Background Over the long term, unhealthy lifestyles can lead to many health problems, especially type 2 diabetes (T2D). The aim of the present study was to determine associations between lifestyle factors (smoking, alcohol consumption, physical activity, and diet) and T2D in American adults (aged ≥20 years) in a nationally representative sample. Methods Data for 12 987 American adults participating in the National Health and Nutrition Examination Survey 2005–2014 were evaluated. Weighted multiple logistic regression models were used to examine associations between the four lifestyle factors and T2D after adjusting for demographics and socioeconomic status (SES). Prevalence trends for T2D were examined using Cochran–Armitage tests. Results There was a significant increasing prevalence trend for T2D among American adults. Smokers and individuals consuming >12 alcoholic drinks in the past year were less likely to report having T2D than non-smokers (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.35–0.48) and those consuming Conclusion All four lifestyle factors were significantly associated with T2D among American adults. The findings of the present study provide useful information for healthcare providers that may help them promote specific lifestyle modifications.

Access to dental care is the leading unmet health need among American children. Early access to oral health care is critical in the prevention and treatment of early childhood caries, and any barriers perceived by parents can cause delay in seeking treatment. The purpose of this study was to examine child, family, and community factors associated with the utilization of oral health services among U.S. and HRSA region IV children aged 1-5 years. The data were obtained from the 2011/2012 National Survey of Children’s Health. Descriptive statistical summaries were calculated for all independent variables grouped by child, family, and community. A caregiver was asked whether the child received dental care in the past 12 months. Multiple logistic regression analysis using an investigator driven stepwise selection methodology was conducted. Nearly half (46.7%) of caregivers in the national sample reported that their child had visited a dentist in the past 12 months, slightly fewer (46.0%; p

Metabolic syndrome (MetS) is a major risk factor for cardiovascular disease yet it has been little studied in Hispanic children of rural areas. This pilot study aimed to estimate the prevalence of MetS and its components (high waist circumference (WC), elevated blood pressure (BP), high triglycerides (TRI), low high-density lipoprotein (HDL), and hyperglycemia) in a sample of Hispanic children aged 2 to 10 years from northeast Tennessee (TN). Between June and October 2015, 46 Hispanic children were recruited during their well-child visit at a community health center in Johnson City, TN. Anthropometric data, blood pressure readings, and a blood sample were collected. Descriptive statistics were used to estimate the prevalence of MetS and its components. Chi-squared test or Fisher’s exact test was used to test differences of proportions. Results showed that 41.3% of Hispanic children (mean age:6.8 years; SD:2.5) were overweight or obese (Body Mass index (BMI) for age and sex ≥85th percentile), 15.2% had a high WC (≥90th percentile for age and sex), 30.4% had elevated BP (systolic or diastolic BP for age, sex and height ≥90th percentile), 13.0% had low HDL (≤5th percentile for age and sex), and 45.6% had high TRI (≥95th percentile for age and sex). Overall, 17 (37%) children were negative for every component of MetS, 17 (37%) were positive for one component, 6 (13%) for two components, 5 (11%) for three components, and 1 (2%) for four components. The prevalence of MetS (≥3 components) was 13%. While the prevalence of MetS did not vary by sex, it tended to be higher (33.3%) in children aged 4 or younger than in 5 to 10 (12.1%) year olds (P=0.05). The prevalence of having 2 or more positivities for MetS was significantly higher among overweight/obese children than in children with lean weight (47.4% vs. 11.1%, P=0.03). Findings provide evidence that Hispanic children are at high risk for MetS. Prevention efforts should begin early and target children with elevated BMI.

Objective Genetic factors play an important role in modulating the vulnerability to body mass index (BMI). The purpose of this study is to identify novel genetic variants for BMI using genome-wide association (GWA) meta-analysis. Methods PLINK software was used to perform meta-analysis of two GWA studies (the FUSION and Marshfield samples) of 5218 Caucasian individuals with BMI. A replication study was conducted using the SAGE sample with 762 individuals. Results Through meta-analysis we identified 33 SNPs associated with BMI with p < 10− 4. The most significant association was observed with rs2967951 (p = 1.19 × 10− 6) at 5p15.2 within ROPN1L gene. Two additional SNPs within ROPN1L and 5 SNPs within MARCH6 (the top SNP was rs2607292 with 4.27 × 10− 6) further supported the association with BMI on 5p15.2 (p < 1.8 × 10− 5). Conditional analysis on 5p15.2 could not distinguish the effects of ROPN1L and MARCH6. Several SNPs within MARCH6 and ROPN1L were replicated in the SAGE sample (p < 0.05). Conclusion We identified a novel locus for BMI. These findings offer the potential for new insights into the pathogenesis of BMI and obesity and will serve as a resource for replication in other populations to elucidate the potential role of these genetic variants in BMI and obesity.

It is widely believed that the median is “usually” between the mean and the mode for skewed unimodal distributions. However, this inequality is not always true, especially with grouped data. Unavailability of complete raw data further necessitates the importance of evaluating this characteristic in grouped data. There is a gap in the current statistical literature on assessing mean–median–mode inequality for grouped data. The study aims to evaluate the relationship between the mean, median, and mode with unimodal grouped data; derive conditions for their inequalities; and present their application.

Background. The diagnosis of metabolic syndrome is currently based on synthesizing measurements on five different biochemical and anthropometric scales. The logistics involved makes it less than an ideal screening test of cardiometabolic risk. Adipocytokines, c-peptide and ghrelin have emerged as important non-traditional biomarkers for understanding cardio-metabolic risk, and offer potential as tests of cardiometabolic risk. However, optimal sensitivity and specificity cut-offs of non-traditional biomarkers for detecting cardiometabolic risk are scarce, especially in pre-adolescent ethnic minorities. Objective. To assess the efficacy of 7 non-traditional biomarkers for detecting 3 or more cardiometabolic risk factors in pre-adolescent Hispanic children. Methods. The study population consisted of a healthy control group of 23 children and an at-risk group of 15 children aged 2-10 years with 3 or more cardiometabolic risk factors (blood pressure>=90th percentile; waist circumference >=90th percentile; triglycerides>=95th percentile; and HDL<5th >percentile) who were recruited as part of a larger pilot study of metabolic syndrome in Hispanic children receiving well-child care at a community health center in Johnson City, TN, from June 2015 to September 2016. T-test, Mann-Whitney U and Chi-squared tests were used to assess differences in characteristics of the two groups. Spearman’s correlation analysis was used to assess the relationship between biomarkers and cardiometabolic risk factors. ROC analysis and the Youden’s J statistic=maximum (sensitivity +(specificity-1)) were used to determine biomarker cut-off for optimal sensitivity and specificity. Data analysis was performed using SAS 9.4. Results. The mean age of the sample was 6.48 years (SD=2.74). About half of the sample were girls (50.5%). The at-risk group had significantly higher systolic blood pressure, triglyceride levels, waist circumference, leptin and C-peptide levels, but significantly lower HDL-C levels than participants in the control group. Leptin [r (38) = 0.3, p

Drug poisoning due to overdose is a major health problem in Tennessee. In TN there has been an increase of 210% in accidental overdose deaths since 1999 to 2010. About 80% of drug poisonings in Tennessee were either accidental or self-inflicted. Also as indicated by the CDC in 2010 enough drugs were prescribed to medicate every American adult around-the-clock for one month and the vast amount of drugs increases the risk of misuse. Drug Take Back Events are a useful measure for reducing the number of prescription medications kept in the households. However, the extent to which these events have affected in the reduction of drug poisoning is not well known. The objective of this study was to investigate the relation between the total number of drugs collected at Take Back Events and emergency department admissions due to overdose in three Counties in Northeast TN. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations for controlled substances (CS) were analyzed for Washington, Carter and Sullivan County, Tennessee, from 2009 to 2012. Data were obtained from Tennessee Department of Health on number of emergency department (ED) admissions due to overdose based on International Classification of Diseases (ICD)-9 codes occurred between 2009 and 2012 in the above-mentioned counties. Linear forecast trend-line method was used to evaluate associations between the amount of controlled substances collected via donation boxes and number of ED visits occurred during 2009-12. Furthermore Pearson’s correlation analyses were conducted to investigate relationship between drop box donations and ED admissions due to overdose. From 2009 – 2012 the ED visits shows a significant decrease as the amount of drugs collected increases for Washington and Carter County. Also a negative correlation is seen between the ED visit and drugs collection for Washington and Carter County with R2 values of -0.96 and -0.90 respectively. However the same is not true for Sullivan County as the trend was not inversely proportional and also the correlation between ED visits and gathered drugs is low with R2 value of -0.562. These results quantify the potential impact of drug take back events on reduction in drug poisoning due to overdose in Northeast Tennessee. Further study is required to examine the effect of the events on the epidemic of prescription drug abuse and misuse.

Farmers’ markets are increasingly promoted for their potential to improve access to healthful foods. University campuses are strategic settings for farmers’ markets, because they could improve access to fresh, local produce for large and diverse communities—including college students, who are at risk for poor dietary intake. Universities also offer resources that facilitate farmers’ markets, such as built-in communication channels, common areas, and student volunteers. However, literature describing how to establish campus-based farmers’ markets is limited. We describe the process of developing and operating a student-driven, campus-based farmers’ market at a public university in the Appalachian region of the United States.

Structures made of chromated copper arsenic (CCA) have been shown to leach arsenic into the surrounding soil. Soil cores were taken adjacent to six CCA decks at 0, 15, 60 and 300 cm from the deck at depths of 0–10, 10–20, and 20–30 cm, and were analyzed for soil arsenic concentrations. Median soil arsenic concentrations ranged from 1.8 μg/g at a depth of 10–20 cm and a distance of 300 cm to 34.5 μg/g at a depth of 0–10 cm and a distance of 30 cm. Soil arsenic concentrations taken at depths of 0–10 and 10–20 cm decreased as distance from the deck increased. Soil arsenic concentrations close to the deck were higher at lower soil depths and at homes with greater deck wipe arsenic concentrations. Age of deck and slope of land had significant effects on the differences in arsenic concentrations between samples taken at different distances when evaluated in models by themselves, but not in models adjusting for deck wipe concentrations. Size of deck and bulk density of soil did not have significant effects on soil arsenic concentrations.

Youth violence is a public health threat in the United States. Inadequate sleep is identified as a risk factor, however, the majority of previous studies were cross-sectional and focused only on adolescents. This study aimed to investigate the association between average hours of sleep during adolescence and violent behavior among youths. Individuals who participated in both Waves II (1996) and III (2000-2001) of National Longitudinal Study of Adolescent and Adult Health (n=3,557) were included. A composite variable on violent behavior was created using three different questions on fighting or using a weapon. Age, gender, ethnicity, violent behavior during adolescence, depressive symptoms, impulsivity, and current sleep hours were considered as covariates. Negative binomial regressions were conducted using SAS 9.4. The mean age of the participants was 15.85 years (SD=1.62) and 21.29 years (SD=1.60) in waves II and III, respectively. The majority of the participants were female (54.15%) and non-Hispanics (88.93%). Average hours of sleep during adolescence was not significantly associated with violent behavior during young adulthood (p=0.75). In the final model, gender (beta=1.65, p<0.001), age (beta=-0.1267, p<0.001), history of violent behavior (wave II) (beta=0.3158, p<0.0001), current average hours of sleep (wave III) (beta=-0.073, p=0.044), depressive symptoms (beta=0.0834, p <0.0001), and impulsivity (beta=0.1379, p<0.0001) were significantly associated with violent behavior in early adulthood. Reduced number of sleep hours during early adulthood, unlike during adolescence, increased the likelihood of getting involved in violent activities during early adulthood. This information is useful to promote healthy behavior among individuals in all phases of their life.