This research suggests that prenatal characteristics, particularly race, ethnicity, maternal smoking during pregnancy, and maternal prepregnancy obesity, exert influence on the child's weight states through an early tendency toward overweight, which then is perpetuated as the child ages. These findings are intriguing as they provide additional clues to the genesis of childhood overweight and suggest that overweight prevention may need to begin before pregnancy and in early childhood.

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Objective To examine the association between maternal prepregnancy obesity and cognitive test scores of children at early primary school age. Methods A descriptive observational design was used. Study subjects consist of 3412 US children aged 60 to 83 months from the National Longitudinal Survey of Youth 1979 Mother and Child Survey. Cognitive test scores using the Peabody Individual Achievement Test reading recognition and mathematics tests were used as the outcomes of interest. Association with maternal prepregnancy obesity was examined using the ordinary least square regression controlling for intrauterine, family background, maternal and child factors. Results Children of obese women had 3 points (0.23 SD units) lower PIAT reading recognition score (p=0.007), and 2 points (0.16 SD units) lower PIAT mathematics scores (p<.0001), holding all other factors constant. As expected, cognitive test score was associated with stimulating home environment (reading: β=0.15, p<.0001, and math: β=0.15, p<.0001), household income (reading: β=0.03, p=0.02 and math: β=0.04, p=0.004), maternal education (reading: β=0.42, p=0.0005, and math: β=0.32, p=0.008), and maternal cognitive skills (reading: β=0.11, p<.0001, and math: β=0.09, p<.0001). Conclusion There was a significant association between maternal prepregnancy obesity and child cognitive test scores that could not be explained by other intrauterine, family background, maternal, and child factors. Children who live in disadvantaged postnatal environments may be most affected by the effects of maternal prepregnancy obesity. Replications of the current study using different cohorts are warranted to confirm the association between maternal prepregnancy obesity and child cognitive test scores.

The U.S. Public Health Service smoking cessation clinical practice guideline is the accepted gold standard for smoking cessation treatment. It offers evidence-based treatment recommendations for all clinicians to deliver to all patients at each visit. Despite the release of the guideline and the publication of Healthy People 2010, health care providers still may not appropriately counsel patients to quit smoking. Furthermore, disparities may exist among smokers who are assisted to quit smoking by their health care providers. The present study tested for an association between selected sociodemographic and tobacco-related factors and assistance to quit smoking. This 2001 National Health Interview Survey secondary analysis included a U.S. civilian, noninstitutionalized population. Participants were self-reported current smokers who visited a health care provider in the past 12 months and were at least 25 years old. The outcome measure was smokers' self-report of whether assistance to quit smoking was given by a health care provider. Of smokers who received advice (N = 3,046), only 38% received assistance to quit smoking. Smokers were less likely to report assistance to quit smoking if they were younger or Black, or if they had a high or middle level of socioeconomic disadvantage. In the final logistic regression model, being married, attempting to quit in the past 12 months, and consuming more tobacco were associated with receiving assistance to quit smoking. Increased age also was associated with receiving assistance, as was greater socioeconomic advantage (higher education, higher income, health insurance). The mechanisms responsible for the disparities in delivery of tobacco dependence treatment must be investigated further.

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Extensive literature suggests that adverse experiences in early childhood may deleteriously impact later health. These effects are thought to be related to the impact of persistent or chronic stress on various biological processes, mediated by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and ultimately irregularities in cortisol levels. Ameliorating persistent stress in young children requires accurately measuring the chronicity of physiologic stress, which is difficult in young children because of unreliable self-report and the burden and inaccuracy associated with using invasive acute-stress biomeasures. A better way to approximate persistent stress in young children is measuring hair cortisol concentration (HCC), as it only requires one noninvasive collection to measure months of HPA-axis activity or experienced stress. However, few studies measure HCC in young children despite wide use in adult stress research. This article reviews and synthesizes research that uses HCC to approximate persistent stress in healthy children, 12-60 months of age. Reviewed studies indicate that HCC is elevated in young children who are experiencing forms of persistent stress such as low socioeconomic status and maternal distress. Hair cortisol is thus a promising measure of early childhood persistent stress, but due to the limited use of HCC in this population, much research is still needed. Specifically, nurse researchers may need to measure several factors associated with early childhood persistent stress and HCC to identify which children are at risk for stress-related disease.

Inequalities in cigarette smoking prevalence exist, with smokers more likely to be poor and less educated. Higher socioeconomic status (SES) is associated with higher quit rates. The overall relationship between low SES and poor health, as measured by morbidity and mortality, is well established. However, research indicates that inequalities in health are not explained by SES alone; other variables, such as psychosocial factors, may play a significant role. Williams has developed a conceptual framework to examine relationships among SES, psychosocial factors, and medical care related to health outcomes. According to Williams, the interrelationships among these factors have yet to be determined. As such, the pathways among the variables within psychosocial factors are explored and the authors discuss application to public health nursing practice and areas for future research. Further understanding of these relationships in the context of smoking may inform prevention and cessation strategies.

Although this group of Medicaid patients with severe and persistent mental illness had access to providers, they received an unacceptably low level of preventive care. Use of health services for general medical problems differed somewhat by primary psychiatric illness.