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ImportanceThe American Heart Association put forth the Life’s Essential 8 construct to assess cardiovascular health (CVH) based on 8 behavioral and health factors. Few studies have characterized the natural history of CVH in early life or identified its sociodemographic determinants.ObjectiveTo characterize CVH trajectories across childhood and adolescence and identify associations with sociodemographic variables.Design, Setting, and ParticipantsThis study used data from the Project Viva prebirth cohort, an ongoing prospective prebirth cohort study conducted in a large multispecialty group practice in eastern Massachusetts among women who were pregnant and enrolled from April 1999 to November 2002. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 metrics or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Of 2218 live births in the original cohort, 1523 were included in the present analysis. Data were analyzed from June to December 2023.ExposuresChild sex, race, and ethnicity; maternal education; and household income.Main Outcomes and MeasuresCVH score (0-100 points) from early childhood to late adolescence, calculated as the unweighted average of all available CVH metrics at each life stage.ResultsAmong 1523 children, 782 (51.4%) were male; 53 (3.5%) were non-Hispanic Asian, 231 (15.2%) were non-Hispanic Black, 988 (65.0%) were non-Hispanic White, and 175 (11.5%) were non-Hispanic other. The mean (SD) CVH score was 82.6 (8.6) in early childhood, 84.1 (8.3) in midchildhood, 82.0 (9.8) in early adolescence, and 73.8 (11.5) in late adolescence. The estimated mean (SD) age of inflection when CVH score declined was 10.1 (0.7) years for male children and 10.0 (0.6) years for female children; the decline in CVH was associated with health behaviors rather than health factors. Male children (vs female children) had faster CVH score gain before the inflection (β, 0.79 points/year; 95% CI, 0.67 to 0.91) and faster CVH score decline after the inflection (β, −0.33 points/year; 95% CI, −0.44 to −0.22). Non-Hispanic Black children (β, 0.32 years; 95% CI, 0.20 to 0.43) and children of other non-Hispanic races (β, 0.16 years; 95% CI, 0.05 to 0.28) children had later timing of inflection compared with non-Hispanic White children. Children of mothers without (vs with) a college degree or with household income $70 000 per year or less (vs greater than $70 000/year) exhibited lower CVH trajectory throughout childhood. Children of mothers with some college education (vs a college degree) had later timing of inflection (β, 0.16 years; 95% CI, 0.07 to 0.26) and slower CVH score gain before the inflection (β, −0.24 points/year; 95% CI, −0.40 to −0.08).ConclusionsThis study provides insight into the trajectory of CVH early in life, which may contribute to CVH disparities in adulthood, and identified modifiable health behaviors for focused prevention efforts to optimize CVH in early life.
ImportanceThe American Heart Association put forth the Life’s Essential 8 construct to assess cardiovascular health (CVH) based on 8 behavioral and health factors. Few studies have characterized the natural history of CVH in early life or identified its sociodemographic determinants.ObjectiveTo characterize CVH trajectories across childhood and adolescence and identify associations with sociodemographic variables.Design, Setting, and ParticipantsThis study used data from the Project Viva prebirth cohort, an ongoing prospective prebirth cohort study conducted in a large multispecialty group practice in eastern Massachusetts among women who were pregnant and enrolled from April 1999 to November 2002. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 metrics or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Of 2218 live births in the original cohort, 1523 were included in the present analysis. Data were analyzed from June to December 2023.ExposuresChild sex, race, and ethnicity; maternal education; and household income.Main Outcomes and MeasuresCVH score (0-100 points) from early childhood to late adolescence, calculated as the unweighted average of all available CVH metrics at each life stage.ResultsAmong 1523 children, 782 (51.4%) were male; 53 (3.5%) were non-Hispanic Asian, 231 (15.2%) were non-Hispanic Black, 988 (65.0%) were non-Hispanic White, and 175 (11.5%) were non-Hispanic other. The mean (SD) CVH score was 82.6 (8.6) in early childhood, 84.1 (8.3) in midchildhood, 82.0 (9.8) in early adolescence, and 73.8 (11.5) in late adolescence. The estimated mean (SD) age of inflection when CVH score declined was 10.1 (0.7) years for male children and 10.0 (0.6) years for female children; the decline in CVH was associated with health behaviors rather than health factors. Male children (vs female children) had faster CVH score gain before the inflection (β, 0.79 points/year; 95% CI, 0.67 to 0.91) and faster CVH score decline after the inflection (β, −0.33 points/year; 95% CI, −0.44 to −0.22). Non-Hispanic Black children (β, 0.32 years; 95% CI, 0.20 to 0.43) and children of other non-Hispanic races (β, 0.16 years; 95% CI, 0.05 to 0.28) children had later timing of inflection compared with non-Hispanic White children. Children of mothers without (vs with) a college degree or with household income $70 000 per year or less (vs greater than $70 000/year) exhibited lower CVH trajectory throughout childhood. Children of mothers with some college education (vs a college degree) had later timing of inflection (β, 0.16 years; 95% CI, 0.07 to 0.26) and slower CVH score gain before the inflection (β, −0.24 points/year; 95% CI, −0.40 to −0.08).ConclusionsThis study provides insight into the trajectory of CVH early in life, which may contribute to CVH disparities in adulthood, and identified modifiable health behaviors for focused prevention efforts to optimize CVH in early life.
Children today are growing up in a world that feels increasingly polarized and at risk from natural and manufactured threats, such as poverty, pandemics, war, and climate change. They face increasing mortality rates in 44 of 50 states. 1 Many children live in neighborhoods with limited access to healthy foods and associated higher rates of obesity. 2 All live on a planet where hotter temperatures are linked to adverse health outcomes. 3 When daily news feels like a litany of pessimism, science offers the agency to identify problems and the optimism to test solutions. Research can contribute to positive policy change by providing rigorous evidence to guide decision-making. In this spirit, JAMA Pediatrics has published timely research under the "Health and the 2024 US Election" theme. 4 As was done for the 2020 election 5 and in conjunction with other JAMA Network journals, 6 we have assembled 23 articles describing empirical studies on topics highly relevant to the issues being debated across the US in the 2024 election.This collection of articles alerts policymakers about how children are affected by the issues at stake in this election. Children are caught up in the intersection of the migrant crisis and the lack of affordable housing. Roche and colleagues 7 call attention to adverse outcomes related to adolescent Latinx mental health and parent-child stress associated with family member detention or deportation. Lebrun-Harris and colleagues 8 demonstrate that 17% of children have experienced unstable housing, with higher rates in racial and ethnic minoritized populations and associated with challenges affording health care and experiencing food insufficiency and unsafe neighborhoods. McQuillan and colleagues 9 demonstrate challenges in the school environment for transgender students, with higher rates of reporting bullying, skipping school due to not feeling safe, anxiety, depression, and self-harming behaviors compared to their cisgender peers.Several articles on firearms provide direction on where to target injury prevention and policy efforts. Firearm injuries were the leading cause of death in 25 states and were among the top 2 causes in 42 states, 1 and firearm suicides accounted for more than half of firearm deaths in 19 states for children aged 10 to 19 years. 10 Nearly half of parents reported demonstrating proper firearms handling, but were also more likely to store a gun unlocked and loaded, suggesting a need to focus on safe storage. 11 Providing evidence to enable access to reproductive health care is even more crucial in the current post-Dobbs v Jackson Multimedia Opinion EDITORIAL jamapediatrics.com
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