Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury

BACKGROUND

Patients with traumatic brain injury (TBI) experience a variety of physical, cognitive, and affective symptoms. However, the evolution of symptoms, especially during the 3- to 12-month convalescence period (when recovery of function is still possible), is understudied.

OBJECTIVE

This study aims to identify symptoms and the relationships with functional outcomes that occur during the 3- to 12-month period after a TBI.

METHODS

Participants who were 3 to 12 months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. Clinical data were obtained from the electronic health record. Participants completed the Brain Injury Association of Virginia Symptom Checklist, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep Disturbance assessments to report symptoms, and the Disability Rating Scale and Satisfaction with Life Scale. Descriptive statistics were used to characterize demographics and symptoms. Linear regression was performed to analyze the relationships between symptoms and outcomes.

RESULTS

A total of N = 39 patients participated in the study. Memory problems and difficulty concentrating were the most common symptoms. Hospital length of stay, intensive care unit length of stay, cognitive, and physical symptoms were significantly associated with the Disability Rating Scale score. Physical, cognitive, depressive, and anxiety symptoms had significant associations with the Satisfaction with Life Scale.

CONCLUSION

Cognitive symptoms should be integrated into the clinical care of rehabilitating TBI patients. Nurses should monitor for physical, affective, and cognitive symptoms during the recovery phase of TBI.

Multidimensional Frailty, Quality of Life and Self-Management in Aging Hispanics Living With HIV

An observational cross-sectional study was conducted to examine multidimensional frailty and its potential impact on quality of life (QOL) in aging Hispanic people living with HIV (PLWH) and assess the extent to which HIV self-management moderates this association. The sample included 120 Hispanic PLWH aged 50 years and older (M = 59.11; SD = 7.04). The structural equation modeling analyses demonstrated that multidimensional frailty was significantly related to QOL in its two dimensions, physical and mental (p < .001). The relationship between multidimensional frailty and mental and physical QOL remained significant even after controlling for confounders (age and gender). The moderator analyses indicated no statistically significant moderator effect of HIV self-management on multidimensional frailty and mental or physical QOL. These study results have practical implications that highlight the need for early screening for frailty with a multidimensional focus. Age-appropriate and culturally tailored interventions to prevent or mitigate multidimensional frailty may improve QOL.

Changes in Telomere Length and Indicators of Oxidative Stress in Critically Ill Mechanically Ventilated Adults - A Pilot Study

BACKGROUND

Telomeres are structures at the end of chromosomes that shorten with each cell division. The purpose of this pilot project is to report changes in telomere length (T/S ratio), indicators of oxidative stress (serum protein carbonyl, vitamin C, GSH:GSSG, and total antioxidant capacity) from Intensive Care Unit (ICU) admission to ICU discharge, and to explore their association with ICU-related morbidities among critically ill mechanically ventilated adults.

METHODS

Blood was collected from mechanically ventilated patients (n = 25) at enrollment and within 48 hours of ICU discharge. Telomere length from peripheral blood mononuclear cells (PBMCs) was determined using RTqPCR. ELISAs were used to measure indicators of oxidative stress. Descriptive analysis, paired t-tests, and Pearson's correlations were performed.

RESULTS

Mean age was 62.0 ± 12.3 years, 28.6% were male, and 76.2% were White with disease severity using APACHE III (74.6 ± 24.6) and SOFA (7.6 ± 3.2). Mean T/S ratios shortened (ICU: 0.712, post-ICU: 0.683, p < 0.001, n = 19) and serum protein carbonyl increased (ICU: 7437 nmol/mg ± 3328, post-ICU: 10,254 nmol/mg ± 3962, p < 0.005) as did the oxidative stress index (protein carbonyl/GSH:GSSG, ICU: 1049.972 ± 420.923, post-ICU: 1348.971 ± 417.175, p = 0.0104). T/S ratio was positively associated with APACHE III scores (ICU: r = 0.474, post-ICU: r = 0.628, p < 0.05).

CONCLUSIONS

Pilot findings suggest that critical illness significantly correlates with telomere attrition, perhaps due to increased oxidative stress. Future larger and longitudinal studies investigating mechanisms of telomere attrition and associations with clinical outcomes are needed to identify potential modifiable factors for subsequent intervention to improve outcomes for critically ill patients.

Frailty among older Hispanics living in the United States: A scoping review

A scoping review was conducted to identify the available evidence about frailty among older Hispanics living in the U.S. using the Integral Model of Frailty. A not time-limited search was conducted in five peer-reviewed databases. Identified factors associated with frailty among older Hispanics are presented in four categories: (1) Characteristics and prevalence of frailty, (2) Life course determinants of frailty, (3) Comorbidities associated with frailty, and (4) Adverse outcomes of frailty. A total of 1030 articles were identified, and 37 articles were included in the scoping review. Most studies measured frailty based on the Fried Frailty Phenotype (59.5%, n= 22) and had a longitudinal design (64.9%, n= 24). The overall prevalence of frailty among Hispanics ranged from 4.3% to 37.1% (n= 20 studies). Further research is needed that targets Hispanics from different backgrounds in the U.S., particularly those that are high in number (i.e., Mexicans, Puerto Ricans, and Central Americans).

A prospective cohort study of the association between key family and individual factors and obesity status among youth

There remains a significant gap in our knowledge of the synergistic nature of family dynamics, child characteristics, and child-rearing features in the etiology of obesity from childhood through adolescence. We assessed the associations of family dynamics (poverty, family structure), child characteristics (child temperament), and child-rearing features (maternal depression, maternal sensitivity, and type of child care) with the development of childhood obesity. Children (n = 1240) whose weights and heights were measured at least once for ten time points (from 2 years through 15 years) from the NICHD Study of Early Child Care and Youth Development were included. Generalized estimating equation (GEE) was used to examine the associations of family and individual factors with the childhood obesity after adjusting for covariates. Adjusted GEE models showed that living below poverty level was associated with an increased odds of obesity (odds ratio = 1.62, 95% confidence interval 1.05, 2.53). Among these key family and individual factors, poverty status was observed to be the strongest predictor of obesity of offspring across time. Findings highlight the importance of systemic-level public health changes in obesity reduction efforts and suggest that poverty-reduction based prevention and intervention are likely more effective targets than more individual/family specific targets.

Biomarkers of Neuroinflammation in Traumatic Brain Injury

Traumatic brain injury (TBI) is characterized by neuroinflammation and structural damage leading to symptoms and altered brain function. Biomarkers are useful in understanding neuroinflammation and correlations with TBI sequalae. The purpose of this paper is to identify and discuss biomarkers of neuroinflammation used to study TBI and its sequalae. A systematic review was conducted using PubMed, CINAHL, Embase, and Web of Science. A total of 350 articles met criteria; 70 used biomarkers. PRISMA criteria were used for Quality Assessment. Articles included reviews (n = 17), case-control (n = 25), cross-sectional (n = 25) studies, and randomized controlled trials (n = 3). Twenty-seven biomarkers were identified, including inflammasomes, cytokines, neuropeptides, complement complexes, miRNA and exosomes, and glial cell-specific proteins. Biomarkers aid in predicting morbidity and mortality and advance our understanding of neuroinflammation in TBI. This systematic review advances our understanding of the neuroinflammatory response to better enable nurses and clinicians to provide informed care of TBI patients.

Income Disparities in Obesity Trends among U.S. Adults: An Analysis of the 2011-2014 California Health Interview Survey

The aim of this study was to examine income disparities in obesity trends among California adults. Data were obtained from the 2011−2014 California Health Interview Survey (n = 83,175 adults). Obesity for adults was defined as a body mass index of 30 kg/m2 or above. Family income was categorized as below 100%, 100% to 299%, or 300% and above of the federal poverty level (FPL). Weighted multiple logistic regression analyses were used to examine the association between family income and obesity across survey years after controlling for age, sex, race/ethnicity, smoking status, marital status, education, physical activity, and healthy diet. Obesity prevalence among California adults increased slightly from 25.1% in 2011 to 27.0% in 2014. Compared to 300% FPL or above, <100% FPL and 100−299% FPL were associated with increased odds of obesity, respectively (OR = 1.35, 95% CI = 1.22−1.50, for 100−299% FPL; OR = 1.18, 95% CI = 1.10−1.27, for 300% FPL or above). Each year, lower FPL was associated with higher odds of obesity, except for the year 2014. An inverse association between obesity and family income in each survey year was observed, with the magnitude of the income disparity decreasing from 2011 to 2014. The findings of this study show that family income was negatively associated with obesity among adults in California from 2011−2014, and the magnitude of the income disparity in obesity prevalence decreased over this period. Future studies need to examine potential risk factors associated with the decreasing trend.

Primary care physicians' opioid-related prevention behaviors and intentions: A descriptive analysis

OBJECTIVE

Primary care physicians (PCPs) are positioned to mitigate opioid morbidity and mortality, but their engagement in primary, secondary, and tertiary opioid-related prevention behaviors is unclear. The objective of this study was to evaluate Tennessee PCPs' engagement in and intention to engage in multiple opioid-related prevention behaviors.

METHODS

A survey instrument was developed, pretested, and pilot tested with practicing PCPs. Thereafter, a census of eligible Tennessee PCPs was conducted using a modified, four-wave tailored design method approach. Three patient scenarios were employed to assess physician intention to engage in 10 primary, secondary, and tertiary prevention behaviors. Respondents were asked to report, given 10 similar scenarios, the number of times (0-10) they would engage in prevention behaviors. Descriptive statistics were calculated using SPSS version 25.

RESULTS

A total of 296 usable responses were received. Physician intention to engage in prevention behaviors varied across the 10 behaviors studied. Physicians reported frequently communicating risks associated with prescription opioids to patients (8.9 ± 2.8 out of 10 patients), infrequently utilizing brief questionnaires to assess for risk of opioid misuse (1.7 ± 3.3 out of 10 patients), and screening for current opioid misuse (3.1 ± 4.3 out of 10 patients). Physicians reported seldomly co-prescribing naloxone for overdose reversal and frequently discharging from practice patients presenting with an opioid use disorder.

CONCLUSIONS

This study noted strengths and opportunities to increase engagement in prevention behaviors. Understanding PCPs' engagement in opioid-related prevention behaviors is important to effectively target and implement morbidity and mortality reducing interventions.

Ethnic group differences in obesity in Asian Americans in California, 2013-2014

Background

Obesity has been generally understudied in Asian Americans. It is important to identify subgroups of Asian Americans at high risk of obesity to help develop targeted interventions for those subgroups. This study aimed to examine the disparities in obesity among Asians (i.e., Chinese, Filipino, Japanese, Korean, and Vietnamese) living in California.

Methods

A sample of Adult Americans in California (n = 47,970) including Asian American adults (n = 3810) aged 18 years or older were obtained from the 2013–2014 California Health Interview Survey (the U.S. nation’s largest state cross-sectional health survey). Body mass index was calculated using self-reported height and weight. Weight status was determined using the WHO Asian BMI cut points in 4 categories: < 18.5 kg/m² (underweight), 18.5–22.9 kg/m² (normal weight), 23–27.5 kg/m² (overweight), and ≥ 27.5 kg/m² (obese). Multiple logistic regression analyses were used to estimate odds ratio (OR) and 95% confidence interval (CI) after adjustment for covariates.

Results

Overall, the prevalence of Asians was 23.3% for obesity and 40.0% for overweight. The obesity prevalence was higher in Asians who were males, aged 45–64 years old, had higher family income, were current smokers, never got married, had lower education level, had an insufficient level of physical activity, and had more frequent consumption of fast foods. After adjusting for other factors, compared to Whites, being Hispanics and Blacks were associated with higher odds of obesity (OR = 1.47, 95%CI = 1.31–1.65; OR = 2.04, 95%CI = 1.65–2.53, respectively); being Chinese, Korean, and Vietnamese were associated with lower odds of obesity (OR = 0.28, 95%CI = 0.18–0.45; OR = 0.14, 95%CI = 0.04–0.46; OR = 0.28, 95%CI = 0.14–0.58, respectively). Compared to Chinese, being Japanese and Filipino were associated with higher odds of obesity (OR = 2.75, 95%CI = 1.52–4.95; OR = 2.90, 95%CI = 1.87–4.49, respectively).

Conclusions

The prevalence of adult obesity was high among Asian Americans in California. Ethnic/racial disparities in obesity among Asian Americans in California were observed in 2013–2014. Compared to Whites, being Chinese, Korean, Vietnamese were associated with lower odds of obesity. Among Asians, compared to Chinese, being Japanese and being Filipino were associated with higher odds of obesity. These findings can help design better interventions to reduce racial and ethnic disparities in obesity, especially for Asian Americans.

The co-existence of diabetes and subclinical atherosclerosis in rural central Appalachia: Do residential characteristics matter?

Aim Disparities exist in cardiovascular diseases (CVD) and diabetes in the United States (U.S.) with Central Appalachia having disproportionate burden. This study examined prevalence and correlates of CVD risk-factors among patients with diabetes/subclinical atherosclerosis in Central Appalachia.

METHODS

During 2012-2016, 3000 patients from Central Appalachia were screened for subclinical atherosclerosis, using coronary artery calcium (CAC) scores; 419 participants had diabetes. Patients were categorized into four groups, with emphasis on those having subclinical atherosclerosis, CAC score ≥ 1. Descriptive statistics and multilevel multinomial logistic regression were conducted to identify CVD risk and spatial factors associated with co-existence of diabetes and subclinical atherosclerosis.

RESULTS

Among participants, prevalence of CVD risk-factors ranged from 11.7% for current smokers to 69.2% for those with CVD family history. Average BMI was 29.8. Compared to patients with diabetes only, age [RR = 1.07; p ≤ 0.0001], being male [RR = 5.33; p ≤ 0.0001], having hypertension [RR = 2.37; p ≤ 0.05] and being a former smoker were associated with increased likelihood of having diabetes/subclinical atherosclerosis. At the zip-code level, unemployment rate [RR = 1.37; p ≤ 0.05] was significantly associated with having diabetes/subclinical atherosclerosis.

CONCLUSION

Consistent with clinical guidelines, study results suggest the need to integrate CAC screening into primary care diabetes programs while addressing spatial issues that predispose patients to have diabetes/subclinical atherosclerosis.

CTRP3 and serum triglycerides in children aged 7-10 years

INTRODUCTION

The prevalence of obesity-related disorders has been steadily increasing over the past couple of decades. Diseases that were once only detected in adults are now prevalent in children, such as hyperlipidemia. The adipose tissue-derived hormonal factor C1q TNF Related Protein 3 (CTRP3) has been linked to triglyceride regulation especially in animal models. However, the relationship between circulating CTRP3 levels and obesity-related disorders in human subjects is controversial. CTRP3 can circulate in different oligomeric complexes: trimeric (<100 kDa), middle molecular weight (100-300 kDa), and high molecular weight (HMW) oligomeric complexes (>300 kDa). Previous work has identified that it is not the total amount of CTRP3 present in the serum, but the specific circulating oligomeric complexes that appear to be indicative of the relationship between CTRP3 and serum lipids levels. However, this work has not been examined in children. Therefore, the purpose of this study was to compare the levels of different oligomeric complexes of CTRP3 and circulating lipid levels among young children (aged 7-10 years).

METHODS

Morphometric data and serum samples were collected and analyzed from a cross-sectional population of 62 children of self-identified Hispanic origin from a community health center, between 2015 and 2016. Serum analysis included adiponectin, insulin, leptin, ghrelin, glucagon, C-reactive peptide, triglyceride, cholesterol, IL-6, TNF, and CTRP3. Correlation analyses were conducted to explore the relationships between CTRP3 and other biomarkers.

RESULTS

Total CTRP3 concentrations were significantly positively correlated with total cholesterol and HDL cholesterol. Whereas, HMW CTRP3 was not significantly associated with any variable measured. Conversely, the middle molecular weight (MMW) CTRP3 was negatively correlated with triglycerides levels, and very low-density lipoprotein (VLDL), insulin, and body mass index (BMI). The negative correlations between MMW CTRP3 and triglycerides and VLDLs were particularly strong (r2 = -0.826 and -0.827, respectively).

CONCLUSION

Overall, these data indicate that the circulating oligomeric state of CTRP3 and not just total CTRP3 level is important for understanding the association between CTRP3 and metabolic diseases. Further, this work indicates that MMW CTRP3 plays an important role in triglyceride and VLDL regulation which requires further study.

Community pharmacist engagement in opioid use disorder prevention and treatment behaviors: A descriptive analysis

OBJECTIVES

This study describes community pharmacists' opioid analgesic and medication for opioid use disorder (MOUD) practice behaviors and behavioral intentions in the context of primary, secondary, and tertiary prevention of opioid use disorder (OUD).

METHODS

The study sampling frame consisted of 2302 Tennessee community-practice pharmacists who were asked to complete a mailed, paper questionnaire. Behavioral intentions were elicited by asking pharmacists to indicate the number of times (0 to 10) they engage in a behavior, given 10 patients in 3 distinct vignettes. Perceptions of evidence-based MOUD and pain management patient care practices were also elicited.

RESULTS

A response rate of 19.7% was achieved. Pharmacists reported using a brief questionnaire to evaluate risk of opioid misuse with 2.1 ± 3.7 (mean ± SD) out of 10 patients, screening 2.1 ± 3.7 patients for current opioid misuse, discussing co-dispensing of naloxone with 2.9 ± 3.4 to 3.3 ± 4 out of 10 patients at a risk of overdose, and dispensing buprenorphine/naloxone to a mean of 4.6 ± 4.2 patients when they presented a prescription. Respondents perceived 38% of pain management and 30% of MOUD prescribers in their area to practice evidenced-based care.

CONCLUSION

Pharmacists have an opportunity to improve the outcomes for patients prescribed opioids by increasing engagement across OUD prevention levels.

Perceived Barriers to Contraceptive Access and Acceptance among Reproductive-Age Women Receiving Opioid Agonist Therapy in Northeast Tennessee

OBJECTIVES

Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee.

METHODS

A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT.

RESULTS

Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03-36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34-18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08-0.94).

CONCLUSIONS

Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.

Seroprevalence Investigation of Newcastle Disease in Rural Poultries of the Northern Provinces (Golestan, Gilan, and Mazandaran) of Iran

Rural poultry farming is common in the Northern provinces. Similar to commercial poultry, rural poultry is susceptible to most infectious diseases. In addition, by increasing the density of poultry farming, the probability of disease incidences has been increased. Newcastle disease is the most highly infectious disease which is endemic in Iran and causes outbreaks among commercial and rural poultry every year. The present study aimed to investigate the prevalence and virus circulation of Newcastle disease among rural poultry in Northern provinces of Iran. In the current study, 70 villages in 3 provinces (20, 30, and 20 villages in Mazandaran, Golestan, and Gilan, respectively) and a total of 1,374 birds (600, 400, and 374 birds in Mazandaran, Golestan, and Gilan, respectively) were sampled. Each village was regarded as an epidemiological unit. In the present study, birds of 67 (96%) villages were positive (presence of antibodies against Newcastle disease virus), including 28 (93.3%), 19 (95%), and 20 (100%) villages in Golestan, Mazandaran, and Gilan, respectively. Moreover, out of 1,374 birds, 616 (45%) of them were seropositive against Newcastle disease virus with 242 (41%), 159 (39.8%), and 211 (56%) samples in Mazandaran, Golestan, and Gilan, respectively. According to the results of the current study, the seroprevalence rate was reported to be high in both villages and birds. Such a high seroprevalence rate was indicative of the continuous exposure of the rural poultry to Newcastle virus and high virus circulation rate in the mentioned provinces which could result in the dissemination of the disease to commercial farms. Consequently, the implementation of proper control and care programs (e.g., vaccination of native poultry) can facilitate the reduction of Newcastle disease prevalence.

High molecular weight, but not total, CTRP3 levels are associated with serum triglyceride levels

C1q/TNF-related protein 3 (CTRP3) is a relatively novel adipose tissue-derived cytokine (adipokine) which has been linked to improved glucose regulation and insulin sensitivity. However, the relationship between circulating CTRP3 levels and diabetes is controversial. CTRP3 can circulate in different oligomeric complexes: trimeric, hexameric, and high molecular weight (HMW) oligomeric complexes. However, the concentration of the different oligomeric complexes in human disease states has not been previously investigated. Therefore, the purpose of this study was to compare the levels of different oligomeric complexes of CTRP3 between type 2 diabetic and nondiabetic individuals. Additionally, the association between the oligomeric complexes and other serum factors was examined. CTRP3 primarily circulates in the HMW complex (>50%) and the hexametric multimer, with no CTRP3 detected in the trimeric complex or as a monomer. Further, no differences were observed in total, hexameric, or HMW CTRP3 levels regardless of diabetic status. Surprisingly, HMW CTRP3 was found to be positively correlated with circulating triglyceride levels. Combined, these data suggest that CTRP3 is associated with triglyceride regulation, not diabetic status. These data may explain some of the discrepancies in the literature as elevated triglyceride levels are often detected in patients with obesity and type 2 diabetes.

Association between cardiovascular risk factors and the diameter of the main pulmonary artery in asymptomatic population in the Appalachian region

Background

Pulmonary artery (PA) diameter may be altered in association with cardiovascular (CV) risk factors as noted in aorta in systemic hypertension. The flow of blood from the right ventricle to the PA and all the way to the capillary level depends on the pulmonary vascular resistance and to a lesser extent compliance and impedance of the PA, which are the fundamental conduit for maintenance of the right heart hemodynamics. Our objective is to determine the association between CV risk factors and the main pulmonary artery (MPA) diameter.

Methods

The study population are asymptomatic individuals with no known diagnosis of CV diseases in central Appalachia (n=1,282). Adults aged 18 years or older were eligible for the screening if they were referred by a physician. For self-referral, only males aged ≥45 years and females aged ≥55 years were eligible. Unadjusted and adjusted linear regression analyses were performed.

Results

The mean MPA diameter was significantly higher among males compared to females (27.19±4.20 vs. 24.99±3.91 mm, P<0.0001). Participants with diabetes also had wider MPA diameter (26.79±4.56 mm) compared to those without diabetes (25.93±4.11 mm) (P=0.015). Further, hypertensive (26.42±4.15 vs. 25.71±4.21 mm, P=0.002) and obese (27.25±4.11 vs. 25.28±4.07 mm, P<0.0001) participants had significantly wider MPA diameter compared to non-hypertensive and non-obese participants, respectively. Multivariable model showed that age, sex and body mass index (BMI) were significantly associated with MPA diameter. A 1-year increase in age increased MPA diameter by 0.046 mm (P<0.0001). The diameter of MPA was wider among males by 2.16 mm compared to females (P<0.0001). Finally, with one unit increase in BMI, the MPA diameter increased by 0.16 mm (P<0.0001).

Conclusions

MPA diameter was significantly associated with age, sex, and BMI. Further prospective studies are needed to correlate computed tomography (CT) measurement of MPA diameter with pulmonary pressure as assessed by echocardiogram to diagnose pulmonary hypertension (PH).

The influence of immigrant generation on obesity among Asian Americans in California from 2013 to 2014

Objectives

We aimed to examine the association between immigrant generation and obesity among Californian adults and Asian Americans.

Methods

We pooled weighted data (n = 2,967) on Asian Americans from the 2013–2014 California Health Interview Survey. Overweight and obesity were defined using body mass indices (BMI) of 25 kg/m² and 30 kg/m², respectively, in non-Asians, compared with BMI of 23 kg/m² (for being overweight) and 27.5 kg/m² (for being obese) in Asians. First-generation or immigrant Asian Americans were defined as those born outside of the U.S. Second-generation Asian Americans were defined as those born in the U.S. with at least one foreign-born parent. All other Asian participants were classified as third-generation or higher. Multiple logistic regression analyses were used with adjustment for age, sex, family income, smoking status, marital status, education, physical activity, and fast food consumption.

Results

Overall, 23.3% of the Asian population was obese, and 40.0% was overweight. The percentage of 1^st, 2^nd, and 3^rd generation were 72.7%, 22.6%, and 4.6%, respectively. Overall, 1^st generation of Asians had lower odds of being obese compared to Whites (OR = 0.34, 95%CI = 0.26–0.45). Multiple logistic regression analyses showed that overall, 2^nd generation (OR = 1.69, 95%CI = 1.10–2.60) and 3^rd generation (OR = 2.33, 95%CI = 1.29–4.22) Asians had higher odds of being obese compared to 1^st generation Asians. Among Chinese, compared to the 1^st generation, the 3^rd generation had increased likelihood of being obese (OR = 6.29, 95%CI = 2.38–16.6).

Conclusion

Compared to Whites, Hispanics, and Blacks, Asian immigrants are less likely to be obese. Among Asians, 2^nd and 3^rd generations were more likely to be obese compared to 1^st generation. The obesity rate seems to increase the longer Asian immigrants remain in the U.S.

The influence of maternal body mass index and physical activity on select cardiovascular risk factors of preadolescent Hispanic children

BACKGROUND

Maternal obesity and physical inactivity have been identified as correlates of overweight and obesity and physical inactivity in older preadolescents; however, no study has explored this relationship in Hispanic preadolescents. Furthermore, the relation between maternal physical activity (PA) and blood pressure (BP) in Hispanic preadolescents has not been examined.

PURPOSE

This study aimed to assess the associations between Hispanic mothers' PA and body mass index (BMI) and their preadolescents' PA, screen time, BP, and BMI.

METHODS

Data of 118 mother-child (aged 2-10 years) dyads enrolled in a cross-sectional study of metabolic syndrome in Hispanic preadolescents at a community health center in Johnson City, TN were used. Parent and child questionnaires were used to ascertain mothers' BMI and PA and preadolescents' PA and screen time. Preadolescents' height, weight, and BP were measured. Multiple logistic regression was used to examine the association between child and maternal variables, adjusting for mother's education and the child's sex and age.

RESULTS

Pradolescents of obese mothers were more likely than preadolescents of mothers with normal weight to engage in less than three days of at least 60 min of vigorous PA per week (OR: 6.47, 95% CI [1.61-26.0]). Preadolescents whose mothers did not engage in moderate PA were more likely to engage in less than three days of at least 60 min of vigorous PA per week (OR: 2.92, CI [1.18-7.24]); and have elevated BP (OR: 2.50, 95% CI [1.02-4.53]) than preadolescents whose mothers engaged in moderate PA.

DISCUSSION

Our results show a negative relationship between maternal obesity and preadolescent PA, and a positive relationship between lower maternal PA and elevated BP and lower PA in Hispanic preadolescents. This suggests that interventions aimed at improving Hispanic preadolescents' PA and BP may use maternal PA and maternal BMI (for preadolescent PA) as a modification strategy to improve health in Hispanic preadolescents.

Diabetes, subclinical atherosclerosis and multiple cardiovascular risk factors in hard-to-reach asymptomatic patients

AIM

To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes.

METHODS

A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted.

RESULTS

In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemia and smoking increased the odds of the presence of coronary artery calcium (coronary artery calcium score ⩾1) regardless of diabetes status; however, with larger odds ratios in subjects with diabetes. Compared to subjects without diabetes with coronary artery calcium score = 0, having 3, 4 and ⩾5 risk factors increased the odds of presence of coronary artery calcium in subjects with diabetes by 14.06 (confidence interval = 3.26-62.69), 32.30 (confidence interval = 7.41-140.82) and 47.12 (confidence interval = 10.35-214.66) times, respectively.

CONCLUSION

There is a need for awareness about subclinical atherosclerosis in patients with diabetes and more research about coronary artery calcium in subpopulations of patients.

The associated risk factors for coronary artery calcium in asymptomatic individuals with and without diabetes in rural Central Appalachia

AIM

To examine the risk factor of coronary artery calcium (CAC) in individuals with diabetes and those without diabetes in Central Appalachia.

METHODS

Study population included 2479 asymptomatic participants who underwent CAC screening between August 2012 and November 2016. CAC score was classified into four categories [0 (no plaque), 1-99 (mild plaque), 100-399 (moderate plaque), and ≥400 (severe plaque)]. Multinomial logistic regression analyses were conducted to test the association between CAC and cardiovascular disease (CVD) risk factors among participants with diabetes, age and gender matched controls, and randomly selected controls.

RESULTS

13.6% of total participants had diabetes. Around 69%, 59.8%, and 57.7% of the participants with diabetes, matched controls, and randomly selected controls had CAC score ≥1, respectively. Participants with diabetes had higher prevalence of all CVD risk factors than controls. Among participants with diabetes, hypertension and physical inactivity increased the odds of CAC = 100-399, while among those without diabetes, hypertension and hypercholesteremia increased the odds of having CAC = 1-99 and CAC ≥ 400.

CONCLUSION

Half of study participants had subclinical atherosclerosis (i.e., CAC), and individuals with diabetes had higher CAC scores. This study suggests that individuals with diabetes in Central Appalachia might benefit from screening for CAC.

The adipokine C1q TNF related protein 3 (CTRP3) is elevated in the breast milk of obese mothers

Background

C1q TNF related protein 3 (CTRP3) is a relatively novel hormonal factor primarily derived from adipose tissue and has anti-diabetic properties. To determine if CTRP3 could play a role in early childhood development, the purpose of this study was to establish the presence of CTRP3 in breast milk (BM) and to determine whether CTRP3 levels were correlated with pregravid obesity status of the mother.

Methods

Breast milk was collected from breast-feeding mothers who had a pregravid body mass index (BMI) classification of normal weight (BMI 18-25 kg/m², n = 23) or obese (BMI > 30 kg/m², n = 14). Immunoprecipitation followed by immunoblot analysis confirmed the presence of CTRP3 in BM. The concentration of CTRP3 in BM samples was determined by ELISA. Additional bioactive components were also measured by commercially available assays: ghrelin, insulin, leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and glucose. Bioactive components in normal weight and obese mothers were compared using unpaired t-test (parametric) and Mann-Whitney U-test (non-parametric), as appropriate.

Results

The primary findings of this study are that the adipokine CTRP3 is present in BM and CTRP3 levels are increased with pregravid obesity. Additionally, this study independently confirmed previous work that BM from obese mothers has a higher concentration of insulin and leptin. Further, no differences were observed in BM between obese and normal weight mothers in ghrelin, adiponectin, IL-6, TNF-α, or glucose levels.

Conclusion

This study identified a novel factor in BM, CTRP3, and showed that BM CTRP3 levels higher in obese mothers. Because of the purported insulin sensitizing effect of CTRP3, it is possible that the elevated levels of CTRP3 in the BM of obese mothers may offset negative effects of elevated leptin and insulin levels in the BM of obese mothers. Future studies will need to be conducted to determine the relevance of CTRP3 in BM and to examine the presence of other adipose tissue-derived hormonal factors.

The effects of rurality on substance use disorder diagnosis: A multiple-groups latent class analysis

BACKGROUND

Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities.

METHODS

Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership.

RESULTS

Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P value<0.0001). Overall the rural class structure exhibited less diversity in class structure and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants).

CONCLUSIONS

This result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

Ethnic Differences in Risk Factors for Obesity among Adults in California, the United States

Little attention has been given to differences in obesity risk factors by racial/ethnic groups. Using data from the 2011-2012 California Health Interview Survey, we examined differences in risk factors for obesity among Whites, Latinos, Asians, and African Americans among 42,935 adults (24.8% obese). Estimates were weighted to ensure an unbiased representation of the Californian population. Multiple logistic and linear regression analyses were used to examine the differences in risk factors for obesity. Large ethnic disparities were found in obesity prevalence: Whites (22.0%), Latinos (33.6%), African Americans (36.1%), and Asians (9.8%). Differences in risk factors for obesity were also observed: Whites (gender, age, physical activity, smoking, arthritis, and diabetes medicine intake), Latinos (age, arthritis, and diabetes medicine intake), Asians (age, binge drinking, arthritis, and diabetes medicine intake), and African Americans (gender, physical activity, smoking, binge drinking, and diabetes medicine intake). Females were more likely to be obese among African Americans (odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.05-1.94), but less likely among Whites (OR = 0.80, 95% CI = 0.74-0.87). Race/ethnicity should be considered in developing obesity prevention strategies.

The effects of multiple coronary artery disease risk factors on subclinical atherosclerosis in a rural population in the United States

INTRODUCTION

The risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis.

METHODS

This is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0-1, 2, 3, 4, and ≥5). Prevalence of these risk factors and CAC scores (0, 1-99, 100-399, ≥400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression.

RESULTS

Over 98% of participants had ≥1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR=1.65, CI (1.20-2.25)], two times [OR=2.32, CI (1.67-3.23)] and three times [OR=3.45, CI (2.42-4.92)], respectively.

CONCLUSION

The high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.

A systematic review of the relationship between asthma, overweight, and the effects of physical activity in youth

PURPOSE

The association of asthma and overweight in youth is well studied. However, the temporal relationship between asthma and overweight, the strength of their association, and mediating factors involved in this relationship remain unclear. This review investigates the relationship between asthma and overweight in youth, while examining the role of physical activity as a mediator.

METHODS

A systematic review of literature was conducted using PubMed and Medline databases. Studies conducted among youth aged 0-18 years, published in English between 2000-2014 were included. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were consulted to evaluate quality of selected citations.

RESULTS

A comprehensive search yielded 143 studies in PubMed and 133 studies in Medline databases. Of these, 75 studies met the eligibility criteria. The review found varying hypotheses regarding the temporal relationship between asthma and overweight in youth; existing evidence supports the mediation of this association by decreased expenditure of energy due to reduced physical activity. Negative self-perception or parental perception of exercise ability due to asthma symptoms secondary to physical exertion was identified as a determinant of physical activity in asthmatic youth.

CONCLUSIONS

Physical activity likely mediates the relationship between asthma and overweight in youth. Temporality of this relationship remains unclear.

Correlates of Prescription Opioid Legitimacy Judgments Among Community Pharmacists

BACKGROUND

Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose.

OBJECTIVE

To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics.

METHODS

A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations.

RESULTS

Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05).

CONCLUSIONS

Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.

Abstract 615: Association Between Multiple Modifiable Risk Factors of Cardiovascular Disease and Hypertension in a Rural Population of the United States

Background: Hypertension (HTN) is one of the major risk factors for cardiovascular diseases (CVD) that afflicts one-third of the population in United States (US). This study examined the association between multiple modifiable risk factors for HTN in a rural hard-to-reach population.

Methods: During January 2011 and December 2012, 1629 community-dwelling asymptomatic individuals from central Appalachia participated in screening for subclinical atherosclerosis, during which the participants were asked to report whether a physician or health worker has informed them that they had HTN (yes/no). Additionally, baseline data consisting of two non-modifiable risk factors (sex, age) and 5 modifiable risk factors (obesity, diabetes, hypercholesterolemia, smoking, and sedentary lifestyle) were collected. Descriptive statistics involving prevalence of risk factors and multivariate logistic regression analyses to determine the strength of association between hypertension and the number of risk factors were conducted.

Results: Of the 1629 study participants, about half (49.8%) had hypertension. Among hypertensive patients, 31.4% were obese and 62.3% having hypercholesterolemia. Overall, having 2 risk factors consisted the largest group of participants with HTN. After adjusting for the non-modifiable risk factors (sex, age), obesity and diabetes increased the odds of having HTN by more than two folds ([OR=2.02, CI=1.57-2.60] and [OR=2.30, CI=1.66-3.18], respectively) and hypercholesterolemia and sedentary lifestyle increased the odds for HTN by more than one fold ([OR=1.26, CI=1.02-1.56) and [OR=1.38, CI=1.12-1.70], respectively). Compared to those without HTN, having 2, 3, and 4 or 5 modifiable risk factors were significantly associated with increased odds of having HTN by about two-folds [OR=1.72, CI=1.21-2.44], two and half folds [OR=2.55, 1.74-3.74], and six folds [OR=5.96, 3.42-10.41], respectively.

Conclusion: The study suggests that odds of having HTN increases with the number of modifiable risk factors for CVD. Hence, by implementing an integrated CVD program for treating and controlling modifiable risk factors of HTN would decrease the future risk of CVD and help to achieve the 2020 Impact Goal of the American Health Association.

Prescription Disposal Practices: A 2-Year Ecological Study of Drug Drop Box Donations in Appalachia

OBJECTIVES

We quantified controlled substance donations via permanent drug donation boxes over 2 years in a region with high prescription abuse, assessing medication characteristics, time between dispensing and donation, and weight of medications donated per capita.

METHODS

In partnership with Drug Enforcement Administration and local law enforcement, we analyzed permanent drug donation box collections in 8 Northeast Tennessee locations from June 2012 to April 2014. We recorded controlled substance dosage units along with the product dispensing date.

RESULTS

We collected 4841 pounds of pharmaceutical waste, 4.9% (238.5 pounds) of which were controlled substances, totaling 106,464 controlled substance doses. Analysis of dispensing dates for controlled substances indicated a median of 34 months lapsed from dispensing to donation (range = 1-484 months). The mean controlled substance donation rate was 1.39 pounds per 1000 residents. Communities with fewer than 10,000 residents had a statistically higher controlled substance donation rate (P = .002) compared with communities with 10,000 or more residents.

CONCLUSIONS

Permanent drug donation boxes can be an effective mechanism to remove controlled substances from community settings. Rural and urban community residents should be provided convenient and timely access to drug disposal options.

Prevalence and Correlates of Indoor Tanning and Sunless Tanning Product Use among Female Teens in the United States

BACKGROUND

Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens.

METHODS

Teenage females (N=778) aged 12-18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use.

RESULTS

Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR=1.82, 95% CI:1.07-3.10). Age, geographic regions, and race increased the likelihood of IT and STP use.

CONCLUSIONS

Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.

Independent and joint effects of prenatal maternal smoking and maternal exposure to second-hand smoke on the development of adolescent obesity: a longitudinal study

AIM

To examine associations of prenatal maternal smoking and second-hand smoke (SHS) exposure with the development of adolescent obesity.

METHODS

Longitudinal data (1991-2007) from National Institute of Child Health and Human Development Study of Early Child Care and Youth Development involving mothers that smoked and or exposed to SHS during the year before birth were analysed. Adolescent obesity in ages 12.0-15.9 years was defined as a BMI ≥ 95th percentile. Generalised estimating equations (GEE) were used for the analyses.

RESULTS

Obesity was more prevalent among adolescents whose mothers smoked or had SHS exposure than those that did not smoke or exposed to SHS. After adjusting for maternal and child factors, GEE models showed that odds of adolescent obesity increased with prenatal maternal smoking (OR = 1.57, 95% CI = 1.03-2.39) and SHS exposure (OR = 1.53, 95% CI = 1.04-2.27). The odds for obesity increased more than two times among adolescents exposed to both maternal smoking and SHS (OR = 2.10, 95% CI = 1.24, 3.56) compared with those without exposure. Additionally, not breastfeeding, maternal obesity, and longer screen viewing hours per day were associated with increased odds of obesity.

CONCLUSIONS

There is possibly a long-term joint effect of prenatal maternal smoke (smoking and SHS) exposure on obesity among adolescent offspring, and the effect is independent of birthweight. These findings suggest that adolescent obesity could possibly be curtailed with the development and promotion of smoking cessation programmes for families during the year before birth.

Cesarean section and the risk of overweight in grade 6 children

We examined the relationship between cesarean section (C-section) and the risk of overweight and obesity in children in grade 6 (mean age, 11.92 years; standard deviation = 0.34). Data from phase I through phase III of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used. Children with complete data from 1991 through 2004 were included in this study (n = 917). Multiple logistic regression analyses were used to adjust for potential confounding and to evaluate the association of C-section and childhood overweight and obesity. Compared to children delivered vaginally, children delivered by C-section had approximately twice the likelihood of being overweight (odds ratio (OR) = 1.86, 95 % confidence interval (CI) = 1.27-2.73) or obese (OR = 1.87, 95 % CI = 1.19-2.95). However, when examined according to sex, males delivered by C-section had an increased risk for being overweight (OR = 1.78, 95 % CI = 1.01-3.12) and obese (OR = 2.58, 95 % CI = 1.36-4.88), while females had an increased risk only for being overweight (OR = 1.99, 95 % CI = 1.17-3.39).

CONCLUSION

C-section was associated with an increased risk of overweight and obesity in children in grade 6, but the relationship differed according to gender. Further longitudinal studies are warranted to examine the long-term effect of delivery mode on the risk of childhood overweight.

Investigation of residents' health literacy status and its risk factors in Jiangsu Province of China

Health literacy has become an important public health concern. Multistage cluster random sampling was used to select 12 450 individuals. Using the 2009 Chinese Health Literacy questionnaire, participants were divided into groups with poor or not poor health literacy status. The knowledge rates for 6 areas of health literacy were determined with the following results: science concept of health (60.0%), literacy for preventing acute infectious disease (66.8%), literacy for preventing noncommunicable chronic disease (51.9%), safety and first aid (66.8%), obtaining and making use of basic medical care (55.3%), and comprehensive health literacy (52.5%). Multiple logistic regression showed that living in a rural area, fewer individuals in a household, younger age, low education, agricultural or rural migrant occupation workers, and low family income were associated with a poor health literacy status. Our results support the use of health education and promotion interventions to improve health literacy in this high-risk population in China.

Individual and social determinants of multiple chronic disease behavioral risk factors among youth

BACKGROUND

Behavioral risk factors are known to co-occur among youth, and to increase risks of chronic diseases morbidity and mortality later in life. However, little is known about determinants of multiple chronic disease behavioral risk factors, particularly among youth. Previous studies have been cross-sectional and carried out without a sound theoretical framework.

METHODS

Using longitudinal data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children who are followed biennially, the present study examines the influence of a set of conceptually-related individual/social distal variables (variables situated at an intermediate distance from behaviors), and individual/social ultimate variables (variables situated at an utmost distance from behaviors) on the rate of occurrence of multiple behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a sample of children aged 10-11 years at baseline. Multiple behavioral risk factors were assessed using a multiple risk factor score. All statistical analyses were performed using SAS, version 9.1, and SUDAAN, version 9.01.

RESULTS

Multivariate longitudinal Poisson models showed that social distal variables including parental/peer smoking and peer drinking (Log-likelihood ratio (LLR) = 187.86, degrees of freedom (DF) = 8, p < .001), as well as individual distal variables including low self-esteem (LLR = 76.94, DF = 4, p < .001) increased the rate of occurrence of multiple behavioral risk factors. Individual ultimate variables including age, sex, and anxiety (LLR = 9.34, DF = 3, p < .05), as well as social ultimate variables including family socioeconomic status, and family structure (LLR = 10.93, DF = 5, p = .05) contributed minimally to the rate of co-occurrence of behavioral risk factors.

CONCLUSIONS

The results suggest targeting individual/social distal variables in prevention programs of multiple chronic disease behavioral risk factors among youth.

Pesticide exposure during pregnancy and low birth weight

BACKGROUND

Limited epidemiologic studies have investigated the effects of pesticide exposure during pregnancy on low birth weight in offspring in rural China.

METHODS

A survey of a total of 503 women was conducted in Ling county of Shandong Province of China following delivery from 1 November 2009 to 8 February 2010.

RESULTS

After adjustment for confounding and compared with no pesticide exposure, multiple logistic regression showed a non-significant increased likelihood of low birth weight for both children of mothers exposed to pesticides when not pregnant (OR = 1.80, 95% CI: 0.62, 5.22) and mothers exposed to pesticides during pregnancy (OR = 2.42, 95% CI: 0.73, 8.08); multiple linear regression showed a non-significant reduced birth weight for both children of mothers exposed to pesticides when not pregnant (β=-0.59, p=0.28) and mothers exposed to pesticides during pregnancy (β=-0.89, p=0.15).

CONCLUSIONS

Exposure to pesticides during pregnancy was associated with a non-significant increase in low birth weight in this rural Chinese population. Future studies using larger sample sizes and longer follow-up periods are warranted.

Correlates of multiple chronic disease behavioral risk factors in Canadian children and adolescents

The authors assessed individual, social, and school correlates of multiple chronic disease behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a representative sample of Canadian youth aged 10-15 years (mean = 12.5 years) attending public schools. Cross-sectional data (n = 1,747) from cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth were used. Ordinal regression models were constructed to investigate associations between selected covariates and multiple behavioral risk-factor levels (0/1, 2, 3, or 4/5 risk factors). Older age (odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.21, 3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09, 2.03), reporting that most/all of one's peers smoked (OR = 7.31, 95% CI: 4.00, 13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18, 6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31, 2.88) increased the likelihood of having multiple behavioral risk factors. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85, 0.99) and youth from families with postsecondary education (OR = 0.58, 95% CI: 0.41, 0.82) were less likely to have a higher number of risk factors. Although several individual and social characteristics were associated with multiple behavioral risk factors, no school-related correlates emerged. These variables should be considered when planning prevention programs.

A comprehensive view of sex-specific issues related to cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.

Use of dietary supplements among women at high risk of hereditary breast and ovarian cancer (HBOC) tested for cancer susceptibility

Although use of dietary supplements among women with breast cancer is high, use among women at high risk of hereditary breast and ovarian cancer (HBOC) is unknown. This study assesses the prevalence of use of dietary supplements and identifies characteristics associated with use among women at high risk of HBOC who underwent genetic testing for cancer susceptibility. Participants were 303 women who underwent BRCA1/2 testing as part of Interdisciplinary Health Research International Team on Breast Cancer Susceptibility. Dietary supplements use was measured 12 mo post-disclosure. Potential determinants of use included personal cancer history, test result, psychological distress, cancer genetics knowledge, and health-related behaviors. Globally, 51% of participants used at least one dietary supplement. Calcium (26%), multivitamins (17%), vitamins D (14%), E (12%), and C (10%) were most frequently reported. Women > or = 50 yr were more likely to be using dietary supplements (P < 0.0001). Women with an inconclusive test result were more likely to use mineral supplements than noncarriers [odds ratio (OR) = 2.6; 95% confidence interval (CI) = 1.3-5.3]. Cigarette smoking was negatively associated with use of vitamin supplements (OR = 0.3; 95% CI = 0.1-0.7). Use of dietary supplements among women at high risk of HBOC who underwent BRCA1/2 testing is as frequent as use among patients with other types of tumors or use among individuals from the general population.