During the past year we have done extensive analyses of the data from both the child and adult components of the NHANES surveys and have published several papers. We investigated 10,198 children aged 4 to 18 years old who participated in the 1999 to 2004 National Health and Nutrition Examination Surveys (NHANES) to determine the prevalence, socio-demographic correlates and comorbid medical conditions of recurrent headache in U.S. children. We found that frequent or severe headaches including migraine in the past 12 months were reported in 17% of children. Asthma, hay fever, and frequent ear infections were more common in children with headache, with at least 1 of these occurring in 42% of children with headache versus 25% of children free of headache. Other medical problems associated with childhood headaches include anemia, overweight, abdominal illnesses, and early menarche. The high frequency of recurrent headaches and their association with school absences suggest that headaches in U.S. youth have major public health significance (Lateef et al, 2009). We investigated prevalence and demographic correlates of diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) disorders (generalized anxiety disorder (GAD), panic, eating disorder, major depressive disorder/dysthymic disorder, attention deficit hyperactivity disorder (ADHD) and conduct disorders) in 3042 child and adolescents aged 8 to 15 years in NHANES 2001-2004 (Merikangas et al, in press). This provides the first nationally representative data on child mental health in the U.S. In order to assess the severity of these conditions, we have also calculated prevalence by four alternative impairment algorithms. These data provide the population estimates in children ages 8 through 15 in a national probability sample of the US, which is rarely available. A separate project set out to describe the prevalence, demographic correlates, comorbidity, and service patterns for nocturnal enuresis. There are no published nationally representative prevalence estimates of enuresis among children in the United States using standardized diagnostic criteria. Enuresis is a common condition among children in the United States (12-month prevalence of enuresis was 4%). The prevalence in boys (6%) was significantly greater than that in girls (3%). Enuresis was more common at younger ages and among black youth. ADHD was strongly associated with enuresis (odds ratio 2.88;95% confidence interval 1.26-6.57). About one-third families with enuretic children seek treatment for enuresis despite the potential for adverse effects on emotional health. We used NHANES 2001-2004 survey to examine ethnic differences in prevalence estimates of mental disorders;and patterns of service utilization among children and adolescents who have a mental disorder. Our results indicate that there were no ethnic differences in mental disorders and services. Household head place of birth largely explained any ethnic differences in mental disorders and services. Previous reported differences in mental disorders and services may be explained by demographic variables, such as age, gender, poverty, insurance status, and place of birth. The manuscript is in preparation. We are investigating the prevalence and correlates of sleep disorders, and are working on extensive analyses in this area. The NHANES includes questions regarding sleep apnea, insomnia, and restless leg syndrome specifically as well as other questions regarding sleep patterns and problems. We are analyzing the prevalence of each of these disorders by various demographic correlates, and are also examining the comorbidity with major depression and other physical illnesses and disorders. Additionally, we are interested in examining biomarkers that may be related to these sleep disorders. We are currently in the analytic stage, although preliminary findings have been presented in a poster. This will be the first nationally representative prevalence estimates published from a large-scale study on sleep disorders, and the design of the NHANES provides a wealth of correlates that have not been examined in sleep disorders at the community level. A better understanding of the prevalence of sleep disorders will help us understand the public health impact of these disorders, and our analyses of the comorbidity and biomarkers are a significant step towards understanding the biologic mechanisms of sleep, sleep disorders, and associated conditions. To understand the association between severe/recurrent headache and a range of cardiovascular and immunologic measures in the adult U.S. population, we used NHANES 1999-2004 surveys data including 14,503 adults and found that the major laboratory correlates of cardiovascular disease assessed in the NHANES including C-reactive protein, folate, homocysteine and HDL cholesterol differed among those with severe headaches/migraine compared to their non-headache counterparts. Moreover, people with severe headaches or migraine were more likely to have high BMI and diastolic blood pressure. These findings suggest that inflammatory mechanisms may play an important role in the pathophysiology of migraine as a risk factor for stroke and cardiovascular disease. The manuscript is in preparation for submission. A parallel study to investigate the association of childhood headache with biomarkers for cardiovascular and cerebrovascular disease was also conducted among 11,770 children aged 4 to 19 years old in NHANES 1999 -2004 data. We found mean values for homocysteine, C reactive protein, and body mass index were higher in children with than without headaches, and more children with headaches were in the highest quintile for these factors. Serum and red cell folate were lower in children with headache. More children with headache (32% in children <12 years) than without headache (18%) were in the highest quintile of risk for 3 or more of these factors. The findings indicate that these important risk factors for long-term vascular morbidity cluster with severe or recurrent headache in childhood or adolescence. Recognition of the subgroup among children with headache in whom these risk factors concentrate may permit improved preventive management. The manuscript is in preparation of submission. We have also started investigating the association between nutrient intake, particularly fish oil (omega 3), and mental disorder;and the relationship between magnesium and migraine. Public Health Impact: These findings provide new information on the significant role of comorbid disorders, specifically comorbid mood and anxiety disorders, on the impact of severe headaches or migraine, and on health care utilization and health perception. These results are a significant first step towards research to understand biologic mechanisms, identify more homogeneous subgroups in clinical and genetic studies, and develop better clinical management. Future analyses will then examine the risk factors and biological correlates of these conditions in the general population. We will prioritize our analyses to address the key study questions that are the focus of our own research.
