- Email: [email protected]
Prenatal Secondhand Smoke Exposure and Infant Birth Weight in China
748
ABSTRACTS (ACE)
AEP Vol. 17, No. 9 September 2007 : 723–751
METHODS: The SC Autism and Developmental Disabilities Monitoring (ADDM) program is part of the CDC’s on-going ADDM Network, a multi-state active, multiple-source, recordsbased surveillance program among children aged 8 years in specified study years. SC’s catchment area consists of 21 counties in the coastal half of the state, utilizing records from 41 school districts, 21 SC Department of Disabilities and Special Needs Boards, and clinics at the area’s two major universities. Cases from the first two study years (2000 and 2002) have been combined for this analysis. RESULTS: A total of 296 children met criteria for ASD, yielding a prevalence of 6.2 per 1000. The racial distribution of cases was similar to that of 8 year olds in the catchment area: 50% white, 42% black, 2% other, 6% unknown. Males were more commonly affected than females (2.9:1); however, females were more often cognitively impaired than males (4.1:1, male to female, in the average/above average range, 1.8:1 in the moderate/severe/ profound range). Regression (loss of previously acquired skills) was noted in 19% of cases and an additional 3% experienced a developmental plateau. In addition to social and communication delays and atypical behaviors, other commonly observed features among cases were: hyperactivity/attention problems (82%), delayed motor functioning (62%), abnormality in mood/affect (55%), abnormality in eating/drinking/sleeping (54%), temper tantrums (53%), argumentative/oppositional/defiant behavior (51%). Developmental concerns were noted before 36 months in 85% of cases, with earliest evaluation with an ASD diagnosis at median 57 months. Seventy-eight percent of cases were served in special education. CONCLUSION: Because this is an ongoing study, these estimates establish a baseline for assessment of changes in ASD prevalence over time. doi: 10.1016/j.annepidem.2007.07.075
P72 COMPARISON OF BLOOD LEAD CONCENTRATIONS IN U.S. CHILDREN BY AGE, RACE/ETHNICITY, AND INCOME M Harris, LLF Scott, LM Nguyen, LC Haws, ChemRisk, Houston, TX PURPOSE: To evaluate changes in associations between demographic factors and elevated BLLs in children, we determined the percentage of children 1–5 years of age in the various NHANES cycles with blood lead levels >10 mg/dL and assessed demographic trends by survey period. METHODS: Serum lead, demographic, and housing data from NHANES II (1976–1980), NHANES III (1988–1994), and the three continuous NHANES cycles (1999–2000, 2001–2002, 2003–2004) were used in these analyses. Geometric mean (GM) BLLs, 95% confidence intervals, and weighted proportions were calculated using SUDAAN software. Elevated BLLs were defined as BLLs >10 mg/dL. RESULTS: The overall GM BLLs for children 1-5 years of age during 1999–2004 was 1.9 mg/dL (95% CI: 1.8-2.0; NZ4,298), an 86% reduction in levels from 1976–1980 (NZ2,445) and a 40% reduction in levels from 1988–1994 (NZ4,570). Consistent with these results was the remarkable reduction in the percentage of children with elevated BLLs between the periods 1976–1980 and 1988–1994 and a further decline between the 1988–1994 and
1999–2004 periods. While an inverse trend in BLLs and age was observed generally for the 1988–1994 and 1999–2004 periods, increasing age was associated with increasing BLLs from 1976– 1980. For race/ethnicity, a considerably higher percentage of non-Hispanic white children had elevated BLLs during 1976– 1980 whereas the percentage of non-Hispanic white and black children with BLLs >10 mg/dL approached similar proportions for both the 1988–1994 and 1999–2004 survey periods. More notably, the percentage of children with elevated BLLs by income varied from survey period to survey period with a consistent trend observed for the first two periods. CONCLUSION: These results demonstrate not only the considerable decline in blood lead levels and the percentage of children with elevated BLLs, but also the importance of continuously evaluating which demographic characteristics impact serum lead levels in children, as the effect of these factors may shift over time. doi: 10.1016/j.annepidem.2007.07.076
P73 RISK OF TESTICULAR GERM CELL CANCER IN RELATION TO CHILDHOOD PHYSICAL ACTIVITY MB Cook, Y Zhang, BI Graubard, MV Rubertone, RL Erickson, KA McGlynn, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD PURPOSE: The only consistently reported risk factors for testicular germ-cell tumors (TGCTs) are cryptorchism, prior history of TGCT and family history of TGCT. The obesity pandemic and development of a more sedentary lifestyle have been implicated as important etiological factors in many cancers. Specifically, increased levels of physical activity have been shown to be protective against various malignancies. We examined the effect of childhood physical activity on TGCT risk. METHODS: The U.S. Servicemen’s Testicular Tumor Environmental and Endocrine Determinants (STEED) case-control study enrolled participants and their mothers between April 2002 and January 2005. Hours of sports or vigorous physical activity per week were ascertained for three time periods; 1st–5th grades, 6th–8th grades and 9th–12th grades. Son and mother-reports were analyzed separately and included 539 control son-mother pairs and 499 case son-mother pairs. Odds ratios and 95 percent confidence intervals were produced using unconditional logistic regression with adjustment for the matching variables of age, race and year of serum collection. RESULTS: The analysis of the sons’ responses found no relationship between childhood physical activity and TGCT whilst the mothers’ analysis found an inverse association. When the mothers’ data were stratified by histologic group, the protective effect was solely and consistently associated with development of nonseminoma. CONCLUSION: In summary, the data reported by mothers suggest that increased physical activity decreases the risk of TGCT (nonseminoma), although the data reported by sons do not substantiate this protective effect. Future studies of childhood physical activity should seek to validate responses further using recorded information sources such as school records. doi: 10.1016/j.annepidem.2007.07.077
AEP Vol. 17, No. 9 September 2007 : 723–751
ABSTRACTS (ACE)
REPRODUCTIVE HEALTH P74 PRENATAL SECONDHAND SMOKE EXPOSURE AND INFANT BIRTH WEIGHT IN CHINA NL Lee, JM Samet, G Yang, M Zhou, J Yang, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD PURPOSE: Maternal smoking during pregnancy is known to reduce infant birth weight. Epidemiologic evidence also supports a causal association between maternal second-hand smoke (SHS) exposure during pregnancy and reduction in infant birth weight, although the impact is less in magnitude. The primary purpose of this cross-sectional study is to examine the magnitude of this association in a population where both prevalence and dose of SHS exposure are thought to be higher than in U.S. populations. METHODS: Women who gave birth in four hospitals in two Chinese cities (Beijing and Changchun) between September 2000 and November 2001 were interviewed during their post-partum stay to quantify self-reported prenatal SHS exposure. Their medical records were reviewed for data on pregnancy complications and birth outcomes. Non-smoking women who delivered term babies (> 37 weeks gestation) were included in the study (NZ2,770). Multiple linear regression was applied to determine the difference in mean birth weights between exposed and unexposed babies. RESULTS: Nearly a quarter of the women (24%) reported daily SHS exposure and 47% reported no exposure during the entire pregnancy, although 58% reported no exposure when asked about specific sources of SHS. Most of the women (75%) denied any SHS exposure from the husband smoking at home. The greatest deficit in infant birth weight associated with SHS exposure was -7 grams (95% CI -32, +19) for every hour/day exposed to husband smoking at home in Changchun. Interestingly, infants in Beijing had higher mean birth weights among the exposed than the unexposed for all measures of SHS exposure. Overall, no deficit in mean birth weight was observed between exposed and unexposed from all sources of SHS combined (+8 grams, 95% CI -1, +16). CONCLUSION: No statistically significant reduction in birth weight was found with prenatal SHS exposure in this population. Future studies on SHS exposure and infant birth weight in China, where smoking is a critical public health issue, should emphasize more objective measures of exposure. doi: 10.1016/j.annepidem.2007.07.078
P75 BIRTH OUTCOMES AFTER MATERNAL USE OF MEDICATIONS FOR MENTAL HEALTH ILLNESSES DURING PREGNANCY LRB Huber, S Wiley, Department of Public Health Sciences, The University of North Carolina at Charlotte, Charlotte, NC PURPOSE: The use of medications for mental health illnesses (MHI) has increased in prevalence, particularly for women of childbearing age. Recent investigations into the use of such medications during pregnancy have had inconsistent results. The purpose of this study is to examine the association between maternal use of medications for MHI during pregnancy and risk of select birth outcomes using data from the Pregnancy Risk Assessment Monitoring System (PRAMS).
749
METHODS: PRAMS is a population-based survey of women who delivered live-born infants. Michigan asked state-specific questions regarding the use of medication for MHI during pregnancy from 2000–2003. Complete information on key variables was available for 3,793 women. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between the use of medications for MHI and birth outcomes (specifically, low birth weight [defined as !2,500 grams] and preterm delivery [defined as !37 weeks]). Potential confounding factors that altered the medication use-birth outcome OR estimates by >10% were included in the final logistic models. RESULTS: Women who reported using medications for MHI during pregnancy had a slight increased risk of delivering a low birth weight baby after adjustment for race/ethnicity and hypertensive disorders during pregnancy (ORZ1.14; 95% CI: 0.71, 1.84). The association between medication use for MHI and preterm delivery was similar after adjustment for the same confounding factors (ORZ1.13; 95% CI: 0.61, 2.07). CONCLUSION: In this study, the use of medication for MHI was associated with slight increased risks of low birth weight and preterm delivery; however, these risks were not statistically significant. Women who discontinue the use of these medications may risk a relapse of their illness. Women and healthcare professionals need to discuss the risks and benefits of using medications for MHI during preconception and prenatal care counseling sessions in order to make personalized decisions as to whether to continue their use during pregnancy. doi: 10.1016/j.annepidem.2007.07.079
P76 KNOWLEDGE OF DES AND THALIDOMIDE: RELATIONSHIP TO ATTITUDES TO PARTICIPATION OF WOMEN IN BIOMEDICAL RESEARCH SL Russell1, RV Katz1, NR Kressin2, C Claudio3, BL Green4, MQ Wang5, S Kegeles6, K Tzvetkova1, 1New York University, 2 Boston University, 3University of Puerto Rico, 4Texas A&M University, 5University of Maryland, 6University of Connecticut PURPOSE: The purpose of this study was to examine the relationship between attitudes towards risks perceived for women when participating as subjects in biomedical research and knowledge of diethylstilbestrol and thalidomide, and to examine whether relationships vary across race/ethnic groups and by sex. METHODS: The Tuskegee Legacy Project Questionnaire was administered via a RDD telephone interview to 353 adult Blacks, 157 Hispanics and 623 Whites in Birmingham, AL; Tuskegee, AL; Hartford, CT; and San Antonio, TX. This questionnaire included questions which asked study participants whether or not they felt a) that women, compared to men, were more likely to be taken advantage of when participants in biomedical research studies, b) whether women of childbearing age should participate in biomedical research studies. Participants were also asked whether they knew about the ‘‘diethylstilbestrol study’’ and/or the ‘‘thalidomide study.’’ RESULTS: Overall, knowledge of DES, but not of thalidomide, was increased in those who felt that women were more likely, compared to men, to be ‘‘taken advantage of’’ when controlling for potential confounders (ORadjusted Z 1.58, 95%CI 1.02, 1.93). Knowledge of DES was also independently related to whether
ABSTRACTS (ACE)
AEP Vol. 17, No. 9 September 2007 : 723–751
METHODS: The SC Autism and Developmental Disabilities Monitoring (ADDM) program is part of the CDC’s on-going ADDM Network, a multi-state active, multiple-source, recordsbased surveillance program among children aged 8 years in specified study years. SC’s catchment area consists of 21 counties in the coastal half of the state, utilizing records from 41 school districts, 21 SC Department of Disabilities and Special Needs Boards, and clinics at the area’s two major universities. Cases from the first two study years (2000 and 2002) have been combined for this analysis. RESULTS: A total of 296 children met criteria for ASD, yielding a prevalence of 6.2 per 1000. The racial distribution of cases was similar to that of 8 year olds in the catchment area: 50% white, 42% black, 2% other, 6% unknown. Males were more commonly affected than females (2.9:1); however, females were more often cognitively impaired than males (4.1:1, male to female, in the average/above average range, 1.8:1 in the moderate/severe/ profound range). Regression (loss of previously acquired skills) was noted in 19% of cases and an additional 3% experienced a developmental plateau. In addition to social and communication delays and atypical behaviors, other commonly observed features among cases were: hyperactivity/attention problems (82%), delayed motor functioning (62%), abnormality in mood/affect (55%), abnormality in eating/drinking/sleeping (54%), temper tantrums (53%), argumentative/oppositional/defiant behavior (51%). Developmental concerns were noted before 36 months in 85% of cases, with earliest evaluation with an ASD diagnosis at median 57 months. Seventy-eight percent of cases were served in special education. CONCLUSION: Because this is an ongoing study, these estimates establish a baseline for assessment of changes in ASD prevalence over time. doi: 10.1016/j.annepidem.2007.07.075
P72 COMPARISON OF BLOOD LEAD CONCENTRATIONS IN U.S. CHILDREN BY AGE, RACE/ETHNICITY, AND INCOME M Harris, LLF Scott, LM Nguyen, LC Haws, ChemRisk, Houston, TX PURPOSE: To evaluate changes in associations between demographic factors and elevated BLLs in children, we determined the percentage of children 1–5 years of age in the various NHANES cycles with blood lead levels >10 mg/dL and assessed demographic trends by survey period. METHODS: Serum lead, demographic, and housing data from NHANES II (1976–1980), NHANES III (1988–1994), and the three continuous NHANES cycles (1999–2000, 2001–2002, 2003–2004) were used in these analyses. Geometric mean (GM) BLLs, 95% confidence intervals, and weighted proportions were calculated using SUDAAN software. Elevated BLLs were defined as BLLs >10 mg/dL. RESULTS: The overall GM BLLs for children 1-5 years of age during 1999–2004 was 1.9 mg/dL (95% CI: 1.8-2.0; NZ4,298), an 86% reduction in levels from 1976–1980 (NZ2,445) and a 40% reduction in levels from 1988–1994 (NZ4,570). Consistent with these results was the remarkable reduction in the percentage of children with elevated BLLs between the periods 1976–1980 and 1988–1994 and a further decline between the 1988–1994 and
1999–2004 periods. While an inverse trend in BLLs and age was observed generally for the 1988–1994 and 1999–2004 periods, increasing age was associated with increasing BLLs from 1976– 1980. For race/ethnicity, a considerably higher percentage of non-Hispanic white children had elevated BLLs during 1976– 1980 whereas the percentage of non-Hispanic white and black children with BLLs >10 mg/dL approached similar proportions for both the 1988–1994 and 1999–2004 survey periods. More notably, the percentage of children with elevated BLLs by income varied from survey period to survey period with a consistent trend observed for the first two periods. CONCLUSION: These results demonstrate not only the considerable decline in blood lead levels and the percentage of children with elevated BLLs, but also the importance of continuously evaluating which demographic characteristics impact serum lead levels in children, as the effect of these factors may shift over time. doi: 10.1016/j.annepidem.2007.07.076
P73 RISK OF TESTICULAR GERM CELL CANCER IN RELATION TO CHILDHOOD PHYSICAL ACTIVITY MB Cook, Y Zhang, BI Graubard, MV Rubertone, RL Erickson, KA McGlynn, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD PURPOSE: The only consistently reported risk factors for testicular germ-cell tumors (TGCTs) are cryptorchism, prior history of TGCT and family history of TGCT. The obesity pandemic and development of a more sedentary lifestyle have been implicated as important etiological factors in many cancers. Specifically, increased levels of physical activity have been shown to be protective against various malignancies. We examined the effect of childhood physical activity on TGCT risk. METHODS: The U.S. Servicemen’s Testicular Tumor Environmental and Endocrine Determinants (STEED) case-control study enrolled participants and their mothers between April 2002 and January 2005. Hours of sports or vigorous physical activity per week were ascertained for three time periods; 1st–5th grades, 6th–8th grades and 9th–12th grades. Son and mother-reports were analyzed separately and included 539 control son-mother pairs and 499 case son-mother pairs. Odds ratios and 95 percent confidence intervals were produced using unconditional logistic regression with adjustment for the matching variables of age, race and year of serum collection. RESULTS: The analysis of the sons’ responses found no relationship between childhood physical activity and TGCT whilst the mothers’ analysis found an inverse association. When the mothers’ data were stratified by histologic group, the protective effect was solely and consistently associated with development of nonseminoma. CONCLUSION: In summary, the data reported by mothers suggest that increased physical activity decreases the risk of TGCT (nonseminoma), although the data reported by sons do not substantiate this protective effect. Future studies of childhood physical activity should seek to validate responses further using recorded information sources such as school records. doi: 10.1016/j.annepidem.2007.07.077
AEP Vol. 17, No. 9 September 2007 : 723–751
ABSTRACTS (ACE)
REPRODUCTIVE HEALTH P74 PRENATAL SECONDHAND SMOKE EXPOSURE AND INFANT BIRTH WEIGHT IN CHINA NL Lee, JM Samet, G Yang, M Zhou, J Yang, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD PURPOSE: Maternal smoking during pregnancy is known to reduce infant birth weight. Epidemiologic evidence also supports a causal association between maternal second-hand smoke (SHS) exposure during pregnancy and reduction in infant birth weight, although the impact is less in magnitude. The primary purpose of this cross-sectional study is to examine the magnitude of this association in a population where both prevalence and dose of SHS exposure are thought to be higher than in U.S. populations. METHODS: Women who gave birth in four hospitals in two Chinese cities (Beijing and Changchun) between September 2000 and November 2001 were interviewed during their post-partum stay to quantify self-reported prenatal SHS exposure. Their medical records were reviewed for data on pregnancy complications and birth outcomes. Non-smoking women who delivered term babies (> 37 weeks gestation) were included in the study (NZ2,770). Multiple linear regression was applied to determine the difference in mean birth weights between exposed and unexposed babies. RESULTS: Nearly a quarter of the women (24%) reported daily SHS exposure and 47% reported no exposure during the entire pregnancy, although 58% reported no exposure when asked about specific sources of SHS. Most of the women (75%) denied any SHS exposure from the husband smoking at home. The greatest deficit in infant birth weight associated with SHS exposure was -7 grams (95% CI -32, +19) for every hour/day exposed to husband smoking at home in Changchun. Interestingly, infants in Beijing had higher mean birth weights among the exposed than the unexposed for all measures of SHS exposure. Overall, no deficit in mean birth weight was observed between exposed and unexposed from all sources of SHS combined (+8 grams, 95% CI -1, +16). CONCLUSION: No statistically significant reduction in birth weight was found with prenatal SHS exposure in this population. Future studies on SHS exposure and infant birth weight in China, where smoking is a critical public health issue, should emphasize more objective measures of exposure. doi: 10.1016/j.annepidem.2007.07.078
P75 BIRTH OUTCOMES AFTER MATERNAL USE OF MEDICATIONS FOR MENTAL HEALTH ILLNESSES DURING PREGNANCY LRB Huber, S Wiley, Department of Public Health Sciences, The University of North Carolina at Charlotte, Charlotte, NC PURPOSE: The use of medications for mental health illnesses (MHI) has increased in prevalence, particularly for women of childbearing age. Recent investigations into the use of such medications during pregnancy have had inconsistent results. The purpose of this study is to examine the association between maternal use of medications for MHI during pregnancy and risk of select birth outcomes using data from the Pregnancy Risk Assessment Monitoring System (PRAMS).
749
METHODS: PRAMS is a population-based survey of women who delivered live-born infants. Michigan asked state-specific questions regarding the use of medication for MHI during pregnancy from 2000–2003. Complete information on key variables was available for 3,793 women. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between the use of medications for MHI and birth outcomes (specifically, low birth weight [defined as !2,500 grams] and preterm delivery [defined as !37 weeks]). Potential confounding factors that altered the medication use-birth outcome OR estimates by >10% were included in the final logistic models. RESULTS: Women who reported using medications for MHI during pregnancy had a slight increased risk of delivering a low birth weight baby after adjustment for race/ethnicity and hypertensive disorders during pregnancy (ORZ1.14; 95% CI: 0.71, 1.84). The association between medication use for MHI and preterm delivery was similar after adjustment for the same confounding factors (ORZ1.13; 95% CI: 0.61, 2.07). CONCLUSION: In this study, the use of medication for MHI was associated with slight increased risks of low birth weight and preterm delivery; however, these risks were not statistically significant. Women who discontinue the use of these medications may risk a relapse of their illness. Women and healthcare professionals need to discuss the risks and benefits of using medications for MHI during preconception and prenatal care counseling sessions in order to make personalized decisions as to whether to continue their use during pregnancy. doi: 10.1016/j.annepidem.2007.07.079
P76 KNOWLEDGE OF DES AND THALIDOMIDE: RELATIONSHIP TO ATTITUDES TO PARTICIPATION OF WOMEN IN BIOMEDICAL RESEARCH SL Russell1, RV Katz1, NR Kressin2, C Claudio3, BL Green4, MQ Wang5, S Kegeles6, K Tzvetkova1, 1New York University, 2 Boston University, 3University of Puerto Rico, 4Texas A&M University, 5University of Maryland, 6University of Connecticut PURPOSE: The purpose of this study was to examine the relationship between attitudes towards risks perceived for women when participating as subjects in biomedical research and knowledge of diethylstilbestrol and thalidomide, and to examine whether relationships vary across race/ethnic groups and by sex. METHODS: The Tuskegee Legacy Project Questionnaire was administered via a RDD telephone interview to 353 adult Blacks, 157 Hispanics and 623 Whites in Birmingham, AL; Tuskegee, AL; Hartford, CT; and San Antonio, TX. This questionnaire included questions which asked study participants whether or not they felt a) that women, compared to men, were more likely to be taken advantage of when participants in biomedical research studies, b) whether women of childbearing age should participate in biomedical research studies. Participants were also asked whether they knew about the ‘‘diethylstilbestrol study’’ and/or the ‘‘thalidomide study.’’ RESULTS: Overall, knowledge of DES, but not of thalidomide, was increased in those who felt that women were more likely, compared to men, to be ‘‘taken advantage of’’ when controlling for potential confounders (ORadjusted Z 1.58, 95%CI 1.02, 1.93). Knowledge of DES was also independently related to whether