Child height and intergenerational transmission of health: Evidence from ethnic Indians in England

A large literature documents a widespread prevalence of small stature among Indian children as well as adults. We show that a height gap relative to a richer population such as whites in England also exists, although substantially reduced, among adult immigrants of Indian ethnicity in England. This is despite positive height selection into migration, demonstrated by ethnic Indian adults in England being on average 6–7 cm taller than in India. However, the difference between natives and ethnic Indians in England disappears among their younger sons and daughters, although it re-appears among adolescents. We estimate that, conditional on age, gender and parental height, ethnic Indian children of age 2–4 in England are 6–8% taller than in India. Such degree of catch up in one generation is remarkable, also because in England children of ethnic Indians have much smaller birthweight than whites, by about 0.4 kg on average.     

American Indians with African Ancestry: Differential Fertility and the Complexities of Social Identity

Interethnic marriage represents a major trend in the demographic history of American Indians. While the majority of these unions involved Indian women and Caucasian men, a sizeable number occurred between Indians and African Americans. The children of these bicultural marriages were “mixed bloods” who in turn typically married non-Indians or other mixed bloods. Using data from the 1910 Census on American Indians in the United States and Alaska, this article explores why American Indians with African ancestry enjoyed high fertility. Differential rates of fertility among American Indians in the past were due to a number of underlying genetic, cultural, and environmental factors. By identifying these factors, the paradox of why Indian women with African heritage did so well in terms of fertility largely disappears. African admixture, however, greatly complicates Indian social identity.     

The language skills of New Zealand Polynesian children: From deficiency to diversity

The American Indian and Alaskan Native population has grown rapidly since 1950 because of changes in the racial classification of persons with mixed Indian and non‐Indian descent. These changes have challenged once common expectations that the Indian population was likely to shrink over time through assimilation. However, in regions of the United States where the recent growth of the Indian population has been particularly sharp most married Indians are married to non‐Indians. Fertility rates of women who are part of intermarried couples are lower than fertility rates for Indian women in racially endogamous marriages. The majority of the children of intermarried Indians in high intermarriage regions are labelled with the race of the non‐Indian parent. Intermarriage is likely to substantially reduce the long‐run impact of changes in identification on the future growth of the Indian population. At the same time, in a few states the American Indian population remains ethnically homogenous and shows no signs of imminent amalgamation into the general American population.     

National survey of notifications of tuberculosis in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit.

In a survey of all notifications of tuberculosis in England and Wales for the first six months of 1983 56% of the 3002 newly notified patients who had not been treated before were of white and 37% were of Indian subcontinent (Indian, Pakistani, or Bangladeshi) ethnic origin, findings similar to those of a survey in 1978-9. In the four and a quarter years between the surveys the number of patients notified had declined by 26%, the decline being 28% among those of white and 23% among those of Indian subcontinent ethnic origin. The white patients were on average older than the patients of Indian subcontinent ethnic origin, and a higher proportion of them had respiratory disease (82% compared with 66%). The pulmonary lesions were on average larger and more often bacteriologically positive in the white patients. There were considerable differences between the ethnic groups in the estimated yearly rates of notifications per 100 000 population in England in 1983. The highest rates occurred in the Indian (178) and the Pakistani and Bangladeshi (169) populations and were roughly 25 times the rate in the white population (6 X 9). In the Indian subcontinent ethnic groups the highest rates occurred among those who had arrived in the United Kingdom within the previous five years.     

Indian time for nature? A multi-level approach to American Indian outdoor time in everyday life

Social scientists have utilized daily time use studies as one method of understanding everyday lives. The bulk of this research, usually quantitative, identifies broad racial, ethnic and gender differences. Yet, certain groups and questions are typically excluded in daily time use research. One such group is American Indians. To address this lacuna, we look at the deeply discussed view that American Indians are closer to nature than other US ethnic groups. We use a nationally representative sample of individual daily time use (American Time Use Survey; n?=?136,960) to look at leisure time outdoors. Our results show that American Indians report greater time spent outdoors but that this is only statistically significant for those who identify as exclusively American Indian (not for American Indians that are multi- and bi-racial). This study confirms previous qualitative research that suggests American Indians have a distinct relationship with nature.     

Child growth and adult physique in Brazillan Xingu Indians

Data on stature, sitting height, biacromial width, and some other body measurements on 267 children and 363 adults of the Xingu Indians of Brazil have been analyzed. Adult height shows no significant decrease with age over an age range of 20–50 years, thus indicating the absence of secular changes. The average Xingu child seems to be around the twenty-fifth to fiftieth centile for height of British children (if our age estimates are correct) until about ten years in girls and 14 years in boys, but ends at below the third British centile as an adult. In sitting height, however, the Indians show substantially lower values, with children being at about the fifteenth centile until ten years in girls and 14 years in boys, while the adults are considerably below the British third centile. Other comparisons show that the Xingu are taller than Surinam Indians although of similar shoulder width. The lack of anthropometric data concerning South American Indian adults, and more especially children has been stressed. Investigations of these populations facing rapid acculturation and possible assimilation will form a baseline for the future work in public health as contacts with non-Indians increase.     

Burden of Severe Pneumonia,Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3–3.9 million) episodes of severe pneumonia and 0.35 million (0.31–0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49–0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92–119 thousand) pneumococcal deaths occurred in India. The top contributors to India’s pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the need to improve access to care and increase coverage and equity of pneumonia preventing vaccines in states with high pneumonia burden.     

Screening children from overseas for infections: is it justified?

OBJECTIVES--To investigate current practice of screening children from abroad for infections after coming to the United Kingdom, and to make recommendations for future practice. DESIGN--A review of literature and a questionnaire sent to all health authorities and boards in the United Kingdom. SETTING--All health authorities and boards in the United Kingdom. SUBJECTS--167 Health authorities or boards that completed questionnaires (response rate 80%), 59 of which used a screening programme. MAIN OUTCOME MEASURE--Response to questionnaire on policies for screening children for infections on their return from overseas. RESULTS--12 Of the 59 authorities screened all children and one screened only those from the West Indian subcontinent. 13 Authorities excluded children from school while awaiting results; 58 screened for tuberculosis and four for diphtheria. CONCLUSIONS--There is a wide variation in screening policies around the country with no national consensus. Screening for diphtheria, typhoid, and salmonellosis is hard to justify and is probably not effective. Screening for tuberculosis, however, is supported by many authorities, is widely practised, and probably is effective. There is a strong case for rationalisation of screening.     

Audit of prenatal diagnosis for haemoglobin disorders in the United Kingdom: the first 20 years.

OBJECTIVES: To audit services for prenatal diagnosis for haemoglobin disorders in the United Kingdom. DESIGN: Comparison of the annual number of cases recorded in a United Kingdom register of prenatal diagnoses for haemoglobin disorders, with the annual number of pregnancies at risk of these disorders, by ethnic group and regional health authority. The number of pregnancies at risk was estimated using data on ethnic group from the 1991 census and data from the United Kingdom thalassaemia register, which records the number of babies born with thalassaemia. SETTING: The three national prenatal diagnosis centres for haemoglobin disorders. SUBJECTS: 2068 cases of prenatal diagnosis for haemoglobin disorders in the United Kingdom from 1974 to 1994. MAIN OUTCOME MEASURES: Utilisation of prenatal diagnosis by risk, ethnic group, and regional health authority. Proportion of referrals in the first trimester and before the birth of any affected child. RESULTS: National utilisation of prenatal diagnosis for haemoglobin disorders was around 20%. During the past 10 years it has remained steady at about 50% for thalassaemias and risen from 7% to 13% for sickle cell disorders. Utilisation for sickle cell disorders varies regionally from 2% to 20%. Utilisation for thalassaemias varies by ethnic group. It is almost 90% for Cypriots and ranges regionally for British Pakistanis from 0% to over 60%. About 60% of first prenatal diagnoses are done for couples without an affected child. Less than 50% of first referrals are in the first trimester. CONCLUSIONS: National utilisation of prenatal diagnosis for haemoglobin disorders is far lower than expected, and there are wide regional variations. A high proportion of referrals are still in the second trimester and after the birth of an affected child. The findings point to serious shortcomings in present antenatal screening practice and in local screening policies and to inadequate counselling resources, especially for British Pakistanis.     

Living standards in Black and White: Evidence from the heights of Ohio Prison inmates, 1829–1913

The use of height data to measure living standards is now a well-established method in the economic history literature. Moreover, a number of core findings are widely agreed upon. There are still some populations, places, and times, however, for which anthropometric evidence remains limited. One such example is 19th century African-Americans in the Northern US. Here, we use new data from the Ohio state prison to track heights of Black and White men incarcerated between 1829 and 1913. We corroborate the well-known mid-century height decline among White men. We find that Black men were shorter than White men, throughout the century controlling for a number of characteristics. We also find a pattern of height decline among Black men in mid-century similar to that found for White men.     

The Global Epidemiology and Contribution of Cannabis Use and Dependence to the Global Burden of Disease: Results from the GBD 2010 Study

AimsEstimate the prevalence of cannabis dependence and its contribution to the global burden of disease.MethodsSystematic reviews of epidemiological data on cannabis dependence (1990-2008) were conducted in line with PRISMA and meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Culling and data extraction followed protocols, with cross-checking and consistency checks. DisMod-MR, the latest version of generic disease modelling system, redesigned as a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. The disability weight associated with cannabis dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs) and disability-adjusted life years (DALYs). YLDs and DALYs attributed to regular cannabis use as a risk factor for schizophrenia were also estimated.ResultsThere were an estimated 13.1 million cannabis dependent people globally in 2010 (point prevalence0.19% (95% uncertainty: 0.17-0.21%)). Prevalence peaked between 20-24 yrs, was higher in males (0.23% (0.2-0.27%)) than females (0.14% (0.12-0.16%)) and in high income regions. Cannabis dependence accounted for 2 million DALYs globally (0.08%; 0.05-0.12%) in 2010; a 22% increase in crude DALYs since 1990 largely due to population growth. Countries with statistically higher age-standardised DALY rates included the United States, Canada, Australia, New Zealand and Western European countries such as the United Kingdom; those with lower DALY rates were from Sub-Saharan Africa-West and Latin America. Regular cannabis use as a risk factor for schizophrenia accounted for an estimated 7,000 DALYs globally.ConclusionCannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.     

Estimating the Number of Paediatric Fevers Associated with Malaria Infection Presenting to Africa's Public Health Sector in 2007

Background

As international efforts to increase the coverage of artemisinin-based combination therapy in public health sectors gather pace, concerns have been raised regarding their continued indiscriminate presumptive use for treating all childhood fevers. The availability of rapid-diagnostic tests to support practical and reliable parasitological diagnosis provides an opportunity to improve the rational treatment of febrile children across Africa. However, the cost effectiveness of diagnosis-based treatment polices will depend on the presumed numbers of fevers harbouring infection. Here we compute the number of fevers likely to present to public health facilities in Africa and the estimated number of these fevers likely to be infected with Plasmodium falciparum malaria parasites.

Methods and Findings

We assembled first administrative-unit level data on paediatric fever prevalence, treatment-seeking rates, and child populations. These data were combined in a geographical information system model that also incorporated an adjustment procedure for urban versus rural areas to produce spatially distributed estimates of fever burden amongst African children and the subset likely to present to public sector clinics. A second data assembly was used to estimate plausible ranges for the proportion of paediatric fevers seen at clinics positive for P. falciparum in different endemicity settings. We estimated that, of the 656 million fevers in African 0–4 y olds in 2007, 182 million (28%) were likely to have sought treatment in a public sector clinic of which 78 million (43%) were likely to have been infected with P. falciparum (range 60–103 million).

Conclusions

Spatial estimates of childhood fevers and care-seeking rates can be combined with a relational risk model of infection prevalence in the community to estimate the degree of parasitemia in those fevers reaching public health facilities. This quantification provides an important baseline comparison of malarial and nonmalarial fevers in different endemicity settings that can contribute to ongoing scientific and policy debates about optimum clinical and financial strategies for the introduction of new diagnostics. These models are made publicly available with the publication of this paper. Please see later in the article for the Editors'' Summary     

Childhood Overweight Prevalence in the United States: The Impact of Parent‐reported Height and Weight

Parent‐reported height and weight are often used to estimate BMI and overweight status among children. The quality of parent‐reported data has not been compared to measured data on a national scale for all race/ethnic groups in the United States. Parent‐reported height and weight for 2–17‐year‐old children in two national health interview surveys—the 1999–2004 National Health Interview Survey (NHIS) and the 2003–2004 National Survey of Children's Health (NSCH)—were compared to measured values from a national examination survey—the 1999–2004 National Health and Nutrition Examination Survey (NHANES). Compared to measured data, parent‐reported data overestimated childhood overweight in both interview surveys. For example, overweight prevalence among 2–17‐year‐olds was 25% (s.e. 0.2) using parent‐reported NHIS data vs. 16% (s.e. 0.6) using measured NHANES data. Parent‐reported data overestimated overweight among younger children, but underestimated overweight among older children. The discrepancy between reported and measured estimates arose mainly from reported height among very young children. For children aged 2–11 years, the mean reported height from NHIS was 3–6 cm less than mean measured height from NHANES (P < 0.001) vs. no difference among children aged 16–17 years. Measured data remains the gold standard for surveillance of childhood overweight. Although this analysis compared mean values from survey populations rather than parent‐reported and measured data for individuals, the results from nationally representative data reinforce previous recommendations based on small samples that parent‐reported data should not be used to estimate overweight prevalence among preschool and elementary school–aged children.     

American Indians without tribes in the twenty-first century

Among American Indians and Alaska Natives, most aspects of ethnicity are tightly associated with the person's tribal origins. Language, history, foods, land and traditions differ among the hundreds of tribes indigenous to the USA. With this in mind, we ask why almost one million American Indians failed to respond to the tribal affiliation part of the Census 2000 race question. We investigate four hypotheses about why one-third of multiracial American Indians and one-sixth of single-race American Indians did not write any response to the tribal affiliation question: (1) survey item non-response that undermines all fill-in-the-blank questions; (2) a non-salient tribal identity; (3) a genealogy-based affiliation; and (4) a mestizo identity, which does not require a tribe. We use multivariate logistic regression models and high-density restricted-use Census 2000 data. We find support for the first two hypotheses and note that predictors differ substantially for single-race versus multiple-race American Indians.     

Clinical standards for growth in height of Belgian boys and girls,aged 2 to 18 years

The present paper presents the first clinical standard for growth in height of Belgian boys and girls, based on purely longitudinal data. Growth charts are provided with centiles of height for age along with growth curves of the typical early, average and late maturing child in the population. These new standards show the classical features of cross-sectional standards, but above that, they also provide information about the variability in individual growth patterns, as a result of variation in maturation. Average adult height is 176.6 cm (SD=6.3 cm) in boys and 163.3 cm (SD=5.7 cm) in girls. The representativity of these new standards with respect to the actual Belgian population has been by comparison with recent cross-sectional data, collected on a large number of subjects. These standards should be applied in all situations where interest lies in the evaluation of the normality of a child's growth pattern over some length of time and will therefore find their usefulness in clinical follow-up studies of growth.     

Clinical standards for growth velocity in height of Belgian boys and girls,aged 2 to 18 years

The present paper presents the first clinical standards for growth velocity in height of Belgian boys and girls, based on purely longitudinal data. Growth charts are provided with centiles of height for age, along with the growth velocity curves of the typical early, average and late maturing child in the population. These new growth velocity standards provide centile lines which allow to judge whether a child's growth velocity over a one-year interval lies within the limits of normal variation for his age, irrespective of his stage of maturation. They also provide information about variability in the individual patterns of growth velocity in the population and can, as such, also be used to evaluate the normality of a child's pattern in growth velocity over a longer period of time. Age at peak velocity occured in 95% of the children within an age range of about 4 years. The average age at peak height velocity at puberty was 14.0 years (S.D.=1.0) in boys and 11.6 years (S.D.=0.9) in girls. Peak height velocity was in the average 9.1 cm/year (S.D.=1.4) in boys and 7.5 cm/year (S.D.=1.1) in girls. The representativity of these new standards with respect to the actual Belgian population was tested by comparison with recent cross-sectional data, collected on a large number of subjects. These new charts will find useful applications in longitudinal health screening surveys, and in clinical follow-up studies, where interest lies in the examination of a child's growth retardation in relation to some disease, or catch-up growth, as a response to subsequent medical treatment.     

Sudden infant death syndrome and postneonatal mortality in immigrants in England and Wales.

To examine ethnic differences in postneonatal mortality and the incidence of sudden infant death in England and Wales during 1982-5 records were analysed, the mother''s country of birth being used to determine ethnic group. Postneonatal mortality was highest in infants of mothers born in Pakistan (6.4/1000 live births) followed by infants of mothers born in the Caribbean (4.5) and the United Kingdom and Republic of Ireland (4.1). Crude rates were lower in infants of mothers born in India (3.9/1000), east and west Africa (3.0), and Bangladesh (2.8) than in infants of mothers born in the United Kingdom despite less favourable birth weights. Mortality ratios standardised separately for maternal age, parity, and social class were significantly higher in infants of mothers born in Pakistan and lower in those of mothers born in Bangladesh. The ratio for infants of Caribbean mothers was significantly higher when adjusted for maternal age. Ratios for infants of Indian and east African mothers did not show significant differences after standardisation. An important finding was a low incidence of sudden infant death in infants of Asian origin. This was paralleled by lower mortality from respiratory causes. During 1975-85 postneonatal mortality in all immigrant groups except Pakistanis fell to a similar or lower rate than that in the United Kingdom group; Pakistanis showed a persistent excess. During 1984-5 several immigrant groups (from the Republic of Ireland, India, west Africa, and the Caribbean) recorded an increase in postneonatal mortality. Surveillance of postneonatal mortality among ethnic communities should be continued, and research is needed to identify the causes underlying the differences.     

Serological testing versus other strategies for diagnosis of active tuberculosis in India: a cost-effectiveness analysis

Background

Undiagnosed and misdiagnosed tuberculosis (TB) drives the epidemic in India. Serological (antibody detection) TB tests are not recommended by any agency, but widely used in many countries, including the Indian private sector. The cost and impact of using serology compared with other diagnostic techniques is unknown.

Methods and Findings

Taking a patient cohort conservatively equal to the annual number of serological tests done in India (1.5 million adults suspected of having active TB), we used decision analysis to estimate costs and effectiveness of sputum smear microscopy (US$3.62 for two smears), microscopy plus automated liquid culture (mycobacterium growth indicator tube [MGIT], US$20/test), and serological testing (anda-tb ELISA, US$20/test). Data on test accuracy and costs were obtained from published literature. We adopted the perspective of the Indian TB control sector and an analysis frame of 1 year. Our primary outcome was the incremental cost per disability-adjusted life year (DALY) averted. We performed one-way sensitivity analysis on all model parameters, with multiway sensitivity analysis on variables to which the model was most sensitive.If used instead of sputum microscopy, serology generated an estimated 14,000 more TB diagnoses, but also 121,000 more false-positive diagnoses, 102,000 fewer DALYs averted, and 32,000 more secondary TB cases than microscopy, at approximately four times the incremental cost (US$47.5 million versus US$11.9 million). When added to high-quality sputum smears, MGIT culture was estimated to avert 130,000 incremental DALYs at an incremental cost of US$213 per DALY averted. Serology was dominated by (i.e., more costly and less effective than) MGIT culture and remained less economically favorable than sputum smear or TB culture in one-way and multiway sensitivity analyses.

Conclusions

In India, sputum smear microscopy remains the most cost-effective diagnostic test available for active TB; efforts to increase access to quality-assured microscopy should take priority. In areas where high-quality microscopy exists and resources are sufficient, MGIT culture is more cost-effective than serology as an additional diagnostic test for TB. These data informed a recently published World Health Organization policy statement against serological tests. Please see later in the article for the Editors'' Summary     

Independent Association of Hip Circumference with Metabolic Profile in Different Ethnic Groups

Objective: In whites, a larger hip circumference has been shown to be associated with a better metabolic profile, after adjustment for BMI and waist circumference. Our aim was to investigate this association in a variety of ethnic groups, some highly susceptible to type 2 diabetes. Research Methods and Procedures: We measured weight, height, waist and hip circumferences, systolic and diastolic blood pressure, fasting and 2‐hour postload glucose, triglycerides, and high‐density lipoprotein‐cholesterol in 1020 Melanesians, 767 Micronesians, 3697 Indians, and 2710 Creoles from Pacific and Indian Ocean islands. Leptin and body fat percentage were determined in Indian and Creole Mauritians only. Results: In all ethnic groups, larger hip circumference was associated with lower glucose and triglyceride levels in both sexes and higher high‐density lipoprotein levels in women only, after adjustment for waist circumference, BMI, and age. Adjustment for height or leptin did not materially change the results. Discussion: In conclusion, we confirmed the protective association of relatively larger hips in four nonwhite ethnic groups. Leptin does not seem to play a mediating role in this association.     

Ethnic and racial differences on the Standard Progressive Matrices in Mexico

Raven's Standard Progressive Matrices test was administered to a representative sample of 920 white, Mestizo and Native Mexican Indian children aged 7-10 years in Mexico. The mean IQs in relation to a British mean of 100 obtained from the 1979 British standardization sample and adjusted for the estimated subsequent increase were: 98.0 for whites, 94.3 for Mestizos and 83.3 for Native Mexican Indians.