Gender-specific Logistic Regression Models Research Articles

Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study.

To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p<0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.

The Relationship between Urinary Incontinence, Osteoarthritis, and Musculoskeletal System Disorders.

Background/Objectives: Urinary incontinence diminishes quality of life, and its severity can be worsened by mobility impairments. This study explored the link between urinary incontinence, osteoarthritis, and back musculoskeletal system disorders, considering pain, mobility issues, and daily activity difficulties. Methods: This cross-sectional study included respondents aged ≥ 15 years from the 2008 Turkish Health Studies Survey (n = 13,976). We assessed self-reported urinary incontinence, daily activity, mobility impairment, pain, osteoarthritis, and musculoskeletal disorders to explore their association with urinary incontinence. Gender-specific logistic regression models included chronic conditions related to urinary incontinence. Results: The prevalence of urinary incontinence was higher in the participants with osteoarthritis and back musculoskeletal system problems. Among the patients with osteoarthritis, the prevalence was 25.84% in the mobility-impaired group and 10.03% in the non-impaired group. Similarly, 33.02% of those with activities of daily living (ADL) difficulties and 12.93% of those without difficulties had incontinence. The frequency of urinary incontinence increased with pain severity. According to the multivariable logistic regression analyses, the adjusted odds ratio (95% confidence interval) of urinary incontinence for osteoarthritis was 1.58 (95% CI 1.23-2.02, p < 0.01) for females and 2.38 (95% CI 1.62-3.49, p < 0.01) for males. Conclusions: Urinary incontinence was more common in females, increased with age, and was found to be associated with osteoarthritis and back musculoskeletal system disorders. Among the patients with osteoarthritis and back musculoskeletal system disorders, those with mobility impairment and daily activity difficulties had a higher prevalence of urinary incontinence. The patients with more severe pain had a higher frequency of urinary incontinence.

Social Mobility and Cognitive Impairment Among Korean Older Adults: Does Gender Matter?

The purpose of this study is to investigate the association between social mobility and cognitive impairment among older adults in Korea. The study sample is drawn from nationally representative data, which comes from the 2016 Korean Longitudinal Study of Ageing (KLoSA). The final sample consists of 4264 KLoSA respondents aged 65 or older. Gender-specific logistic regression models are used to examine the association between social mobility and cognitive impairment. The results show that, when compared to the reference group (stable low social mobility), women in the downward and the stable high social mobility groups were less likely to have cognitive impairment. In contrast, upward social mobility was a protective factor for cognitive impairment only among men. Gender-specific interventions may be needed to enhance cognitive health among older Koreans. Further research is needed to examine the causal relations between social mobility and cognitive health between the genders.

Gender, Tobacco Control Policies, and Persistent Smoking Among Older Adults: A Longitudinal Analysis of 11 European Countries.

Little is known about sociodemographic and macro-level predictors of persistent smoking when one has developed a health condition that is likely caused by smoking. We investigate the impact of gender, education, and tobacco control policies (TCPs) on persistent smoking among older Europeans. Respondents (aged 50 +) with a smoking history and at least one smoking-related health condition were pooled from the Survey of Health, Aging and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) from four waves from 2004 to 2013. We fitted gender-specific logistic regression models with two-way fixed effects (country and year) and tested interaction terms between gender, education, and TCPs. Although women are less likely to smoke than men, they were more likely to smoke persistently. The effects of education and general TCPs on persistent smoking were significant for women only. Compared to women with low levels of education, those with moderate education (odds ratio [OR] = .63; .49-.82) and high education (OR = .57; .34-.98) are less likely to be persistent smokers. TCPs are associated with a reduced risk of women's persistent smoking (OR = .70; .51-.95) and the association is stronger for those having less education. Older women, particularly those with low levels of education, are vulnerable to persistent smoking. TCPs might be effective in reducing persistent smoking for older women, with greater effects for less-educated women. Future studies are needed to understand mechanisms that explain gender differences in responsiveness to TCPs. Persistent smoking is a particularly harmful smoking behavior as it is associated with greater risks of comorbidity and mortality. By employing the framework of the multilevel social determinants of health, this study examined the behavior of persistent smoking among older adults in European countries. Women, especially women with low levels of education are vulnerable to persistent smoking. Moreover, TCPs, in general, are significantly related to a reduction in persistent smoking among older women only and the negative association is stronger for those having less education, indicating gender and socioeconomic differences in responsiveness to TCPs.

Gender, Tobacco Control Policies, and Recalcitrant Smoking Among Older Adults in 20 European Countries

Little is known about sociodemographic and macro-level predictors of “recalcitrant smoking,” defined as persistent smoking when one has developed a health condition that is likely caused by smoking. We aim to investigate the impact of gender, education, and tobacco control policies on recalcitrant smoking among older adults in Europe from 2006 through 2013. Data from 33,839 respondents—aged 50 years and older with a smoking history and at least one smoking-related health condition—were pooled from the 2006–07, 2011, and 2013 waves of three harmonized longitudinal studies on ageing (SHARE, ELSA, and TILDA). We fitted gender-specific logistic regression models with two-way fixed effects and tested interaction terms between gender, tobacco control policies, and education, adjusting for age, marital status, GDP per capita, smoking prevalence, country, and year-fixed effects. Compared to men and individuals with higher levels of education, women and less educated individuals were more likely to be recalcitrant smokers. The association between education and recalcitrant smoking was stronger for women than men. The inverse association between the TCS and recalcitrant smoking was stronger for those having upper secondary education (for men: OR = 0.905, CI = 0.849–0.965; for women: OR = 0.897, CI = 0.834–0.964) and tertiary education (for men: OR = 0.802, CI = 0.717–0.898; for women: OR = 0.739, CI = 0.603–0.907), compared to those having less than upper secondary. As women and less educated individuals are vulnerable to recalcitrant smoking, future policies targeting these marginalized groups are needed to prevent recalcitrant smoking in old age.

Association between Nightlife Goers' Likelihood of an Alcohol Use Disorder and Their Preferred Bar's Closing Time: A Cross-Sectional Observational Study in Perth, Australia.

Introduction and aims: Associations between longer-term alcohol-related conditions and licensed outlet trading hours are not well understood. We investigated the association between nightlife-goers’ likelihood of an alcohol use disorder (AUD) and their preference for bars with special permits to remain open ‘late’ (i.e., spent more time there compared to any other venue) until 2 a.m. or 3 a.m. (Friday; Saturday) or midnight (Sunday) compared to bars with ‘standard’ closing times of midnight (Friday; Saturday) or 10 p.m. (Sunday). Design and methods: A cross-sectional observational study was conducted in four major nightlife areas of Perth, Australia, in 2015–2016. We conducted weekend street intercept surveys outside bars between 8 p.m. and 3 a.m. and screened participants who reported alcohol use prior to the survey and spent more time in a bar than any other venue type (n = 667) regarding their past year drinking pattern using AUDIT-C (n = 459). We used gender-specific logistic regression models to estimate associations between AUDIT-C categories (1–4, low risk; 5–7, hazardous; 8–12, active AUD) and preference for bars with different closing times (late vs. standard). Results: A large proportion of participants were hazardous drinkers or had active AUD (83% males; 65% females), and over half preferred a late to a standard closing bar. We found evidence of a positive association between preference for late closing bars and hazardous drinking females (OR = 3.48; 95% CI 1.47–8.23; p = 0.01), but not for females with active AUD, male hazardous drinkers, nor males with active AUD. Discussion and conclusions: Our study adds new evidence on associations between likelihood of AUD among nightlife-goers and trading hours. With increasing international relaxation of trading hours, evidence that late closing bars may be preferred by hazardous drinking females will be of concern to policymakers wanting to curb alcohol-related harms in the community.

Daily tobacco consumption and associated socioeconomic factors in the Portuguese population: National Health Interview Survey data 1987-2014

Introduction and ObjectivesSmoking patterns inform tobacco control policies. This study aimed to assess trends in smoking prevalence and associated socioeconomic factors in Portugal between 1987 and 2014. MethodsWe used data from National Health Interview Surveys (NHIS) conducted in 1987, 1995/96, 1998/99, 2005/06 and 2014/15. For each NHIS, we estimated gender-specific and age-standardized smoking prevalences, stratified by education, occupation, marital status and region. We constructed NHIS- and gender-specific logistic regression models, adjusting for the above-mentioned variables. We describe changes in smoking prevalence and inequalities in associated socioeconomic factors between 1987 and 2014. ResultsIn men, smoking prevalence (32.2% and 26.7%, respectively) and inequalities for all factors except for education decreased between 1987 and 2014. For women, inequalities decreased for region, age and occupation, and these changes occurred through increasing smoking prevalence in all groups. For marital status and education, inequalities were stable but smoking prevalence increased for all groups within these variables. In both sexes, the unemployed (adjusted odds ratio [aOR] 2014: men 2.33, women 2.76) and divorced (aOR 2014: men 2.12, women 3.18) consistently had the highest prevalences and aORs of smoking. For the first three NHIS higher aORs of smoking were observed among less-educated men and highly-educated women, while for the last two the higher odds were for the less-educated in both sexes. ConclusionsSmoking trends among men showed decreasing prevalences and diminishing inequalities. For women, inequalities were stable but there was an overall increase in prevalence. The unemployed and divorced had the highest smoking prevalences in both sexes. Smoking prevention and cessation policies in Portugal should take into consideration inequalities, particularly among men, and increasing consumption among women.

Gender Differences in Smoking Among an Urban Emergency Department Sample.

Background:Urban emergency department (ED) patients have elevated smoking and substance use compared with the general population. We analyzed gender differences in smoking among an urban ED sample and assessed the contribution of substance use, demographic, and couple factors.Methods:We conducted a secondary analysis of data obtained from a cross-sectional, observational survey (N = 1037 participants) on drinking, drug use, and intimate partner violence (IPV). Gender-specific logistic regression models for current (past 30-day) smoking and multinomial regression models for smoking intensity (light: ⩽5 cigarettes per day [CPD]; moderate: 6 to 10 CPD; heavier: >10 CPD) were estimated.Results:Smoking prevalence was higher among men than women (35.5% vs 18.9%; P < .001). Substance use (frequency of intoxication, marijuana, amphetamine, and cocaine use), demographic (food insufficiency, unemployment), and couple-related factors (having a spouse/partner who smoked, IPV involvement, being in a same-gender couple) were differentially associated with current smoking and level of intensity among men and women.Conclusions:Emergency department staff should consider the impact of polysubstance use, food insufficiency, unemployment, and whether both partners in the couple smoke when screening patients for smoking and formulating cessation treatment plans. Women in same-gender relationships and those who have experienced IPV involvement may require additional referral.

Associations between perceived social and physical environmental variables and physical activity and screen time among adolescents in four European countries.

Associations between the perceived social and physical environment and self-reported moderate-to-vigorous physical activity (MVPA) and screen time (ST) were examined among adolescents in four European countries. Representative samples were surveyed with standardised methodologies. Associations between environmental variables and meeting MVPA recommendations and tertiles of ST were tested in gender-specific logistic regression models. Moderation by country and country-specific relationships were also examined. The most consistent findings across countries were found for the significant associations between neighbourhood social environment and MVPA in both boys and girls. Significant associations with the physical environment varied more between countries and by gender. The most consistent negative associations with ST were found for the social environmental variable of having parental rules for spending time outside the home. The present findings provided evidence for the generalisability of the associations between environmental correlates and MVPA across four European countries. The findings show clear differences in correlates for MVPA and ST. Further research is needed to better understand the unique aspects of the social and physical environment which explain each of the two behaviours.

Abstract PR05: Does a comprehensive family history of colorectal cancer improve risk prediction?

Abstract Background: Family history of colorectal cancer (CRC) is a strong and well-established risk factor for CRC. To date, however, family history (FH) of the disease is generally only broadly categorized (usually as present or absent) in most risk prediction models (Freedman et al. 2009). These approaches fail to fully utilize information on family history and may lead to suboptimal predictive performance of CRC risk. We investigated the utility of a CRC risk model that incorporates a comprehensive family history of CRC as well as information on known genetic and environmental risk factors and personal characteristics. Methods: We used data from the Colon Cancer Family Registry (CCFR), a large, international consortium of six study centers. Prediction models were developed based on incident invasive CRC cases (N = 4445) and population-based controls (N = 3967) that were recruited from three study sites (Seattle, USA; Ontario, Canada; and Melbourne, Australia). A familial risk profile (FRP) score, a probability index of absolute risk for lifetime CRC was estimated based on family structure, age of onset for affected relatives and the polygenic effect of MLH1, MSH2, MSH6, PMS2 and MUTYH using modified segregation analysis, an approach adapted from Antoniou et al (2002)). Two sets of gender-specific logistic regression models were built: (I) the FRP models, which included FRP and other known risk factors (e.g., BMI, consumption of red meat, calcium and NSAID use duration, smoking amount (pack-years), a history of polyps, and history of FOBT, sigmoidoscopy, colonoscopy, fruit intake, and use of hormone replacement therapy for female); and (II) binary FH models, which replaced FRP with a binary indicator (yes/no) for any self-reported first-degree family member with CRC. 5-year absolute risks were calculated based on the estimated odds ratios (OR), country-, sex- and age-specific CRC incidence rate and mortality due to causes other than CRC. Model validation was conducted with unaffected relatives (N=12,120) and population-based controls (N=1,899) from five study sites based on the follow-up information on incident CRC and death status. The primary endpoint was CRC diagnosis within 5-year after baseline. We used calibration plots to compare the predicted 5-year absolute risks with the observed cumulative incidence rates. Receiver Operating Characteristic (ROC) curve analyses were conducted and areas under the ROC curve (AUC) were used to assess the discriminatory capacity for separating subjects with and without a CRC diagnosis within 5 years, accounting for censoring and competing risk. Results: The ORs (95% confidence interval [CI]) using the FRP per 10% increase were 1.16 (1.11-1.20) for males, and 1.09 (1.06-1.12) for females in the FRP models, while the ORs for the binary FH model were 2.32 (1.88- 2.85) for men and 1.70 (1.38-2.09) for women. The FRP models provided slightly better calibration, with average predicted risks falling within the 95% CIs of the empirical cumulative rates. The binary FH models, by comparison, tended to yield higher estimated CRC risks compared with the observed risks among individuals whose risks were above the top10% of the risk distribution. Both models yielded comparable AUCs using the full validation set. Among individuals with at least one first-degree family member affected with CRC, the FRP model performed significantly better (AUC = 0.71) than the FH model (AUC = 0.63) for male participants; difference equaled 0.09 (95% CI: 0.02, 0.16). The models were comparable for females. Conclusion: Our CRC prediction model that incorporates more comprehensive family history of CRC can provide improved calibration and discrimination of risks compared with the simple FH model, especially in populations with higher underlying risk. The models developed may potentially further improve screening decision making among subgroups with elevated CRC risk.

Prevalence of Anemia among Older Adults Residing in the Coastal and Andes Mountains in Ecuador: Results of the SABE Survey.

Objectives. To estimate the prevalence of anemia and its determinants among older adults in Ecuador. Methods. The present study was based on data from the National Survey of Health, Wellbeing, and Aging. Hemoglobin concentrations were adjusted by participants' smoking status and altitude of residence, and anemia was defined according to the World Health Organization criteria (<12 g/dL in women and <13 g/dL in men). Gender-specific logistic regression models were used to examine the association between demographic and health characteristics and anemia. Results. A total of 2,372 subjects with a mean age of 71.8 (SD 8.2) years had their hemoglobin measured, representing an estimated 1.1 million older adults. The crude prevalence of anemia was 20.0% in women and 25.2% in men. However, higher anemia prevalence rates were seen with advancing age among black women and subjects residing in the urban coast. Likewise, certain health conditions such as hypoalbuminemia, cancer in men, chronic kidney disease, iron deficiency, and low grade inflammation were associated with increased odds of having anemia. Conclusions. Anemia is a prevalent condition among older adults in Ecuador. Moreover, further research is needed to examine the association between anemia and adverse health-related outcomes among older Ecuadorians.

The Association between Unintended Pregnancy and Violence among Incarcerated Men and Women

Background: In this article, we examine the association between unintended pregnancy and individual and community level indicators of violence in a population of both women and men in the criminal justice system. Methods: We conducted a cross-sectional survey with 290 women and 306 men in 3 correctional facilities in Kansas City and used logistic regression models to assess relationships between key independent variables and unintended pregnancy. Findings: In gender-specific logistic regression models, women with a history of intimate partner violence were 2.02 times more likely (CI 1.15, 3.56), and those with a history of sexual abuse before age 16 were 1.23 times more likely (CI 1.02–1.49) to have experienced unintended pregnancy. Men or their family members who were victimized by neighborhood violence were 1.82 times more likely to have experienced unintended pregnancy (CI 1.01, 3.28). Discussion: These findings suggest the need for gender and community-specific interventions that address the relationship between violence and unintended pregnancy.

Who Tests, Who Doesn't, and Why? Uptake of Mobile HIV Counseling and Testing in the Kilimanjaro Region of Tanzania

BackgroundOptimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania.MethodsBetween December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups.ResultsMVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84).ConclusionsMVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.

Low High Density Lipoprotein Cholesterol: Prevalence and Associated Risk-Factors in a Large French Population

High density lipoprotein-cholesterol (HDL-C) is a strong predictor of cardiovascular risk. We investigated the distribution of HDL-C in a French general population according to age, sex, and the risk factors associated with low HDL-C values. A group of 18,483 men and 22,047 women 16-79 years of age were investigated during a medical check-up. Relevant parameters were studied in three groups according to age and gender-specific percentile classes (≤5th [HDL₅] median and >95th). Gender-specific logistic regression models selected variables associated with HDL₅. Using the National Cholesterol Education Program Adult Treatment Panel III criteria (threshold: 40 mg/dL in men, 50 mg/dL in women) the prevalence of low HDL-C was 11.1% and 26.4% in men and women and it decreased with age. Mean HDL-C levels increased with age. HDL₅ was positively associated with a sedentary lifestyle and deprivation (p < 0.00001) even after adjustment on alcohol consumption and smoking. Abdominal obesity, smoking, hypertriglyceridemia, hyperleucocytosis, and low alcohol consumption were associated with HDL₅ for both genders. The prevalence of low HDL-C was similar to that observed in other Europeans but lower than in the United States. HDL₅ was associated with cardiovascular risk factors, metabolic syndrome, and social deprivation. A prevention policy to increase HDL-C levels should focus on reducing smoking and abdominal obesity, particularly in deprived subjects.

Correlates of Weight Patterns during Middle Age Characterized by Functional Principal Components Analysis

Describing weight trajectories using functional methods may further our understanding of how weight impacts health. We characterize weight patterns and describe correlates of these patterns. Using a subset of the Framingham Heart Study original cohort limited-access data set (n=1,429), we conducted a functional principal components analysis (PCA) of body mass index from 40 to 55 years of age. Scores from the principal component functions defined weight patterns. Gender-specific logistic regression models provided estimates of association with sociodemographic and lifestyle factors. Overall weight status, weight changes, and cycling emerged as weight patterns during middle age. Overweight/obesity at 25 years was the most consistent correlate of weight patterns (adjusted odds ratios [AORs] for men and women were 14.2 and 3.7 for overall overweight, 99.5 and 28.3 for overall obese, and 1.4 and 3.9 for cycling). Weight status at 25 years was not associated with weight gain in either gender or weight loss in men; for women the AOR was 2.7 for weight loss. Functional PCA described weight patterns during middle age. The strong associations between weight status at 25 years and overall weight status and cycling during middle age underscore the importance of addressing weight earlier in life.

Gender differences in the socioeconomic gradient in self-reported diabetes: Does health service access play a role?

Aims To investigate the hypothesis that gender difference in the socioeconomic gradient of self-reported diabetes might be partially determined by a detection bias: among low SEP men, but not women, a less frequent use of medical care would result in lower diabetes detection and awareness. Methods We conducted a cross-sectional analysis of 2387 (57.1% women) Brazilian university non-faculty civil servants. We quantified the association between educational attainment (a marker of socioeconomic position) and self-reported diabetes through gender-specific logistic regression models adjusting for age. Health insurance coverage (a marker of potential health care access) and never having had serum cholesterol tested (a marker of actual care access) were analyzed to investigate the role of detection bias. Results Compared to participants with college education or higher, the adjusted odds ratio (OR) and 95% confidence interval for diabetes for those with less than high school was 2.5 (1.0–6.5) in men and 5.0 (2.1–11.7) in women. Only among men we observed an increment in this OR after an additional adjustment for markers of care access [men 3.5 (1.3–9.1); women 4.9 (1.9–12.1)]. Conclusions Our findings suggest that health service access may explain some of the gender difference in the socioeconomic gradient of self-reported diabetes.

Second-hand smoke exposure in homes and in cars among Canadian youth: current prevalence, beliefs about exposure, and changes between 2004 and 2006

The present study examines second-hand smoke (SHS) exposure and the beliefs youth have about being exposed to SHS in their home and in cars and explores changes in exposure and beliefs over time. Nationally representative data from the 2006 Youth Smoking Survey (YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 71,003 Canadian youth in grades 5-12. Gender-specific logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around kids at home or smoking around kids in cars. In 2006, 22.1% of youth in grades 5-12 were exposed to smoking in their home on a daily or almost daily basis and 28.1% were exposed to smoking while riding in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around kids at home (88.3%) or in cars (88.4%). Youth exposed to smoking in the home or in cars reported missing substantially more days of school in the previous month because of their health. Among both male and female youth, being an ever smoker, living in a house where someone smokes inside daily, and having ridden in a car with someone who was smoking cigarettes in the past seven days were all associated with being more likely to report that smoking should not be allowed around kids at home or in cars. Compared to their male counterparts, female youth with at least one parent who smokes were more likely to report that smoking should not be allowed around kids at home or in cars. As rates of SHS exposure in the home and car decreased between 2004 and 2006, the prevalence of youth who reported that they do not think smoking should be allowed around kids at home or in cars also decreased over the same period of time. These results highlight that Canadian youth are frequently exposed to SHS in their homes and in cars despite the fact that the vast majority of youth do not think smoking should be allowed around kids in those locations. Considering the health and social consequences associated with SHS exposure, it may be a timely opportunity to move forward with programs and policies designed to prevent individuals from smoking around youth in these locations.

National Estimates and Factors Associated With Medication Treatment for Childhood Attention-Deficit/Hyperactivity Disorder

In this study we identified child and family-level characteristics that were associated with medication treatment for attention-deficit/hyperactivity disorder using nationally representative survey data. National Survey of Children's Health data from 79264 youth 4 to 17 years of age were used. Data were weighted to adjust for the complex survey design of the National Survey of Children's Health. Gender-specific logistic regression models were generated to identify child and family-level characteristics that were collectively associated with current medication status among youth with a reported diagnosis of attention-deficit/hyperactivity disorder. Nationally, 7.8% of youth aged 4 to 17 years had a reported attention-deficit/hyperactivity disorder diagnosis, and 4.3% had both a disorder diagnosis and were currently taking medication for the disorder. Current medication treatment among youth with attention-deficit/hyperactivity disorder was associated with white race, younger age, English spoken in the home, health care coverage, a health care contact within the last year, and reported psychological difficulties. Gender-specific logistic regression models revealed that, together, younger age, higher income, health care coverage, having psychological difficulties, and a health care contact in the past year were associated with medication use among boys with attention-deficit/hyperactivity disorder. Among girls with the disorder, younger age, psychological difficulties, fair-to-poor paternal mental health status, and a health care contact within the last year were collectively associated with current medication use. CONCLUSIONS. Regardless of gender, younger age, the presence of psychological difficulties, and a recent health care contact were significantly associated with medication treatment for attention-deficit/hyperactivity disorder. However, additional health care access and income variables among boys and paternal mental health status among girls represented gender-specific factors that were also associated with medication treatment for the disorder. Future studies should characterize how and when the burden associated with attention-deficit/hyperactivity disorder leads to treatment, support, or services for this prevalent and impairing neurobehavioral disorder.

Gender differentials of abdominal obesity among the adults in the district of Colombo, Sri Lanka

Objective To assess the gender-specific prevalence and determinants of abdominal obesity (AO) within the population and lifestyle diversity of an urban district in Sri Lanka. Methods Prevalence of AO (defined by waist circumference) was estimated in a cross-sectional study of 1400 adults aged 20–64, residing in the district of Colombo in 2004. Demographic, socio-economic and lifestyle factors were assessed in gender-specific logistic regression models to identify determinants of AO. Results Prevalence of AO was 44.7% (95% confidence interval (CI): 41.0, 48.5) in females and 25.7% (95% CI: 22.6, 29.0) in males. Significant determinants of AO were age 35–49 (adjusted odds ratio: 1.7; 95% CI: 1.2, 2.5), moderately urban sector (1.9; 1.3, 2.9) and insufficient level of physical activity (1.7; 1.1, 2.4) among females in contrast to household income > Rupees 10,000 (6.1; 2.7, 13.5), increased alcohol (medium: 1.9; 1.2, 2.9; high: 2.1; 1.2, 3.5), low-fiber diet (1.6; 1.1, 2.4) and frequent large meals (1.7; 1.0, 2.8) among males. Determinants common to males (M) and females (F) were age ≥ 50 years (M: 2.5; 1.5, 4.2 and F: 2.9; 1.9, 4.4), most urban sector (M: 2.0; 1.3, 3.1 and F: 1.8; 1.2, 2.7) and married status (M: 2.2; 1.3, 3.6 and F: 2.4; 1.6, 3.6). Conclusions A distinct gender differential was observed in the prevalence and determinants of AO. It appears vital that preventive strategies of AO be developed to be more ‘gender-sensitive’ in urban districts.

Regional fat localizations and racial/ethnic variations in odds of hypertension in at-risk American adults.

The objective of this study was to determine the contribution of regional fat localizations defined as abdominal (AO) or truncal (TO) obesity in racial/ethnic differences to the prevalence odds of hypertension in overweight American adults. Data (n=5,694) from the 1999-2002 US National Health and Nutrition Examination Survey were utilized for this analysis. Abdominal obesity was defined as waist circumference >or=102 and >or=88 cm for men and women, respectively. Truncal obesity was defined using ratio of subscapular to triceps skinfold thickness and were >or=2.24 and >or=1.32, for men and women, respectively. Prevalence odds ratios from gender-specific logistic regression models were used to evaluate the contribution of regional fat localizations to racial/ethnic variation in hypertension. Statistical adjustment was made for age, education, alcohol intake and body mass index. In both men and women, coexistence of AO and TO was associated with much higher prevalence odds of hypertension than association due to each of the regional fat localizations. In men, coexistence of AO and TO was associated with 1.99, 2.47 and 2.10 increased prevalence odds of hypertension in Whites, Blacks and Mexican Americans, respectively. The corresponding values in women were 2.83, 4.07 and 3.61 in Whites, Blacks and Mexican Americans, respectively. The coexistence of AO and TO appears to be the culprit that contributes to high blood pressure on top of body mass index. Weight reduction programs that are targeted toward abdominal and truncal regions in at-risk populations and along racial/ethnic lines may help to alleviate racial/ethnic disparity in risk of hypertension.