Abstract available through Circulation.

Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the health field, resulting in a lack of progress. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine the main types of cancer that affect AYAs in Tennessee and understand if there were any cancer types that warranted additional investigation. A total of 8,097 cancer cases were diagnosed in AYAs in Tennessee from 2004-2008. The main types were breast, melanomas, thyroid, lymphomas, and testicular, accounting for over 50% (N=4,269) of cancers in the sample. The incidence of melanoma and thyroid cancer was higher in Tennessee compared to the United States, deserving further examination. In Tennessee, females were significantly more likely to be diagnosed with melanomas (AIR 14.01, 95% CI 12.96-15.06) and thyroid cancers (AIR 13.39, CI 12.37-14.42) compared to males (AIR 8.08, CI 7.28-8.88 and AIR 3.50, CI 2.98-4.03. Regression models were used to further analyze melanoma and thyroid cancers, specifically looking at predictors of late stage diagnosis and treatment types, respectively. Individuals with government insurance were eight times (OR 8.41, CI 3.04-23.27) more likely to be diagnosed with late stage melanoma when compared with private or other types of insurance. Individuals diagnosed with regional or distant stage thyroid cancer compared to localized stage were three times (OR 3.01, CI 1.84-4.94) more likely to have a total thyroidectomy. These data suggest the need for additional cancer prevention and control efforts geared towards AYAs.

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.

Objectives: The central Appalachian region of the United States is disproportionately burdened with cardiovascular diseases (CVD) and associated risk factors; however, research to inform clinical practice and policies and programs is sparse. This study aimed to examine the association between multiple modifiable risk factors for CVD and hypertension in asymptomatic patients in central Appalachia. Methods: Between January 2011 and December 2012, 1629 asymptomatic individuals from central Appalachia participated in screening for subclinical atherosclerosis. Participants were asked to report their hypertension status (yes/no). In addition, data on two nonmodifiable risk factors (sex, age) and five modifiable risk factors (obesity, diabetes mellitus, hypercholesterolemia, smoking, and sedentary lifestyle) were collected. Multivariable logistic regression analyses were conducted to assess association between hypertension and risk factors. Results: Of the 1629 participants, approximately half (49.8%) had hypertension. Among people with hypertension, 31.4% were obese and 62.3% had hypercholesterolemia. After adjusting for sex and age, obesity and diabetes mellitus were associated with a more than twofold increased odds of having hypertension (odds ratio [OR] 2.02, confidence interval [CI] 1.57–2.60 and OR 2.30, CI 1.66–3.18, respectively). Hypercholesterolemia and sedentary lifestyle were associated with higher odds for hypertension (OR 1.26, CI 1.02–1.56 and OR 1.38, CI 1.12–1.70, respectively), compared with referent groups. Having two, three, and four to five modifiable risk factors was associated with increased odds of having hypertension by about twofold (OR 1.72, CI 1.21–2.44), 2.5-fold (OR 2.55, CI 1.74–3.74), and sixfold (OR 5.96, CI 3.42–10.41), respectively. Conclusions: This study suggests that the odds of having hypertension increases with a higher number of modifiable risk factors for CVD. As such, implementing an integrated CVD program for treating and controlling modifiable risk factors for hypertension would likely decrease the future risk of CVD.

Mental health disorder is the leading cause of disease burden in women worldwide. Pregnant women with mental disorder are especially at risk of having offspring with adverse outcomes. This study aimed to investigate risk factors of mental health disorder among Chinese pregnant women in the third trimester. A total of 462 pregnant women in their third trimester completed interviews at three hospitals in Shandong Province, China from July to December, 2010. The Symptom Checklist-90-R (SCL-90-R) was used to evaluate mental health disorder, and was defined as total score ≥160, or scores of any symptom dimensions ≥3, or total of positive symptoms ≥43. Multiple logistic regression was used to examine the risk factors of mental health disorder, and to adjust for covariates. The total score and scores of somatization, obsessive-compulsive, anxiety, and phobic anxiety were higher than corresponding national norm by SCL-90-R assessment (all p<0.05). Multiple logistic regression showed family income, relationship with parents-in-law, concerns about child's health, fear of delivery, and pregnancy complications were negatively associated with mental health disorder (all p<0.05). More specifically, relationship with parents-in-law, fear of delivery, preference on mode of delivery (Caesarean section), and body image concerns were positively associated with anxiety (all p<0.05); Fear of delivery was positively associated with depression (p=0.023). Family income, relationship with parents-in-law, concern about child's health, fear of delivery, and pregnancy complications were identified as potential risk factors of mental health disorder in this Chinese pregnant women population. Strategies to reduce mental health disorder are needed among Chinese pregnant women.

Cancer is a leading cause of death in the Appalachian region of the United States. Existing studies compare regional mortality rates to those of the entire nation. We compare cancer mortality rates in Appalachia to those of the nation, with additional comparisons of Appalachian and non-Appalachian counties within the 13 states that contain the Appalachian region. Lung/bronchus, colorectal, female breast and cervical cancers, as well as all cancers combined, are included in analysis. Linear regression is used to identify independent associations between ecological socioeconomic and demographic variables and county-level cancer mortality outcomes. There is a pattern of high cancer mortality rates in the 13 states containing Appalachia compared to the rest of the United States. Mortality rate differences exist between Appalachian and non-Appalachian counties within the 13 states, but these are not consistent. Lung cancer is a major problem in Appalachia; most Appalachian counties within the 13 states have significantly higher mortality rates than in-state, non-Appalachian counterparts. Mortality rates from all cancers combined also appear to be worse overall within Appalachia, but part of this disparity is likely driven by lung cancer. Education and income are generally associated with cancer mortality, but differences in the strength and direction of these associations exist depending on location and cancer type. Improving high school graduation rates in Appalachia could result in a meaningful long term reduction in lung cancer mortality. The relative importance of household income level to cancer outcomes may be greater outside the Appalachian regions within these states.

Group B Streptococcus, or GBS, is a gram positive bacteria commonly found in the gastrointestinal, genital and urinary tract of healthy adults. Between 10% and 30% of all pregnant women are colonized with GBS in the vagina or rectum. While GBS colonized mothers typically show no symptoms or adverse health effects, the bacteria can be passed to their child during labor and delivery. Although significant progress has been made in the identification and treatment of GBS, it remains the leading infectious cause of Page 14 2014 Appalachian Student Research Forum morbidity and mortality among newborns in the United States. The current guidelines recommended by the Center for Disease Control and Prevention (CDC) and endorsed by the American College of Obstetrics and Gynecology (ACOG) is to test pregnant women for GBS colonization between 34-37 weeks of gestation. The current gold standard for identification of GBS colonization is the use of selective enrichment broth (SEB) followed by culture and biochemical testing. Identified concerns with the culture procedure are: 1) the length of time it takes to get the results, 2) the lower sensitivity if the SEB step is left out to improve turn-around-time (TAT) and 3) the limited number of qualified technicians available to perform the complex test. Recently, several semi-automated molecular assays have been developed for identification of GBS which are marketed as having equivalent sensitivity and specificity to SEB followed by culture. The goals of this study were to: 1) validate the sensitivity and specificity of an FDA approved GBS molecular assay (Illumigene, Meridian Bioscience) and 2) evaluate a new testing strategy utilizing SEB followed by the Illumigene GBS assay to see if it offers an improvement in TAT when compared to SEB culture in our in-house microbiology lab and to those sent out to a national reference lab for GBS DNA assay. During the validation process, 20 consecutive samples were submitted to SEB followed by simultaneous in-house culture and Illumigene assay for GBS. The method validation experiments were analyzed using the EP Evaluator version 11 statistical software (Data Innovations). Comparison of TAT was evaluated utilizing a blinded report generated from our Laboratory Information System (Harvest, Orchard Software) for a 2 month period for the GBS tests performed using the SEB followed by Illumigene molecular assay (n=73), in-house SEB followed by culture (n=50) and send-out reference lab GBS DNA assay (n=43) procedures. The TAT (hrs) for each method (Mean±SEM) were determined from the time of collection until result approval. The Illumigene assay had a high sensitivity (100%) and specificity (100%) when compared to SEB followed by culture for identification of GBS. Utilization of the Illumigene assay following SEB significantly (p

Background: Measures of central tendency are one of the foundational concepts of statistics, with the most commonly used measures being mean, median, and mode. While these are all very simple to calculate when data conform to a unimodal symmetric distribution, either discrete or continuous, measures of central tendency are more challenging to calculate for data distributed asymmetrically. There is a gap in the current statistical literature on computing median and mode for most skewed unimodal continuous distributions. For example, for a standardized normal distribution, mean, median, and mode are all equal to 0. The mean, median, and mode are all equal to each other. For a more general normal distribution, the mode and median are still equal to the mean. Unfortunately, the mean is highly affected by extreme values. If the distribution is skewed either positively or negatively, the mean is pulled in the direction of the skew; however, the median and mode are more robust statistics and are not pulled as far as the mean. The traditional response is to provide an estimate of the median and mode as current methodological approaches are limited in determining their exact value once the mean is pulled away. Methods: The purpose of this study is to test a new statistical method, utilizing the first order and second order partial derivatives in Taylor series expansion, for approximating the median and mode of skewed unimodal continuous distributions. Specifically, to compute the approximated mode, the first order derivatives of the sum of the first three terms in the Taylor series expansion is set to zero and then the equation is solved to find the unknown. To compute the approximated median, the integration from negative infinity to the median is set to be one half and then the equation is solved for the median. Finally, to evaluate the accuracy of our derived formulae for computing the mode and median of the skewed unimodal continuous distributions, simulation study will be conducted with respect to skew normal distributions, skew t-distributions, skew exponential distributions, and others, with various parameters. Conclusions: The potential of this study may have a great impact on the advancement of current central tendency measurement, the gold standard used in public health and social science research. The study may answer an important question concerning the precision of median and mode estimates for skewed unimodal continuous distributions of data. If this method proves to be an accurate approximation of the median and mode, then it should become the method of choice when measures of central tendency are required.

Background: In 2012, 62,939 cases of child sexual abuse (CSA) were reported in the United States (US). During the same year, binge drinking (BD) cost the US nearly $250 billion. Currently there are 38 million Americans who participate in BD. Researchers have found a significant association between adults who experienced adverse childhood events (ACEs) and BD in adulthood. However, CSA and BD have yet to be investigated using a nationally representative study sample. Objective: This study seeks to investigate the association between CSA and BD among adults in the US. Methods: Data from 2012 Behavioral Risk Factor Surveillance System (BRFSS) were used to analyze a sample of 25,037 adult participants from states that included the ACE questionnaire in the survey. CSA components, including forced touched sexually, forced to touch sexually, and forced sex, were assessed in relation to BD. Covariates included parental alcoholism, parental substance abuse, parental depression, age, sex, income, race, education level, and marital status. Descriptive statistics and logistic regression models were conducted using SAS 9.4. Results: Approximately 17% of the study sample reported BD. Adults who had been touched forcefully during their childhood had around 2.18 times increased odds (adjusted odds ratio (aOR): 2.18; 95% confidence interval (CI) 1.97 – 2.41) of being involved in BD compared to those who did not have this experience. Being forced to touch sexually or forced to have sex during childhood was not significantly associated with BD and was not included in the adjusted model. Having parents who abused drugs (aOR 6.14; 95%CI: 5.56–6.79) and parents who were depressed (aOR: 3.35; 95%CI: 3.09-3.64) significantly increased the odds of BD among this population. Conclusion: Forced sexual touch was found to be significantly associated with BD. Further epidemiologic studies are necessary to determine if this is consistent in different years for the association between CSA and BD, since forced to touch sexually and forced sex were not found to impact BD in adults. The increased odds for BD from experiencing forced touch identifies a population where health education and awareness is vital to reduce the risk for BD in adults, thus reducing alcohol-related health problems and injuries. Health promotion campaigns for families affected by parental substance abuse and parental depression is also important to reduce the risk for BD among adults growing up with these experiences.

Background: It is widely believed that the median of a unimodal distribution is "usually" between the mean and the mode for right skewed or left skewed distributions. However, this is not always true, especially with grouped data. For some research, analyses must be conducted based on grouped data since complete raw data are not always available. A gap exists in the body of research on the mean-median-mode inequality for grouped data. Methods: For grouped data, the median Me=L+((n/2-F)/fm)×d and the mode Mo=L+(D1/(D1+D2))×d, where L is the median/modal group lower boundary, n is the total frequency, F and G are the cumulative frequencies of the groups before and after the median/modal group respectively, D1= fm - fm-1 and D2=fm - fm+1, fmis the median/modal group frequency, fm-1 and fm+1 are the premodal and postmodal group frequency respectively. Assuming there are k groups and k is odd, group width d is the same for each group and the mode and median are within (k+1)/2th group. Necessary and sufficient conditions are derived for each of six arrangements of mean, median and mode. Results: Table available at https://apha.confex.com/apha/143am/webprogram/Paper326538.html Conclusion: For grouped data, the mean-median-mode inequality can be any order of six possibilities.