Scholarship & Creativity

Updated 10:00 AM October 1, 2007

Scholarship & Creativity

Studies: Unhealthy pressures cause childhood obesity

Unhealthy options and pressures influence nearly every part of children's daily lives, according to studies released in a special supplement of the American Journal of Preventative Medicine.

The national studies, which include work conducted at U-M, reveal that, in most middle and high schools across the nation, contracts with soft drink bottling companies give students easy access to sugary beverages.

Low- versus high-income neighborhoods have a higher proportion of their restaurants serving fast foods and have fewer supermarkets and more convenience stores at which to buy their groceries. In the media, television advertisements steer kids to spend their money on junk food, and minority students get considerably more such exposure, the studies show.

For the special supplement, Bridging the Gap, a national research program funded by the Robert Wood Johnson Foundation and based at U-M and the University of Illinois at Chicago, produced a groundbreaking collection of evidence on factors that contribute to the escalating rates of childhood obesity.

The studies offer new insight about how current school policies, neighborhood characteristics and advertising collectively impact the childhood obesity epidemic — and together create an overwhelmingly unhealthy environment for young people.

A study by U-M Distinguished Research Scientist Lloyd Johnston, research professor at the Institute for Social Research (ISR), and colleagues finds that the vast majority of middle schools (67 percent) and high schools (83 percent) have contracts with a soft drink bottling company, which in many cases gives students access to soft drinks all day long.

Estimates of the median annual revenue for soft drink contracts in high schools turn out to be $6,000 ($6.48 per student), while for middle schools the annual revenue is about $500 (70 cents per student).

The U-M studies also show evidence of unhealthy school nutrition policies and serious disparities across racial/ethnic lines and across different socioeconomic levels. An article by Jorge Delva, associate professor of social work, and colleagues documents the great extent to which children in school have access to high-fat, high- sugar and salty foods through vending machines and snack carts in schools.

Patrick M. O'Malley, research professor at ISR, and colleagues found that in the 10 percent of schools that have the least overweight students, one in 10 students are overweight, on average, whereas in the 10 percent of all schools with the greatest problem, fully 44 percent of their students are overweight, on average.
— Joe Serwach, News Service

Economic crisis in Cuba leads to better health

Cubans were less prone to heart disease and diabetes during the 1990s, when their country went through a prolonged economic crisis, a new study shows.

As in other nations, many people in Cuba have excess weight and live sedentary lifestyles, both risk factors for heart disease and diabetes. In 1989 Cuba entered a five-year economic crisis that dramatically reduced imports and caused shortages in the food-rationing system and public transportation. These conditions led to Cubans walking or riding a bike more often, eating less and smoking fewer cigarettes.

"The findings were surprising because, during the economic crisis, Cubans' health conditions dramatically improved and the mortality rates declined," says José Tapia Granados, the study's co-author and an adjunct assistant professor in the School of Social Work.

Researchers examined Cuban vital statistics and data from population surveys from 1980 to 2005 to determine the evolution of mortality before, during and after the severe economic crisis in the 1990s.

The crisis reduced the daily per-capita energy intake to 1,863 calories from nearly 2,900 calories. In addition, the lack of public transportation in Cuba meant residents had to find other means of traveling. The prevalence of physical exercise, which is defined as at least 30 minutes of moderate or intense activity at least five days per week, jumped to 67 percent from 30 percent, the research shows.

Food scarcity and increased energy expenditure from exercise made Cubans thinner, Tapia Granados says. The combined effect of reduced dietary energy intake and higher levels of physical activity helped many people who were obese or overweight to lose weight.

The annual per capita use of cigarettes also dropped, continuing a trend from 2,200 in 1980 to 1,200 in 1997.

The findings appear in the recent issue of the American Journal of Epidemiology. Manuel Franco and several other researchers at John Hopkins University, Loyola University, and the Hospital Universitario of Cienfuegos, Cuba also wrote the study.
— Jared Wadley, News Service

Most parents say they take part in kids' medical decisions

The majority of parents feel they play a significant role in making medical decisions for their child, according to researchers at C.S. Mott Children's Hospital.

In a new study published in the October issue of the Journal of Pediatrics, 86 percent of parents report that they participate in decisions made about their hospitalized child's medical care. Researchers also found that parents who feel confident communicating with physicians — as well as those parents whose child has been previously hospitalized — are more likely to participate in medical decisions.

The role of parents as participants in medical decisions may significantly affect the child's health, says study lead author Dr. Beth Tarini, clinical lecturer and member of the Child Health Evaluation Research (CHEAR) Unit in the Division of General Pediatrics at Mott. She notes that previous research has shown that in adult patients, shared decision-making — between patients and health care providers — improves health outcomes.

"Medical care has become more complex, and it behooves us to get parents more involved in that care," says Tarini. "Ultimately, parents are responsible for the care of their child once they leave the hospital. When parents feel informed and empowered, they're likely to be better prepared to care for their child."

For the study, Tarini and her colleagues surveyed parents of children admitted to the general pediatrics ward of a children's hospital in Seattle during a two-month period. All parents surveyed had children younger than 18, and were given the survey within 24 to 48 hours of admission to the hospital, after the parents had met with physicians and other medical staff to discuss their child's care.

The self-administered survey, available in English and Spanish, asked 130 parents general questions about their hospital experience in order to evaluate their participation in medical decision-making during their child's hospitalization.

The study revealed that parents' ability to make medical decisions about their children was strongly linked to self-efficacy, or confidence in their ability to interact and communicate with physicians.

"While this study is only the first step to learning more about parental participation in medical decisions, it is a reminder to physicians of the potential modifiability of parents' involvement in their child's medical care," says Tarini.
— Krista Hopson, UMHS Public Relations

Black Caribbeans do better in America than in England

Black Caribbeans living in America enjoy better health, higher incomes and less discrimination at work than both their English counterparts and black Americans, according to the first international comparative study of these populations.

The study, published this month online in the journal Sociology of Health and Illness, was led by sociologist James Nazroo of the University of Manchester, U.K., and social psychologist James Jackson, director of the Institute for Social Research (ISR).

For the study, Nazroo, Jackson and colleagues compared survey data from national probability samples of five groups: black, Caribbean and white Americans, and white and Caribbean English. In all, they analyzed data on approximately 20,000 individuals.

The surveys were independent, but similarly designed, allowing researchers to sort out how differences in health were affected by economic and cultural factors, and by migration experiences. The U.S. survey data are part of the National Survey of American Life, funded by the National Institute of Mental Health.

They found that Caribbeans in the United States were more than twice as likely as Caribbeans in England to say their health was good.

They also found that whites and Caribbeans in the United States had similar levels of good health whereas Caribbeans in England had much worse health than their white counterparts.

The team also found that Caribbean Americans are wealthier than their English counterparts, with an income profile close to that of white Americans. In addition, Caribbean Americans reported less discrimination at work than their English counterparts, although levels of experienced racial abuse were similar in the two countries.

According to Jackson, these differences can be at least partly explained by the different patterns of migration of Caribbeans to America and to England.

"Around 80 percent of the English Caribbean group came to the U.K. before the 1970s in a wave of migration driven by a shortage of labor after the war," he said. "On the other hand, over 80 percent of American Caribbeans migrated during and after the 1970s, just after the period when the U.S. civil rights movement had succeeded in opening up opportunities for black Americans."

A print edition of the journal will be published later this year. In addition to Nazroo and Jackson, co-authors of the article are Saffron Karlsen of University College London and Myriam Torres of ISR.
— Diane Swanbrow, News Service

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