The Infant Mortality Racial Disparity in North Carolina: Contributing Social/Behavioral and Biomedical Risk Factors

Objectives: This study examined a number of social/behavioral and biomedical factors as potential mediators of the association between race and infant mortality, with maternal education as an effect modifier. Methods: Birth certificate data from singleton, non-Hispanic white and African American births to North Carolina residents in 2009 were used to calculate odds of infant mortality adjusting for race and potential mediators, stratified by maternal education. Results: The racial disparity between white and African American infants was reduced but remained significant after adjusting for mediators, and the disparity increased with increasing level of maternal education. Conclusions: Social/behavioral and biomedical factors contribute to the association between race and infant mortality. However, additional factors likely influence the racial disparity, particularly among mothers with higher levels of education.Master of Public Healt

Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index

Background To address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children’s body mass index (BMI). Methods A seven-month randomized control trial was conducted in 17 licensed child care centers serving predominantly low income families in California, Connecticut, and North Carolina, including 137 child care providers and 552 families with racially and ethnically diverse children three to five years old. The NAP SACC intervention included educational workshops for child care providers and parents on nutrition and physical activity and consultation visits provided by trained nurse child care health consultants. Demographic characteristics and pre - and post-workshop knowledge surveys were completed by providers and parents. Blinded research assistants reviewed each center’s written health and safety policies, observed nutrition and physical activity practices, and measured randomly selected children’s nutritional intake, physical activity, and height and weight pre- and post-intervention. Results Hierarchical linear models and multiple regression models assessed individual- and center-level changes in knowledge, policies, practices and age- and sex-specific standardized body mass index (zBMI), controlling for state, parent education, and poverty level. Results showed significant increases in providers’ and parents’ knowledge of nutrition and physical activity, center-level improvements in policies, and child-level changes in children’s zBMI based on 209 children in the intervention and control centers at both pre- and post-intervention time points. Conclusions The NAP SACC intervention, as delivered by trained child health professionals such as child care health consultants, increases provider knowledge, improves center policies, and lowers BMI for children in child care centers. More health professionals specifically trained in a nutrition and physical activity intervention in child care are needed to help reverse the obesity epidemic. Trial registration National Clinical Trials Number NCT0192184

Associations of Adversity to Indicators of Child Well Being in a High Quality Early Education Context

Studies have shown that adversity in childhood has harmful effects on well-being across the lifespan. This study examined the prevalence of children’s cumulative experiences of adversity, based on parent report, in a national sample of low-income children (N=3,208) enrolled in a high quality early childhood education (ece) program. It explored the association between family adversity that occurred within the year prior to the parents’ interview and the child’s well-being measured after the interview. Well-being was based on language, school readiness, and social emotional outcomes. Almost half of all families reported experiencing at least one adversity. Family adversity was associated with worse school readiness and health outcomes. Adversity had mixed associations with socialemotional outcomes and no association with language outcomes. This study also explored time enrolled in ece (dosage) as a protective or promotive factor in relation to adversity. Time in program had a positive relationship to most child outcomes and could be interpreted as a promotive factor within the context of adversity for all outcomes except behavioral concerns

Circulating Cathelicidin Concentrations in a Cohort of Healthy Children: Influence of Age, Body Composition, Gender and Vitamin D Status.

Cathelicidin is an antimicrobial peptide whose circulating levels are related to vitamin D status in adults. This study sought to determine if circulating cathelicidin concentrations in healthy children are related to the age of the child, body composition and vitamin D status at birth and at the time of the study visit. Blood samples were obtained during yearly visits from 133 children, ages 2-7, whose mothers had participated in a pregnancy vitamin D supplementation RCT. Radioimmunoassay and ELISA were performed to analyze 25(OH)D and cathelicidin, respectively. Statistical analyses compared cathelicidin concentrations with concentrations of 25(OH)D at various time points (maternal levels throughout pregnancy, at birth, and child's current level); and with race/ethnicity, age, gender, BMI, percent fat, and frequency of infections using Student's t-test, χ2, Wilcoxon ranked-sum analysis, and multivariate regression. The cohort's median cathelicidin concentration was 28.1 ng/mL (range: 5.6-3368.6) and did not correlate with 25(OH)D, but was positively correlated with advancing age (ρ = 0.236 & p = 0.005, respectively). Forty patients evaluated at two visits showed an increase of 24.0 ng/mL in cathelicidin from the first visit to the next (p<0.0001). Increased age and male gender were correlated with increased cathelicidin when controlling for race/ethnicity, percent fat, and child's current 25(OH)D concentration (p = 0.028 & p = 0.047, respectively). This study demonstrated that as children age, the concentration of cathelicidin increases. Furthermore, male gender was significantly associated with increased cathelicidin concentrations. The lack of association between vitamin D status and cathelicidin in this study may be due to the narrow range in observed 25(OH)D values and warrants additional studies for further observation

Risk Factors for Sudden Infant Death in North Carolina

Background: Sudden infant death syndrome (SIDS) is the sudden, unexplained death of infants <1 year old. SIDS remains a leading cause of death in US infants. We aim to identify associations between SIDS and race/ethnicity, birth weight/gestational age, and socioeconomic/environmental factors in North Carolina (NC) to help identify infants at risk for SIDS. Methods and Results: In this IRB-approved study, infant mortality 2007–2016 and death certificate-linked natality 2007–2014 were obtained from the NC Department of Health and Human Services. General, NC natality statistics 2007–2016 were obtained from CDC Wonder. Association between SIDS/total infant death and covariates (below) were calculated. Total infant mortality decreased 2007–2016 by an average of 14 deaths/100,000 live births per year, while SIDS incidence remained constant. Risk ratios of SIDS/total infant deaths, standardized to Non-Hispanic White, were 1.76/2.41 for Non-Hispanic Black and 0.49/0.97 for Hispanic infants. Increased SIDS risk was significantly and independently associated with male infant sex, Non-Hispanic Black maternal race/ethnicity, young maternal age, low prenatal care, gestational age <39 weeks, birthweight <2500 g, low maternal education, and maternal tobacco use (p < 0.01). Maternal previous children now deceased also trended toward association with increased SIDS risk. Conclusions: A thorough SIDS risk assessment should include maternal, socioeconomic, and environmental risk factors as these are associated with SIDS in our population

Multivariable Linear Regression Models Assessing Factors Associated with Natural Logarithm for Cathelicidin.

<p>Multivariable Linear Regression Models Assessing Factors Associated with Natural Logarithm for Cathelicidin.</p

Bivariate Analysis between Cathelicidin and Categorical Variables.

<p>Bivariate Analysis between Cathelicidin and Categorical Variables.</p

Change of Cathelicidin Concentration over Time.

<p>In a subset of 40 children with two consecutive visits roughly twelve months apart, the median increase in cathelicidin concentration from the first visit to the second visit was 24.0 ng/mL (ranging from -1.9 ng/mL to +223.4ng/mL, p≤0.0001); ρ value represents Spearman correlation. The upper and lower edges of the box represent the 75^th percentile and the 25^th percentile of cathelicidin concentration, respectively, reported in ng/mL.</p

Child Sociodemographics and Clinical Characteristics.

<p>Child Sociodemographics and Clinical Characteristics.</p

Cathelicidin Concentration by Age.

<p>There was a significant positive correlation between age and cathelicidin concentration (ρ = 0.236, p = 0.005); ρ value represents Spearman correlation. The upper and lower edges of the box represent the 75^th percentile and the 25^th percentile of cathelicidin concentration, respectively, measured by ELISA and reported in ng/mL.</p