formulations.
Conclusion: A historical view into the descriptive epidemiology of ADHD provides a robust context for discussions of recently published increases in ADHD prevalence over time.
P81. Race and Ethnic Disparities in Preterm Births in Infants Conceived by in Vitro Fertilization in the United States X. Xiong, G. Pridjian, R.P. Dickey. Tulane University School of Public Health and Tropical Medicine, New Orleans, LA Purpose: To examine racial and ethnic differences in preterm births in infants conceived by in vitro fertilization (IVF). Methods: We conducted a retrospective cohort study of 56,465 singleton and 23,748 twin pregnancies resulting from fresh non-donor IVF cycles using 2006-2008 data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS). Results: Rates of very early preterm, early preterm, and preterm birth varied across the racial and ethnic groups in both singleton and twin pregnancies. In singletons, with white women as referent, after adjustment of confounding variables, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) of very early preterm birth, early preterm birth, and preterm birth in black women were 4.5 (3.3-6.0), 3.7 (2.9-4.6), and 2.0 (1.8-2.4). Hispanic women had a significantly lower rate of preterm births as compared to black women and similar or slightly higher rates as compared to white women. Native American women were not at an increased risk of any types of preterm births; and Asian women were at a reduced risk of preterm twin births [adjusted OR: 0.8 (0.7-0.9)]. Conclusion: There exist notable racial and ethnic disparities in preterm births in infants conceived by IVF, with the highest rate in black women.
Speaker Abstracts Session Title: Translating Epidemiologic Research Into Policy: What the Implications for Our Profession? R.C. Brownson, O. Carter-Pokras, V.M. Mays. Washington University in St. Louis, University of Maryland, and UCLA Overview: Epidemiology underlies sound public health practice, yet the process of translating epidemiologic research into policy, law, and regulation may be complex, uncertain, and daunting. The goal of this session is to review the lessons that can be gleaned from eight case studies, with particular attention on training and the role of the profession. The presentation will consist of epidemiologists who have worked in the policy arena. A set of eight case studies has been developed across a wide range of public health issues (i.e., food policy, regulation of secondhand smoke, blood alcohol limits for drivers, prevention of child obesity, HIV prevention in lower and middle income countries, veterans' compensation, cancer screening, and health disparities). Objectives:
1. Review and synthesize common lessons across the case studies; 2. Identify gaps and opportunities in the training of epidemiologists; and 3. Discuss the debates in the profession regarding the appropriate role of epidemiologists in the policy process. Moderator: Ross Brownson
Session Title: Environmental Epidemiology & Population Benefits Haiti: The Challenges for Epidemiology Kenneth A. Mundt Ph.D.. ENVIRON International Corporation Overview: Epidemiological methods are rooted in Snow's investigation of the London cholera epidemic of 1854, yet the world's worst cholera