Howard Hoffman

Patients with vestibular disease have been observed to have concomitant cognitive and psychiatric dysfunction. We evaluated the association between vestibular vertigo, cognitive impairment and psychiatric conditions in a nationally representative sample of US adults. We performed a cross-sectional analysis using the 2008 National Health Interview Survey (NHIS), which included a Balance and Dizziness Supplement, and questions about cognitive function and psychiatric comorbidity. We evaluated the association between vestibular vertigo, cognitive impairment (memory loss, difficulty concentrating, confusion) and psychiatric diagnoses (depression, anxiety and panic disorder). We observed an 8.4% 1-year prevalence of vestibular vertigo among US adults. In adjusted analyses, individuals with vestibular vertigo had an eightfold increased odds of 'serious difficulty concentrating or remembering' (OR 8.3, 95% CI 4.8 to 14.6) and a fourfold increased odds of activity limitation due to ...

The aim of the study was to compare the frequency-specific effects of noise on hearing acuity across the range 250-8000 Hz and the extent to which the patterns of frequency-specific threshold shifts differ between occupational noise and impulse noise. Pure-tone audiometry was administered to an adult general population sample with 51 975 subjects who also provided questionnaire information about noise exposure and other risk factors. Threshold shifts induced by life-long occupational noise and impulse noise (mostly shooting) were estimated separately in six age and sex groups for eight frequencies. Reported noise exposure, as well as observed threshold shifts, were moderate among women. Threshold shifts averaged over both ears among subjects in the higher 2% of exposure to occupational noise, reached 13 dB (3000 Hz, age 65 years + ) among men and were generally largest at 3000-4000 Hz. The shifts induced by impulse noise reached approximately 8 dB among men 45-64 years and men 65 ye...

Hearing impairment is common in adults, but few studies have addressed it in the US Hispanic/Latino population. To determine the prevalence of hearing impairment among US Hispanic/Latino adults of diverse backgrounds and determine associations with potential risk factors. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a population-based sample of Hispanics/Latinos in four US communities (Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California). Examinations were conducted from 2008 through 2011. The HCHS/SOL examined 16 415 self-identified Hispanic/Latino persons aged 18 to 74 years recruited from randomly selected households using a stratified 2-stage area probability sample design based on census block groups and households within block groups. Hearing thresholds were measured by pure-tone audiometry. Hearing impairment was defined as a pure-tone average (PTA) of thresholds at 0.5, 1, 2, and 4 kHz greater than 25 dB hearing level. Bilatera...

Background: Previous studies have shown that breastfeeding is associated with significant reductions in the risk of common infections among infants in developed countries; however, whether breastfeeding confers longer-term protection against infections is unknown. Methods: We linked data from the 2005-2006 Infant Feeding Practices Study-II and 2012 follow-up data collected when children were 6 years old. We used multivariate logistic regression, controlling for sociodemographics, to examine associations of any and exclusive breastfeeding duration and breastmilk intensity (categorized by tertiles of the percentage of milk feedings being breastmilk from age 0-6 months) with maternal reports of past-year infection (ear, sinus, throat, pneumonia/lung, urinary, cold/upper respiratory) among the 6-year-old children. Results: Among 1,292 respondents with complete data, the most common past-year infections at age 6 years were colds/upper respiratory (66%), ear (25%), and throat (24%) infect...

Previous studies have shown that breastfeeding is associated with reductions in the risk of common infections among infants; however, whether breastfeeding confers longer term protection is inconclusive. We linked data from the 2005-2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old. Multivariable logistic regression was used, controlling for sociodemographic variables, to examine associations of initiation, duration, exclusivity of breastfeeding, timing of supplementing breastfeeding with formula, and breast milk intensity (proportion of milk feedings that were breast milk from age 0-6 months) with maternal reports of infection (cold/upper respiratory tract, ear, throat, sinus, pneumonia/lung, and urinary) and sick visits in the past year among 6-year-olds (N = 1281). The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between b...

Depression among hearing impaired US adults has not been studied previously. To estimate the prevalence of and risk factors for depression among adults with hearing loss. Adults aged 18 years or older (N = 18 318) who participated in the National Health and Nutrition Examination Survey (NHANES), 2005-2010, a nationally representative sample. Multistage probability sampling of US population. Depression, assessed by the 9-item Patient Health Questionnaire (PHQ-9) scale, and hearing impairment (HI), assessed by self-report and audiometric examination for adults aged 70 years or older. The prevalence of moderate to severe depression (PHQ-9 score, ≥10) was 4.9% for individuals reporting excellent hearing, 7.1% for those with good hearing, and 11.4% for participants who reported a little trouble or greater HI. Using excellent hearing as the reference, after adjusting for all covariates, multivariate odds ratios (ORs) for depression were 1.4 (95% CI, 1.1-1.8) for good hearing, 1.7 (1.3-2.2...

Rates of sudden infant death syndrome (SIDS) are over twice as high among African Americans compared with Caucasians. Little is known, however, about the relationship between prone sleeping, other sleep environment factors, and the risk of SIDS in the United States and how differences in risk factors may account for disparities in mortality. To assess the contribution of prone sleeping position and other potential risk factors to SIDS risk in a primarily high-risk, urban African American population. Case-control study consisting of 260 infants ages birth to 1 year who died of SIDS between November 1993 and April 1996. The control group consists of an equal number of infants matched on race, age, and birth weight. Prospectively collected data from the death scene investigation and a follow-up home interview for case infants were compared with equivalent questions for living control participants to identify risk factors for SIDS. Risk of SIDS related to prone sleeping position adjusting for potential confounding variables and other risk factors for SIDS, and comparisons by race-ethnicity. Three quarters of the SIDS infants were African American. There was more than a twofold increased risk of SIDS associated with being placed prone for last sleep compared with the nonprone positions (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.6-3.7). This OR increased after adjusting for potential confounding variables and other sleep environment factors (OR: 4.0; 95% CI: 1.8-8.8). Differences were found for African Americans compared with others (OR: 1.8; 95% CI: 1.2-2.6 and OR: 10.3, 95% CI: 10.3 [3.2-33.8, respectively]). The population attributable risk was 31%. Fewer case mothers (46%) than control mothers (64%) reported being advised about sleep position in the hospital after delivery. Of those advised, a similar proportion of case mothers as control mothers were incorrectly told or recalled being told to use the prone position, but prone was recommended in a higher proportion of black mothers (cases and controls combined) compared with nonblack mothers. Prone sleeping was found to be a significant risk factor for SIDS in this primarily African American urban sample, and approximately one third of the SIDS deaths could be attributed to this factor. Greater and more effective educational outreach must be extended to African American families and the health personnel serving them to reduce prone prevalence during sleep, which appears, in part, to contribute to the higher rates of SIDS among African American infants.

To examine the association of six indices of psychosocial well-being with low prenatal weight gain. Scales assessing depression, trait anxiety, stress, mastery, self-esteem, and social support were self-administered at mid-pregnancy to 536 black and 270 white low-income, nonobese, multiparous women who subsequently delivered at term. All women had one or more risk factors for fetal growth restriction. The association of individual scale scores with prenatal weight gain values below current Institute of Medicine guidelines was examined while controlling for sociodemographic and reproductive variables, and for time between last weight observation and delivery. None of the scales were associated with low gain among black women. Among white women, poor scores (worst quartile) on four of the scales were associated with increased adjusted odds ratios for low gain, including 2.5 for high trait anxiety, 3.0 for increased levels of depression, 3.9 for low mastery, and 7.2 for low self-esteem. When scale scores and weight gain were examined as continuous variables, poor scores on five of the six scales were associated with lower weight gain values among white women (scores on the stress scale were the exception). These data suggest an important role for psychosocial factors in the etiology of low prenatal weight gain among white women but show no such role for black women. Along with reports of wide inter-individual variability in the energy costs of pregnancy, these data also suggest that attempts to manipulate pregnancy weight gain through dietary means will meet with variable success until psychosocial and other factors affecting prenatal energy intake and/or utilization are further delineated.

To estimate the effect of maternal cigarette smoking on birth weight, crown-heel length, and ten other neonatal anthropometric measurements. Data are from a cohort study on risk factors for fetal growth retardation (FGR) in multiparous women conducted from December 1985 through October 1988. Information on smoking status was collected four times during pregnancy. Data analysis included 1205 singleton infants of women delivering at term. Neonatal anthropometric measurements were obtained within 48 hours of birth, including birth weight, crown-heel length, ponderal index, head and abdominal circumferences, arm length and circumference, femur length and thigh circumference, and triceps, thigh, and subscapular skinfold measurements. Analysis of covariance models were used to assess the independent effect of smoking on each neonatal measurement. Neonates born to women who reported smoking during the first trimester had a 0.6-1.9% reduction in most neonatal anthropometric measurements, resulting in an overall reduction of birth weight of 130 g (4%). Neonates born to women who continued to smoke throughout pregnancy had an average adjusted reduction in birth weight of 189 g (5.9%), compared with a 55 g (1.7%) reduction for neonates born to women who stopped smoking after the first trimester. For women who continued to smoke throughout pregnancy, an increased number of cigarettes smoked was associated with increased reductions in birth weight and neonatal chest and abdominal circumferences. For women who stopped smoking after the first trimester, stopping was a better predictor of neonatal anthropometric measurements than the number of cigarettes smoked early in pregnancy. Except for the ponderal index, all neonatal anthropometric measurements studied showed some negative effect of maternal cigarette smoking. Head circumference is the measurement least reduced. Smoking cessation is a better predictor of infant size than the number of cigarettes smoked in the first trimester.

Although a large body of evidence suggests that prenatal weight gain is an important determinant of fetal growth, 23 to 38 percent of nonobese women have low prenatal weight gain. Determination of potential risk factors for low gain is essential to develop targeted intervention programs. This study examined the association of maternal sociodemographic, lifestyle, and reproductive characteristics with the actual occurrence of low gain among 536 black and 270 white low-income, nonobese women. Sociodemographic, pregnancy wantedness, reproductive, and anthropometric data were obtained by interview during the first prenatal visit. A 72-item questionnaire, administered at 24 to 26 weeks' gestation, assessed residential and household characteristics, housing characteristics, income, transportation, physical activity, employment, and institutional support. Variables associated with low gain in bivariate analyses were included in logistic regression analysis to determine the adjusted odds ratios for low gain. Three characteristics were associated with increased adjusted odds ratios for low prenatal weight gain among black women: having a mistimed or unwanted pregnancy, caring for more than one preschool child at home, and not using own car for errands. One characteristic, working more than 40 hours per week when employed, was associated with low gain among white women. Although these preliminary findings require additional confirmation, they suggest that a variety of sociodemographic and lifestyle features deserve investigations that target the identification and characterization of risk factors for low prenatal weight gain.

Our purpose was to determine whether various demographic, behavioral, housing, psychosocial, or medical characteristics explain the difference in pregnancy outcome between black and white women. A sample of 1491 multiparous women with singleton pregnancies, 69% of whom were black and 31% of whom were white and who enrolled for care between Oct. 1, 1985, and March 30, 1988, participated in the study. The frequencies of various demographic, medical environmental, and psychosocial risk factors among black and white women were determined. The outcome measures were birth weight, gestational age, fetal growth restriction, preterm delivery and low birth weight. White infants were heavier and born later than black infants. The white women in this sample smoked more cigarettes, moved more frequently, and had worse psychosocial scores. The black women had lower incomes, were less likely to be married, and had more hypertension, anemia, and diabetes. Besides race, only maternal height, weight, blood pressure, diabetes, and smoking had a consistent impact on outcome and did not explain the difference in outcome between the two groups. In this low-income population, many of the risk factors for low birth weight were more common among white women than black women. Nevertheless, black women had more infants born preterm, with growth restriction, and with low birth weight than did white women. The various maternal characteristics studied did not explain these differences.

To assess the association between infant sleeping position and risk of sudden infant death syndrome (SIDS) in an ethnically diverse US population, the authors conducted a population-based case-control study in 11 counties in California from May 1997 through April 2000. The authors conducted in-person interviews with the mothers of 185 SIDS cases and 312 randomly selected race/ethnicity- and age-matched controls to collect information on sleeping positions. Infants who had last been put down to sleep in the prone or side position were at greater risk of SIDS than were infants who had last been put down on their backs (adjusted odds ratio (AOR) = 2.6 (95% confidence interval (CI): 1.5, 4.5) and AOR = 2.0 (95% CI: 1.2, 3.4) for the prone and side positions, respectively). The risk of SIDS was especially high for an unstable side position in which an infant was placed on its side and found prone (AOR = 8.7, 95% CI: 3.3, 22.7). Infants who were usually placed on their backs to sleep but had last been put down in the prone or side position (an unaccustomed position) had a significantly high risk of SIDS (AOR = 8.2 (95% CI: 2.6, 26.0) and AOR = 6.9 (95% CI: 2.3, 20.6) for the prone and side positions, respectively). Infants placed in an unaccustomed prone or side sleeping position had a higher risk of SIDS than infants who were always placed prone or on the side.

The study "Successive Small-for-Gestational Age Births" (SGA study) was initiated and is sponsored by the National Institutes of Health (N.I.H.) in the U.S.A. Its purpose is to describe and characterize the different types of intra-uterine growth retardation and their consequences, to assess the associated risk factors, and to provide a basis for preventive measures. Starting in 1986, it runs concurrently in Bergen and Trondheim (Norway), Uppsala (Sweden) and Birmingham, Alabama (U.S.A.), recruiting pregnant para 1 and 2 mothers at high risk of having an SGA birth and a random (control) sample of the total pregnant population. Data collection will end in late 1989, when the last-born children have reached 13 months of age. At the present symposium, investigators from all four study centers and the N.I.H. described the study design and discussed problems of methodology. Strict standardization of parameters to determine gestational age (ultrasound, menstrual dates) is a prerequisite for comparison of results over time and between study centers. Some preliminary results were presented.