Pediatric Behavioral
Epidemiology
Xinguang (Jim) Chen, MD, PhD
Pediatric Prevention Research Center
jimchen@med.wayne.edu
Behavior, Morbidity and Mortality
 Rates of disease morbidity and premature mortality
reflect people's behavioral practices (Healthy People 2010).
 Substance use: Tobacco, alcohol and illegal drugs
 HIV risk behaviors: Sexual risk, needle sharing,
 Physical activity: Overweight/obesity, mental health
 Eating behavior: Nutrition and metabolic syndrome
Why Epidemiology?
 To grasp a fuller picture of an issue (including, tobacco
exposure, asthma, obesity, leukemia, etc)
 To detect disease etiology at various levels, ranging from
molecular, genetic, to behavioral, environmental & social
 To take measures for health promotion and disease
prevention at group levels (e.g., tobacco control campaigns,
vaccination programs, etc)
 To understand mechanisms involved in behavioral change
(e.g., dynamic progression), disease spreading and disease
prevention (e.g., Herd immunity) via modeling analysis.
Geographic Distribution of Obese Children 3-5
Years Old from Low Income Families 2006-08
Data source: CDC Pediatric Nutrition Surveillance System (PedNSS)
Trends in the Prevalence of Obesity (BMI>95th
Percentile) in Pre-School Children (2-5 Years Old)
25.0
Prevalence rate (%)
22.5
20.0
Total
17.5
White
15.0
Black
12.5
Hispanic
10.0
7.5
5.0
2.5
0.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Data source: CDC Pediatric Nutrition Surveillance System (PedNSS)
Trends in the Prevalence of Obesity
(BMI≥30) among US Adults (20-39 Years Old)
45.0
Prevalence rate (%)
40.0
Total
(n>2000)
35.0
30.0
White
(n>900)
25.0
Black
(n=377-550)
20.0
15.0
Hispanic
(n=440-540)
10.0
5.0
0.0
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008
Created using data from: Flegal et al, JAMA, 2010, 303 (3): 325-241
Original data: The National Health and Nutrition Examination Survey (NHANES)
Changes in Smoking Behavior During Pregnancy
Among Smoking Mothers (N=160)
100.0
Daily smoking
90.0
Occassional smoking
80.0
Weekly smoking
Quit smoking
70.0
% Smoking
60.0
50.0
40.0
30.0
20.0
10.0
0.0
30 Days prior
1st trimester
2nd trimester
3rd trimester
Data source: Chen & Woodcroft, 2009, Nicotine and Tobacco Research, 11(3): 225-33
Polymorphic CYP2A6 and Changes in Maternal
Smoking Behavior During Pregnancy
90.0
80.0
Ever quit
Reduced smoking
70.0
63.2
Proportion (%)
59.4
59.2
60.0
54.5
50.0
40.0
68.7
56.7
45.5
43.3
40.8
32.8
40.6
31.3
30.0
20.0
10.0
0.0
TT(N=81)
TC/CC(N=77)
Total sample (N=158)
TT(N=70)
TC/CC( N=70)
African American (n=140)
Data source: Chen & Woodcroft, 2009, Nicotine and Tobacco Research, 11(3): 225-33
Questions and Answers
Thank You 