Preterm delivery is one of the important causes of infant morbidity and mortality in the United States (U.S.). Annually, 12% of infants are born preterm in the U.S. and preterm birth related causes of death account for approximately 35% of all infant deaths. Using the latest (2012) National Survey of Children’s Health, the study aims to estimate the prevalence rates of preterm birth in the U.S., and identify key risk factors associated with it. Data (n=42,282) was obtained from the 2012 NSCH. Using the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommendations, preterm birth was defined as one occurring less than 37 completed weeks of gestation from the first day of Page 26 2015 Appalachian Student Research Forum the last menstrual period. Based on existing literature, the following maternal and child characteristics were included as potential factors associated with preterm birth in the U.S. – infant gender, race, maternal smoking or maternal exposure to secondhand smoke (SHS), family income and maternal general health status. Descriptive statistics were reported using frequencies and proportions. Multiple logistic regression analyses were conducted to assess the association of selected variables with the preterm birth. Overall, 10.65% of live births were born preterm in the U.S. during 2012. Preterm birth prevalence rates were higher among males (12.07%), non-Hispanic blacks (14.34%) and those born to mothers who were smokers or exposed to secondhand smoke during pregnancy (23.8%). Males had higher odds of being born preterm (OR 1.07 95% CI 1.01-1.15) than females. Non-Hispanic White is less likely to be born preterm (OR 0.86 95% CI 0.74-0.99) compared to non-Hispanic black. Infants born to mothers who were smokers or exposed to SHS during pregnancy had higher odds of being born preterm (OR 1.05, 95% CI 0.97-1.13) compared to those born to women who were non-smokers and not exposed to SHS. Infants born to women who reported better general health status were less likely to be born preterm (Excellent/Very good vs Fair/Poor: OR 0.51 95% CI 0.46-0.56, Good vs Fair/Poor: OR 0.68 95% CI 0.61-0.75) than referent group. Approximately one-tenths of live births in the U.S. were born preterm. Study findings demonstrated infant race, gender, maternal general health status and maternal smoking or secondhand smoke exposure during pregnancy as factors associated with preterm birth. Determining these factors is important in the development of effective intervention programs and policies to reduce the rates of preterm birth in the U.S.

Abstract available through Annals of Epidemiology.

The National Children’s Study (NCS) Harris County, Texas Study Center participated in the NCS Provider Based Sampling (PBS) substudy of the NCS Vanguard Phase pilot. As part of the hospital-based birth cohort component of the PBS substudy, we conducted a secondary data analysis to evaluate the proportion of postpartum women who consented to future biospecimen collection alone and to both future collection and use of residual birth biospecimens. In phase 1, 32 postpartum women at one hospital were asked to consent only to maternal future biospecimen collection. In phase 2, 40 other postpartum women from the same hospital were asked for an additional consent to use residual clinical biospecimens from the birth event that otherwise would be discarded, including cord blood and maternal blood and urine. Among 103 eligible women, a total of 72 participated. They were 28.3 ± 5.9 years old on average; 58 % were Hispanic; 63 % consented in English, and 37 % in Spanish; 39 % had some college education; 42 % were married; 60 % had an annual family income <$30,000; and 51 % were employed. In phase 1, 59 % consented to future biospecimen collection, and in phase 2, 95 % consented to both future collection and use of at least one residual birth biospecimen, with a difference between phases of 36 % [95 % CI 17–54 %]. Demographic characteristics did not differ among those who did and did not consent. Postpartum women were significantly more likely to grant consent for use of future and residual hospital-obtained biospecimens than future biospecimen collection alone.

Background Recent studies have demonstrated a significant relationship between vitamin D and cholesterol levels. Cholesterol is important in the synthesis and metabolism of vitamin D. Additionally, foods rich in vitamin D also contain high cholesterol supplements. Given that sources of vitamin D and cholesterol are different, we hypothesized that there is a potential mean bias in true relationship between an individual’s vitamin D and cholesterol levels. The study therefore aimed to examine the relationship of serum cholesterol and vitamin D levels. Methods We utilized NHANES 2001-2006 data (n=30,954). The outcome was vitamin D deficiency defined as individuals with serum 25-hydroxyvitamin D level12 ng/ml were classified as normal. Significant differences in cholesterol levels between the two groups were determined using Chi-Square contingency test. Generalized linear models were conducted to assess the association of vitamin D deficiency with cholesterol levels adjusting for age, sex, physical activity (proxy measure for sunlight exposure) and other serum lipid levels. Results Vitamin D deficiency was significantly lower in males(5.2%) than females(7.8%)(P Conclusion Vitamin D deficiency was associated with high LDL and triglyceride levels. Study findings help establish the importance of distinguishing vitamin D and cholesterol levels as separate entities while making inferences about their relationship with chronic diseases.

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.

The objective of this study is to compare two non-invasive thermometer technologies in pregnant women admitted for labor at the Family Birthing Center in Johnson City Medical Center. A total of 50 patients were recruited in the study. Temperature measurements using the oral 3M® Tempa.Dot and the Exergen 5000 Temporal Artery Thermometer (TAT) were obtained by trained personnel. These recordings were obtained once upon admission, at 2-hour intervals until delivery (to a maximal time of 20 hours), 1 hour before and after epidural placement, and 2 hours after vaginal delivery. The temperatures readings were then compared over all time points, and at each time point using SPSS and Student paired t-test. Trends of temperature changes in labor between both thermometers were also evaluated. We noted that over all time points, the skin temperature was 0.38°F higher than the oral temperature. This difference was statistically significant as well (98.19°F ±0.681 vs. 97.81°F ±0.750, p

Objective: To examine the association between subclinical atherosclerosis (ascertained as coronary artery calcium; CAC) in asymptomatic individuals in the Central Appalachian region of the United States and individual- and geographic-level factors. Methods: Data were obtained from participants in CAC screening during 2012 and 2016. CAC score was assessed as CAC=0 (no plaque), 1≤CAC≤99 (mild plaque), 100≤CAC≤399 (moderate plaque), and CAC≥400 (severe plaque). Additionally, data on demographics (age, sex, and race), medical conditions, lifestyle factors, and family history of coronary artery disease (CAD) were obtained. Further, zip codes of place of residence for participants were used to generate geographic-level data. Descriptive statistics were used to estimate the prevalence of CAC, and multinomial logistic regression models were used to delineate significant factors. Results: Of 1512 participants, 57.6% had CAC>0. The prevalence of mild, moderate, and severe plaques was 31.6%, 16.3%, and 9.7%, respectively. Demographic, medical conditions, lifestyle factors, and family history of CAD were associated with increased risk for subclinical atherosclerosis. Further, the proportion of minority residents significantly increased the risk for severe plaque [RRR=1.06; p-value=0.04] and the proportion of residents on government assistance significantly decreased the risk for mild plaque [RRR=0.93; p-value=0.03]. Conclusion: The results imply that the proportion of minority residents in a geographic area is associated with increased relative risk for subclinical atherosclerosis, while the proportion of residents on government assistance decreased such risk. However, future geographic or neighborhood-level studies with larger sample size are needed to delineate further the consistency of these results in the Central Appalachian population.

Background: The association of asthma and obesity in youth is well studied. However, much of this research has been observational and the temporal relationship between the two factors remains the subject of debate. Moreover, there are mixed findings regarding the role of physical activity in the association between asthma and obesity in youth. Methods: A systematic review of existing literature of the relationship between asthma and obesity in youth, while examining the role of physical activity as a mediator, was conducted using PubMed and Medline databases. Studies conducted on children and adolescents aged 0 to 18 years, published in English during the period of 2000 to 2014 were included. A comprehensive search yielded 143 studies in PubMed and 133 studies in Medline databases. Of these, 76 studies met the review’s eligibility criteria. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were consulted to evaluate quality of selected citations. Results: The association between asthma and obesity in youth is well explored. However, there are varying hypotheses and conclusions regarding this relationship, of which temporality remains to be elucidated. Existing evidence was identified to support the mediation of this association by physical activity. Negative self- 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. Also, control of asthma symptoms was found to directly impact daily physical activity levels. Greater odds of increased weight were observed among asthmatic children compared to non-asthmatic peers. However, annual weight gain was found to be similar among asthmatic children with well controlled symptoms to that of their healthy peers. Lastly, the review found that adverse respiratory symptoms secondary to exercise are experienced by 90% of asthmatic youth, resulting in activity limitation. According to this finding, it is reasonable that the incidence of obesity frequently observed to be greater in asthmatic youth than healthy peers is mediated by decreased expenditure of energy in asthmatic children due to reduced physical activity. Conclusions: It is likely that physical activity mediates the relation between asthma and obesity, though further research is required to determine the temporal relation and degree of this association.

Background: Adverse childhood experiences (ACEs) lead to high risk behaviors in adults. In 2015, an estimated 700,000 children reported abuse; 8.4% reported experiencing sexual abuse. In 2014, nearly 10,000 people died from alcohol-related motor vehicle injuries, and >1.1 million were arrested for driving under alcohol or narcotic influence. Studies have reported the role of ACEs in alcohol consumption among adults. However, the association between adult drunk driving (DD) and childhood sexual abuse (CSA) has not been investigated. Objective: This study aimed to estimate the association between CSA and DD in US adults. Methods: Data were obtained from 4,374,390 adults who participated in the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Participants’ self-reported responses were used to define past experience for DD (no/yes) and CSA (no/yes). Covariates included age, sex, race, income, education, marital status and parental substance abuse. Logistic regression models were used to estimate the relative odds of DD among victims of CSA adjusting for covariates. Results: Approximately 3.6% of adults reported DD, and 11.1% adults experienced CSA. Compared to adults who didn’t experience CSA, those who experienced CSA were significantly associated with increased odds of DD behavior (adjusted Odds Ratio (aOR): 1.67, 95% confidence interval (CI):1.27-2.20). Compared to females, males who experienced child sexual abuse were 2.88 times more likely to DD (aOR: 2.88, 95% CI: 2.32-3.59). Conclusion: CSA is significantly associated with DD behavior in adults. Higher estimates of the relationship were identified in males. Future studies, such as prospective cohort studies, are imperative for further evaluation. These findings aided in identifying adults with CSA experience to target and minimize their DD behavior, thus preventing alcohol-related injuries. Public Health Implications: Adults who experienced CSA were associated with increased odds of DD behavior. A multifaceted approach involving several stakeholders at all levels of governance is needed to address this issue. Appropriate public health interventions and/or policies should be developed to prevent sexual abuses during childhood. Health education and promotional campaigns are vital to minimize drunk driving cases by targeting communities and individuals with high risk behaviors.

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.