Recovery of a marine keystone predator transforms terrestrial predator-prey dynamics.

Sea otters (Enhydra lutris) and wolves (Canis lupus) are two apex predators with strong and cascading effects on ecosystem structure and function. After decades of recovery from near extirpation, their ranges now overlap, allowing sea otters and wolves to interact for the first time in the scientific record. We intensively studied wolves during 2015 to 2021 in an island system colonized by sea otters in the 2000s and by wolves in 2013. After wolf colonization, we quantified shifts in foraging behavior with DNA metabarcoding of 689 wolf scats and stable isotope analyses, both revealing a dietary switch from Sitka black-tailed deer (Odocoileus hemionus), the terrestrial in situ primary prey, to sea otters. Here we show an unexpected result of the reintroduction and restoration of sea otters, which became an abundant marine subsidy for wolves following population recovery. The availability of sea otters allowed wolves to persist and continue to reproduce, subsequently nearly eliminating deer. Genotypes from 390 wolf scats and telemetry data from 13 wolves confirmed island fidelity constituting one of the highest known wolf population densities and upending standardly accepted wolf density predictions based on ungulate abundance. Whereas marine subsidies in other systems are generally derived from lower trophic levels, here an apex nearshore predator became a key prey species and linked nearshore and terrestrial food webs in a recently deglaciated and rapidly changing ecosystem. These results underscore that species restoration may serve as an unanticipated nutrient pathway for recipient ecosystems even resulting in cross-boundary subsidy cascades.

Proximity labelling identifies pro-migratory endocytic recycling cargo and machinery of the Rab4 and Rab11 families.

Endocytic recycling controls the return of internalised cargoes to the plasma membrane to coordinate their positioning, availability and downstream signalling. The Rab4 and Rab11 small GTPase families regulate distinct recycling routes, broadly classified as fast recycling from early endosomes (Rab4) and slow recycling from perinuclear recycling endosomes (Rab11), and both routes handle a broad range of overlapping cargoes to regulate cell behaviour. We adopted a proximity labelling approach, BioID, to identify and compare the protein complexes recruited by Rab4a, Rab11a and Rab25 (a Rab11 family member implicated in cancer aggressiveness), revealing statistically robust protein-protein interaction networks of both new and well-characterised cargoes and trafficking machinery in migratory cancer cells. Gene ontological analysis of these interconnected networks revealed that these endocytic recycling pathways are intrinsically connected to cell motility and cell adhesion. Using a knock-sideways relocalisation approach, we were further able to confirm novel links between Rab11, Rab25 and the ESCPE-1 and retromer multiprotein sorting complexes, and identify new endocytic recycling machinery associated with Rab4, Rab11 and Rab25 that regulates cancer cell migration in the 3D matrix.

The cost of doubt: assessing the association between attributional ambiguity and mental health.

OBJECTIVE: To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health. METHODS: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status. RESULTS: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms. CONCLUSION: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations.

Core features of callous-unemotional traits: a cross-cultural comparison of youth in four countries.

With considerable debate concerning the impact of culture on the expression of callous-unemotional (CU) traits, it is unclear whether the core features of CU traits generalize to youth across cultures. This study aimed to examine whether cultural differences are reflected in the core features of CU traits and the associations among these features. Network analysis was employed to identify the core features and to examine the network structure of CU traits operationalized by the Inventory of Callous Unemotional traits (ICU) in four community youth samples from different nations (Australia, N = 190; the UK, N = 437; the USA, N = 330; China, N = 503). The item "Apologizes to people" was identified as a cross-cultural core feature in the ICU network with a greater centrality of this item compared to others in all four samples. In addition, some items were identified as culture-specific core features in the network, differing in their centrality across samples. The network structures of the youth self-report ICU items were moderately similar across samples, while the structures of parent-report items showed substantial differences. These findings have important implications for cross-cultural research on CU traits as well as practical implications for screening and treatment. The core features of ICU appear to be generalizable in youth across cultures, although cultural-specific manifestations should be noted.

Health behavior profiles in young survivors of childhood cancer: Findings from the St. Jude Lifetime Cohort Study.

BACKGROUND: There is limited understanding of associations between a combination of health behaviors (physical activity, sedentary/screen-time, diet) and cardiometabolic health risk factors, physical performance, and emotional health among young (<18) childhood cancer survivors (CCS). The aims of this research were to address this gap by 1) deriving health behavior adherence profiles among CCS, and 2) examining associations among demographic, diagnosis and/or treatment exposures, cardiometabolic, physical performance, and emotional functioning with health behavior profile membership. METHODS: Participants included 397 CCS (≥5 years post-diagnosis; 10-17 years old) enrolled in the St. Jude Lifetime Cohort Study who completed physical health evaluations and questionnaires assessing health behaviors and psychological functioning. Latent profile analysis was used to derive profiles of health behavior adherence. Logistic regression and t-tests were used to examine mean-level differences and associations between profile membership with demographic, diagnosis, treatment exposures, cardiometabolic health, psychological functioning, and physical performance. RESULTS: Two profiles emerged: inactive-unhealthy-diet ("IU") and active-sedentary-unhealthy-diet ("ASU") to guidelines. More participants in IU demonstrated higher resting heart rate (mean [M], 76.54; SD = 12.00) and lower motor proficiency scores (M = 34.73; SD = 29.15) compared to ASU (resting heart rate, M = 71.95, SD = 10.74; motor proficiency, M = 50.40, SD = 31.02). CONCLUSIONS: CCS exhibited low adherence to multiple health behavior guidelines, with adherence patterns differentially associated with cardiometabolic health (i.e., resting heart rate) and physical performance. However, robust protection against all health variables was not observed. Findings suggest interventions designed to improve health outcomes should target multiple health behaviors simultaneously. PLAIN LANGUAGE SUMMARY: Pediatric cancer survivors are at-risk for detrimental health outcomes associated with cancer and treatment. Engagement in healthy lifestyle behaviors serves to reduce health vulnerabilities among adult survivors but less is known about associations with lifestyle behaviors on young survivors. This study documents patterns of lifestyle behaviors among survivors of pediatric cancer, factors that increase susceptibility to nonadherence, and associations among lifestyle behaviors and health indicators.

Service-user experiences of an integrated psychological intervention for depression or anxiety and tobacco smoking in improving access to psychological therapies services: A qualitative investigation into mechanisms of change in quitting smoking.

INTRODUCTION: High smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these interventions have not been investigated. This qualitative study aimed to understand participants' experiences of the mechanisms underlying change in smoking behaviour following an integrated cognitive behavioural technique-based intervention for smoking cessation and depression/anxiety. METHODS: This study was embedded within an ongoing randomized-controlled acceptability and feasibility trial (http://www.isrctn.com/ISRCTN99531779). Semistructured interviews were conducted with 15 IAPT service users. Data were analysed using thematic analysis. During the interviews, participants were asked open-ended questions about their quitting experience and perception of how the intervention aided their behaviour change. RESULTS: Five themes were identified. Acquiring an increased awareness of smoking patterns: participants described an increased understanding of how smoking was contributing towards their mental health difficulty. Developing individualized strategies: participants described acquiring 'a couple of tricks up your sleeve' that were helpful in making smoking cessation feel more 'manageable'. Practitioner style as 'supportive but not lecture-y': participants expressed how important the therapeutic alliance was in helping change their smoking behaviour. Importance of regular sessions: participants expressed the importance of 'having someone that's checking in on you'. Having the opportunity to access the intervention at 'the right time': participants described the intervention as the 'push' that they 'needed'. CONCLUSIONS: Participants identified key factors towards smoking behaviour change. Perceived increased awareness of how smoking negatively impacted participants' mental health, and the opportunity to be offered smoking cessation treatment in a 'non-judgemental', 'supportive' environment, with regular sessions and individualized strategies contributed to successful smoking cessation outcomes. If similar results are found in more diverse samples, these aspects should be embedded within integrated interventions for smoking cessation and depression/anxiety. PATIENT OR PUBLIC CONTRIBUTION: Persons with lived experience of depression, anxiety and tobacco addiction contributed towards the design of the interview schedule, participant information sheets and the debriefing process. This was to ensure that interview questions were relevant, nonjudgemental and acceptable for those who did not manage to quit smoking.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility.

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

Interdependence and the cost of uncoordinated responses to COVID-19.

Social distancing is the core policy response to coronavirus disease 2019 (COVID-19). But, as federal, state and local governments begin opening businesses and relaxing shelter-in-place orders worldwide, we lack quantitative evidence on how policies in one region affect mobility and social distancing in other regions and the consequences of uncoordinated regional policies adopted in the presence of such spillovers. To investigate this concern, we combined daily, county-level data on shelter-in-place policies with movement data from over 27 million mobile devices, social network connections among over 220 million Facebook users, daily temperature and precipitation data from 62,000 weather stations, and county-level census data on population demographics to estimate the geographic and social network spillovers created by regional policies across the United States. Our analysis shows that the contact patterns of people in a given region are significantly influenced by the policies and behaviors of people in other, sometimes distant, regions. When just one-third of a state's social and geographic peer states adopt shelter-in-place policies, it creates a reduction in mobility equal to the state's own policy decisions. These spillovers are mediated by peer travel and distancing behaviors in those states. A simple analytical model calibrated with our empirical estimates demonstrated that the "loss from anarchy" in uncoordinated state policies is increasing in the number of noncooperating states and the size of social and geographic spillovers. These results suggest a substantial cost of uncoordinated government responses to COVID-19 when people, ideas, and media move across borders.

COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States.

To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used data from a large, nationally representative survey conducted during July 21-August 2, 2021. We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001). Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults who receive a COVID-19 diagnosis during clinic visits, or at the time of discharge if hospitalized, and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 infection.

Mental health symptoms and association with COVID-19 vaccination receipt and intention to vaccinate among adults, United States.

Early studies suggest that adults with mental health conditions are at greater risk for COVID-19 infection, severe complications, and higher mortality, yet face barriers in accessing timely health services. Data from the Census Bureau's Household Pulse Survey, a large, nationally representative survey fielded from March 17-29, 2021 (n = 77,104) were analyzed to examine COVID-19 vaccination and intention among adults with mental health symptoms. Separate multivariable regression models were conducted to examine associations between symptoms of anxiety, depression, and anxiety or depression on vaccine receipt (≥ 1 dose) and intention to be vaccinated. Reasons for not being vaccinated were also assessed. Approximately 35% of adults had symptoms of anxiety or depression. This population was less likely to receive COVID-19 vaccination (adjusted prevalence ratio (aPR) = 0.94, 95%CI: 0.91-0.98) but more likely to intend to get a vaccine (aPR = 1.13, 95%CI: 1.08-1.19) than those without these conditions. Females with mental health symptoms were less likely to receive a COVID-19 vaccination but more likely to intend to get vaccinated, while there were fewer significant associations between mental health symptoms and vaccination coverage and intentions to vaccinate among males. Reasons for not getting vaccinated, including concerns about possible vaccine side effects, efficacy, cost, dislike of vaccines, as well as lack of trust in the government and vaccines, were all greater among those with any symptoms of anxiety or depressive disorders than those without symptoms. Efforts are needed to increase vaccination uptake and confidence among this vulnerable population by increasing vaccine confidence and addressing concerns about the vaccine.

Transmission of SARS-CoV-2 among children and staff in German daycare centres.

In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020-06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.

Assessing equity in health, wealth, and civic engagement: a nationally representative survey, United States, 2020.

BACKGROUND: The principle of equity is fundamental to many current debates about social issues and plays an important role in community and individual health. Traditional research has focused on singular dimensions of equity (e.g., wealth), and often lacks a comprehensive perspective. The goal of this study was to assess relationships among three domains of equity, health, wealth, and civic engagement, in a nationally representative sample of U.S. residents. METHODS: We developed a conceptual framework to guide our inquiry of equity across health, wealth, and civic engagement constructs to generate a broad but nuanced understanding of equity. Through Ipsos' KnowledgePanel service, we conducted a cross-sectional, online survey between May 29-June 20, 2020 designed to be representative of the adult U.S. POPULATION: Based on our conceptual framework, we assessed the population-weighted prevalence of health outcomes and behaviors, as well as measures of wealth and civic engagement. We linked individual-level data with population-level environmental and social context variables. Using structural equation modeling, we developed latent constructs for wealth and civic engagement, to assess associations with a measured health variable. RESULTS: We found that the distribution of sociodemographic, health, and wealth measures in our sample (n = 1267) were comparable to those from other national surveys. Our quantitative illustration of the relationships among the domains of health, wealth, and civic engagement provided support for the interrelationships of constructs within our conceptual model. Latent constructs for wealth and civic engagement were significantly correlated (p = 0.013), and both constructs were used to predict self-reported health. Beta coefficients for all indicators of health, wealth, and civic engagement had the expected direction (positive or negative associations). CONCLUSION: Through development and assessment of our comprehensive equity framework, we found significant associations among key equity domains. Our conceptual framework and results can serve as a guide for future equity research, encouraging a more thorough assessment of equity.

Do interventions principally targeting excessive alcohol use in young people improve depression symptoms?: a systematic review and meta-analysis.

BACKGROUND: Excessive alcohol use is common in young people and is associated with a range of adverse consequences including an increased risk of depression. Alcohol interventions are known to be effective in young people, however it is not known if these interventions can also improve depression. OBJECTIVE: To investigate whether psychosocial interventions principally targeting excessive alcohol use in young people reduce depression symptoms compared to controls. DESIGN: We conducted a systematic review and meta-analysis of controlled intervention trials, that measured depression symptoms at follow-up. We used a generic inverse variance random effect meta-analysis to pool the standardised mean difference in change in depression symptoms from baseline to follow-up between intervention and control arms. We used I2 to measure heterogeneity, the Cochrane tool for randomised trials to assess risk of bias, and Egger's tests to assess small study bias. DATA SOURCES: APA PsycNET, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase (including MEDLINE), and clinicaltrials.gov were searched for relevant studies published from inception to December 2020. Reference lists of studies were also searched, and authors contacted where articles presented insufficient data. STUDY ELIGIBILITY CRITERIA: Intervention studies that primarily targeted existing excessive alcohol use in young people (aged 10 to 24) and assessed depression outcomes at baseline with a minimum of four-week follow-up. RESULTS: Five studies were included in the meta-analysis. Interventions targeting excessive alcohol use were associated with a reduction in depression symptoms from baseline to follow-up when compared to control, standardised mean difference = - 0.26, and 95% confidence interval [- 0.41, - 0.12], p < .001. CONCLUSIONS: This study found evidence that interventions primarily targeting excessive alcohol use can reduce depression symptoms in young people. However, this finding should be taken with caution given concerns about risk of bias in all studies. More research is needed to examine whether these findings generalise beyond populations of undergraduate students primarily living in high income countries. TRIAL REGISTRATION: PROSPERO registration number: CRD42020177260 .

Young women's food consumption and mental health: the role of employment.

OBJECTIVES: This study explores the relationship between young women's consumption of healthy and unhealthy food and depression and examines the moderating effect of their employment status on the relationship. METHODS: The National Longitudinal Survey of Youth 79 for Children and Young Adults (NLSY79 CY) was used for this study. The final sample included a total of 1524 young women aged from 18 to 35 years. Multiple Linear Regression was conducted to answer the research questions. RESULTS: Fast food consumption was related to higher levels of depression among young women while fruit intake was associated with lower levels of depression. Employment status moderated the relationship between young women's fruit consumption and depression. CONCLUSIONS: Young women are encouraged to consume more fruit and less fast food in order to ameliorate depression. Programs that target young women's mental health should consider addressing their nutritional needs, through, for example, vouchers for fresh, nutritious foods; nutrition or cooking education; or having a certified nutrition specialist on staff.

Associations among political voting preference, high-risk health status, and preventative behaviors for COVID-19.

BACKGROUND: We investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers' adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences. METHODS: We conducted a nationally-representative online survey of U.S. adults between May-June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity. RESULTS: Among 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes. CONCLUSION: Engagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy.

Longitudinal Associations between Callous-unemotional (CU) Traits and School-based Affiliative Relationships among South Korean Children.

OBJECTIVE: Callous-unemotional traits (CU) traits are characterized by low empathy, guilt, and reduced sensitivity to others' feelings, along with a reduced drive for social affiliation. However, little is known about the relationships between CU traits and social affiliation in the school context, or the influence of gender on these associations. This study tested reciprocal associations between CU traits and school-based affiliative relationships and explored gender as a potential moderator. METHOD: The sample included South Korean children aged 10 to 12 years (N = 218, M = 11.03, SD = .65, 52% boys). Children reported on CU traits, antisocial behavior, teacher-student relationship quality, and peer affiliation. Three-wave longitudinal cross-lagged models tested reciprocal associations between CU traits and affiliation with both teachers and peers, with multi-group modeling employed to test the moderating effect of gender. RESULTS: Higher CU traits at time 1 predicted decreases in teacher affiliation at time 2 controlling for CU traits, teacher-child affiliation, and antisocial behavior at time 1, while lower teacher-child affiliation at time 2 predicted increases in CU traits at time 3 accounting for CU traits, teacher-child affiliation, and antisocial behavior at time 2. However, there were no reciprocal associations between CU traits and teacher affiliation nor significant associations between CU traits and peer affiliation. Gender did not moderate any pathways between CU traits and teacher or peer affiliation. CONCLUSIONS: Findings indicate CU traits may reduce teacher-child affiliation, potentially escalating risk for further increases in CU traits. Thus, teacher-child affiliation may represent an important target for school-based intervention for children with elevated CU traits regardless of gender.

Surgeons' Responses to a Surgical Mortality Audit: Accepting and Improving: A Cross Sectional Survey.

BACKGROUND: Surgeons strive to provide the best care possible to their patients. The Australian and New Zealand Audit of Surgical Mortality is a process for improving surgical care and outcomes via peer-review assessment of mortality cases. This article examines the acceptability of the assessments to Queensland surgeons, in addition to examining their impact on surgical care. METHODS: This study was a cross-sectional survey. Evaluation forms were sent to all Queensland surgeons who had received a first-line assessment with clinical incidents identified or a second-line assessment (with or without clinical incidents), between April 2018 and January 2020 (n = 484). A total of 102 evaluation forms were returned, giving a response rate of 21%. RESULTS: Most respondents agreed that their assessments were fair (78%) and informative (69%). Almost half (43%) agreed that their assessment improved the subsequent surgical care they provided. Comments supported this, with surgeons describing reflections, meetings and changes that had occurred following their assessments. Despite the strong proportion of positive comments, some surgeons disagreed with the opinions or recommendations of their assessors. A large percentage (41%) was neutral towards the ability of the assessments they had received to improve surgical care at the hospital level. CONCLUSIONS: There was a high degree of acceptance of the QASM peer-review assessment process. The assessments facilitated discussion, reflection and implementation of surgical care improvements in Queensland surgeons. Further research into this topic should involve refinement of the study tool with a larger, and therefore more representative, proportion of the surgical population.

Developmental timing of initial racial discrimination exposure is associated with cardiovascular health conditions in adulthood.

OBJECTIVE: To examine the association between developmental timing of initial exposure to racial discrimination and cardiovascular health conditions. DESIGN: Using data from the 1995 Detroit Area Study, logistic and negative binomial regression models were used to assess the association between timing of initial exposure to racial/ethnic discrimination, classified as early childhood (0-7), childhood (8-12), adolescence (13-19), and adulthood (>19), on physician-diagnosed cardiovascular health conditions during adulthood. Each analysis adjusted for age, gender, race/ethnicity, income, education, marital status, health-related behaviors, and pre-existing health conditions. RESULTS: Of the 1,106 participants in the final sample, 520 identified as White and 586 identified as Black. Over half (64%) of the sample experienced at least one major cardiovascular health event at the time of the study, with 39% reporting two or more events. Results from logistic regression models showed that initial exposure to racial discrimination during early childhood was associated with a 2.96 (95%CI:1.15, 7.83) times greater odds of having any cardiovascular-related health condition later in life compared to individuals who reported no discrimination. Results from negative binomial regression models demonstrated that individuals who reported initial exposure to racial discrimination during early childhood and adolescence had a CVD incidence rate that was 1.63 (95%CI:1.11, 2.38) and 1.37 (95%CI:1.10, 1.69) times higher than individuals who reported no discrimination. CONCLUSION: Initial exposure to racial discrimination in early childhood and adolescence may increase the risk of cardiovascular conditions later in life. Clinicians and researchers should consider racial discrimination during childhood as a possible risk factor for illness and disease.

Prior COVID-19 Infection, Mental Health, Food and Financial Insecurity, and Association With COVID-19 Vaccination Coverage and Intent Among College-Aged Young Adults, US, 2021.

INTRODUCTION: More than 700,000 COVID-19 cases have been linked to American colleges and universities since the beginning of the pandemic. However, studies are limited on the effects of the pandemic on college-aged young adults and its association with their COVID-19 vaccination status and intent. METHODS: Using the Census Bureau's Household Pulse Survey (HPS), a large, nationally representative survey fielded from April 14 through May 24, 2021, we assessed the effects of the pandemic (COVID-19 infection, mental health, food and financial security) on COVID-19 vaccination coverage (≥1 dose) and intentions toward vaccination among college-aged young adults in the United States (N = 6,758). We examined factors associated with vaccination coverage and intent, and reasons for not getting vaccinated. RESULTS: Approximately one-fifth (19.6%) of college-aged young adults had a previous diagnosis of COVID-19, 43.5% and 39.1% reported having anxiety or depression, respectively, 10.9% reported that they sometimes or often did not have enough food to eat, and 22.6% and 12.3% found it somewhat or very difficult, respectively, to pay for household expenses. Of college-aged young adults, 63.1% had received at least 1 dose of the COVID-19 vaccine, 15.4% probably would be vaccinated or were unsure about getting the vaccine, and 14.0% probably will not or definitely will not get vaccinated. Adults who were non-Hispanic Black (vs non-Hispanic White) or had food or financial insecurities (vs did not) were less likely to be vaccinated or intend to be vaccinated. Among adults who probably will not or definitely will not be vaccinated, more than one-third said that they did not believe a vaccine was needed. CONCLUSION: Ensuring high and equitable vaccination coverage among college-aged young adults is critical for safely reopening in-person learning and resuming prepandemic activities.

The Maternal Impact, Health Burden, and Postpartum Sequela in Triplet Pregnancies: A Retrospective Cohort.

OBJECTIVE: The aim of the study is to describe the maternal health burden and perinatal outcomes in triplet pregnancies, and identify the maternal and pregnancy indicators associated with increased perinatal morbidity and mortality. STUDY DESIGN: This is a retrospective cohort study of triplet pregnancies from 2007 to 2014. Maternal data were manually collected and assessed until 6 weeks postpartum, and neonatal data were assessed until hospital discharge or death. RESULTS: Eighty-two triplet pregnancies were identified with 246 babies born. Mean gestational age at delivery was 32.3 (standard deviation [SD] ± 3.6) weeks and average birth weight was 1,726 g (SD ± 500). There were 12 perinatal deaths and 25 (10.2%) infants diagnosed with a congenital anomaly. Prior preterm birth and nulliparity had a negative impact on gestational age at delivery (p = 0.016) as compared with prior full-term births. Pregnancy complications (preeclampsia or hypertensive disorders [46.3%], gestational diabetes [28%], postpartum hemorrhage [9.8%], and blood transfusions [8.5%]) also impacted gestational age at delivery (33.0 vs. 34.0 weeks, p = 0.031). Spontaneous conception, chorionicity, and maternal medical problems did not have an impact on median gestational age. CONCLUSION: Nulliparity and presence of pregnancy complications are pertinent to triplet outcomes. This study provides valuable information for anticipatory guidance and preconception counseling to patients considering artificial reproductive technology.