Associations between follicular fluid trace elements and ovarian response during in vitro fertilization.

INTRODUCTION: Exposure to trace elements has been associated with ovarian response in experimental studies. We conducted a hypothesis-generating study of associations between ovarian follicular fluid (FF) trace elements and measures of ovarian response among women using in vitro fertilization (IVF). METHODS: We collected ovarian FF specimens from 56 women. We determined concentrations (µg/L) of 11 trace elements using inductively coupled plasma-tandem mass spectrometry. We estimated associations between women's FF trace elements per interquartile range difference, and measures of ovarian response using linear (peak estradiol (E2), baseline anti-mullerian hormone (AMH), and follicle stimulating hormone (FSH)) and negative binomial (baseline antral follicle count (AFC) and oocyte count) regression, adjusting for confounding factors. We used principal component analysis (PCA) to estimate the associations of the FF trace elements mixture. We also explored FF oxidative stress enzymes as causal mediators of the associations. RESULTS: Higher FF cobalt was associated with greater peak E2 (mean difference = 351.48 pg/mL; 95%CI: 21.76, 724.71) and AFC (rate ratio = 1.14; 95%CI: 1.01, 1.28), and higher FF copper was associated with greater peak E2 (mean difference = 335.66 pg/mL; 95%CI: 81.77, 753.08) and oocyte count (rate ratio = 1.19; 95%CI: 1.02, 1.43). Higher FF mercury was also associated with greater peak E2 (mean difference = 410.70 pg/mL; 95%CI: 61.90, 883.39). Higher FF lead was associated with lesser AFC (rate ratio = 0.85; 95%CI: 0.73, 0.98). Using PCA, the mixture of Sr, Hg, and As was associated with higher peak estradiol, AFC, and oocyte count. FF glutathione peroxidase, paraoxonase, and arylesterase activities were inconsistent mediators of the associations, but the effect estimates were imprecise. CONCLUSION: Our results suggest that essential and non-essential trace elements in FF were associated with ovarian response during IVF.

Early Life Anti-Müllerian Hormone Trajectories in Infant Girls.

BACKGROUND: Minipuberty is a period of increased reproductive axis activity in infancy, but the importance of this period is not well understood, especially in girls. Previous studies reported a peak in hormone concentrations at 3 to 4 months old. Our objective is to describe anti-Müllerian hormone (AMH) trajectories in the context of other minipuberty factors among healthy infant girls using longitudinal measures of AMH. METHODS: The Infant Feeding and Early Development study is a longitudinal cohort study of healthy infants, recruited from hospitals in the Philadelphia area during 2010 to 2013. We measured AMH in 153 girls who contributed 1366 serum samples across 11 study visits over 36 weeks. We also measured follicle stimulating hormone (FSH), estradiol, and ovarian characteristics. We used latent class mixed effects models to cluster trajectories of AMH concentration with age. Using linear mixed models, we estimated FSH and ovarian characteristic trajectories separately by AMH cluster. RESULTS: We classified infants into four clusters that represent patterns of AMH that were high and decreasing (decreasing), had a peak around 12 weeks or 20 weeks (early peak and middle peak), or were consistently low (low). Infants in these clusters differed in their FSH trajectories, timing of estradiol production, and ovarian characteristics. CONCLUSIONS: The AMH clusters identified suggest variation in the timing and the magnitude of the minipuberty response in infant girls. The decreasing and low clusters have not been described previously and should be further evaluated to determine whether they represent an opportunity for the early identification of later reproductive conditions.

Nutritional intake of riboflavin (vitamin B2) and migraine: a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2001-2004.

OBJECTIVES: Clinical studies demonstrate that supplemental riboflavin is an efficacious and low risk prophylactic treatment for migraine. However, background riboflavin intake of adults with migraine from nutritional sources has not been evaluated. This study aimed to evaluate riboflavin consumption of adults with migraine in the United States, and further investigate the relationship between nutritional riboflavin consumption and the prevalence of migraine among adults. METHODS: This cross-sectional secondary analysis included 3439 participants ages 20-50 years old in the National Health and Nutrition Examination Survey from 2001 to 2004. Presence of migraine in the past three months was self-reported. Riboflavin intake was determined from one 24-hour recall interview. Odds ratios and 95% confidence intervals were calculated for riboflavin intake quartiles using an adjusted logistic regression model. Statistical significance was determined using an adjusted Wald test. RESULTS: Results showed that mean dietary consumption of riboflavin fulfilled the Recommended Dietary Allowance for migraine and control groups. Dietary riboflavin intake was associated with the odds of migraine (pWald = 0.002), but no association was found for supplemental or total riboflavin consumption (pWald = 0.479 and 0.136). When stratified by gender, there was no association of dietary riboflavin with migraine in males (pWald = 0.423), but an association was observed in females (pWald = 0.014). DISCUSSION: The RDA value for riboflavin was not relevant for assessing odds of migraine; however, differing odds of migraine were detected across dietary riboflavin consumption groups at levels above the RDA. Future riboflavin supplementation trials for migraine prophylaxis should consider measuring background dietary intake.

Assessing the health estimation capacity of air pollution exposure prediction models.

BACKGROUND: The era of big data has enabled sophisticated models to predict air pollution concentrations over space and time. Historically these models have been evaluated using overall metrics that measure how close predictions are to monitoring data. However, overall methods are not designed to distinguish error at timescales most relevant for epidemiologic studies, such as day-to-day errors that impact studies of short-term health associations. METHODS: We introduce frequency band model performance, which quantifies health estimation capacity of air quality prediction models for time series studies of air pollution and health. Frequency band model performance uses a discrete Fourier transform to evaluate prediction models at timescales of interest. We simulated fine particulate matter (PM2.5), with errors at timescales varying from acute to seasonal, and health time series data. To compare evaluation approaches, we use correlations and root mean squared error (RMSE). Additionally, we assess health estimation capacity through bias and RMSE in estimated health associations. We apply frequency band model performance to PM2.5 predictions at 17 monitors in 8 US cities. RESULTS: In simulations, frequency band model performance rates predictions better (lower RMSE, higher correlation) when there is no error at a particular timescale (e.g., acute) and worse when error is added to that timescale, compared to overall approaches. Further, frequency band model performance is more strongly associated (R2 = 0.95) with health association bias compared to overall approaches (R2 = 0.57). For PM2.5 predictions in Salt Lake City, UT, frequency band model performance better identifies acute error that may impact estimated short-term health associations. CONCLUSIONS: For epidemiologic studies, frequency band model performance provides an improvement over existing approaches because it evaluates models at the timescale of interest and is more strongly associated with bias in estimated health associations. Evaluating prediction models at timescales relevant for health studies is critical to determining whether model error will impact estimated health associations.

Adipose to serum ratio and mixtures of persistent organic pollutants in relation to endometriosis: Findings from the ENDO Study.

BACKGROUND: Endometriosis is an estrogen-dependent disease. Endocrine disrupting chemicals (EDCs) and their mixtures may play an etiologic role. OBJECTIVES: We evaluated an adipose-to-serum ratio (ASR) of lipophilic EDCs and their mixtures associated with incident endometriosis. METHODS: We quantified 13 polychlorinated biphenyl (PCB) congeners, 6 polybrominated diphenyl ether (PBDE) congeners, and 11 organochlorine pesticides (OCPs) in serum and omental fat among women from the ENDO Study (2007-2009) aged 18-44 years diagnosed with (n=190) or without (n=283) surgically-visualized incident endometriosis. Odds ratios (OR) and 95% confidence intervals (CI) between ASR and endometriosis were estimated using logistic regression models adjusted for age (years), body mass index (kg/m2), serum cotinine (ng/ml), and breastfeeding conditional on parity. Bayesian hierarchical models (BHM) compared estimated associations for adipose and ASR to serum. Bayesian kernel machine regression (BKMR) estimated change in latent health and 95% posterior intervals (PI) between chemical mixtures and endometriosis. RESULTS: Select ASR for estrogenic PCBs and OCPs were associated with an increased odds of an endometriosis diagnosis, but not for anti-estrogenic PCBs or PBDEs. Across all chemicals, BHMs generated ORs that were on average 14% (95% PI: 6%, 22%) higher for adipose and 20% (95% PI: 12%, 29%) higher for ASR in comparison to serum. ORs from BHMs were greater for estrogenic PCBs and OCPs, with no differences for PBDEs. BKMR models comparing the 75th to 25th percentile were moderately associated with endometriosis for estrogenic PCBs [adipose 0.27 (95% PI: 0.18, 0.72) and ASR 0.37 (95% PI: 0.06, 0.80)] and OCPs [adipose 0.17 (95% PI: 0.21, 0.56) and ASR 0.26 (95% PI: 0.05, 0.57)], but not for antiestrogenic PCBs and PBDEs. DISCUSSION: ASR added little insight beyond adipose for lipophilic chemicals. BKMR results supported associations between ASR and adipose estrogenic PCB and OCP mixtures and incident endometriosis. These findings underscore the importance of choice of biospecimen and considering mixtures when assessing exposure-disease relationships.

Commuter types identified using clustering and their associations with source-specific PM2.5.

Traffic-related fine particulate matter air pollution (tr-PM2.5) has been associated with adverse health outcomes such as cardiopulmonary morbidity and mortality, with in-vehicle tr-PM2.5 exposure contributing to total personal pollution exposure. Trip characteristics, including time of day, day of the week, and traffic congestion, are associated with in-vehicle PM2.5 exposures. We hypothesized that some commuter characteristics, such as whether commuters travel primarily during rush hour, would also be associated with increased tr-PM2.5 exposures. The commute data consisted of unscripted personal vehicle trips of 46 commuters in the Washington, D.C. metro area over 48-h, with a total of 320 trips. We identified commuter types using sparse K-means clustering, which identifies the hours throughout the day important for clustering commuters. Source-specific PM2.5 over 48 h was estimated using Positive Matrix Factorization. Linear regression was used to estimate differences in source-specific PM2.5 by commuter cluster. Two commuter clusters were identified using the clustering approach: rush hour commuters, who primarily travelled during rush hour, and sporadic commuters, who travelled throughout the day. The hours given the largest weights by sparse K-means were 7-8 a.m. and 6-7 p.m., corresponding to peak travel times. Integrated black carbon (BC) was higher for rush hour commuters (median = 3.1 µg/m3 (IQR = 1.5)) compared to sporadic commuters (2.0 µg/m3 (IQR = 1.9)). Mobile PM2.5, consisting primarily of tailpipe emissions and brake/tire wear, was also higher for rush hour commuters (2.9 µg/m3 (IQR = 1.6)) compared to sporadic commuters (2.1 µg/m3 (IQR = 2.4)), though this difference was not statistically significant in regression models. Estimated differences between commuter types for secondary/mixed PM2.5 and road salt PM2.5 were smaller. Further research may elucidate whether commuter characteristics are an efficient way to identify individuals with highest tr-PM2.5 exposures associated with commuting and to develop effective mitigation strategies.

Urinary levels of environmental phenols and parabens and antioxidant enzyme activity in the blood of women.

BACKGROUND: The balance between oxidative stress and antioxidant enzymes is one biological mechanism by which environmental and lifestyle exposures affect health outcomes. Yet, no studies have examined the relationship between environmental phenolic compounds and parabens or their mixtures in relation to antioxidant enzyme activity in women of reproductive age. METHODS: Sixteen environmental phenols and parabens were measured in urine 2-5 times across two months of follow-up in 143 women aged 18-44 years. Four antioxidant enzymes, erythrocyte and plasma glutathione peroxidase (eGPx, pGPx), glutathione reductase (GSHR), superoxide dismutase (SOD) were measured in plasma. Linear mixed models were adjusted for age, body mass index, race, and creatinine and were weighted with inverse probability of exposure weights. Multi-chemical exposures were estimated using hierarchical principal component analysis (PCA). RESULTS: In line with our hypothesis that environmental phenols and parabens would be associated with decreased antioxidant enzymes, butyl, benzyl, ethyl, and propyl parabens were associated with lower levels of eGPx. Methyl paraben, 2,4-dichlorophenol and 2,5-dichlorophenol were associated with reduced SOD. 2,4,6-trichlorophenol was associated with increased levels of pGPx and GSHR. Several parabens were associated with modest decreases in eGPx and SOD, biomarkers of antioxidant defense. Increases in pGPx and GSHR were noted in relation to butyl and ethyl parabens. Co-exposures to parabens were associated with decreased eGPx (ß = -1.08, 95% CI: -1.74, -0.43) in principal components mixed models, while co-exposure to benzophenones-3 and -1 were associated with increased eGPx (ß = 0.92, 95% CI: 0.20, 1.64). CONCLUSION: These findings indicate that nonpersistent chemicals altered antioxidant enzyme activity. Further human studies are necessary to delineate the relationship between environmental phenol and paraben exposures with erythrocyte and plasma activities of antioxidant enzymes.

Estimating exposure to traffic-related PM2.5 for women commuters using vehicle and personal monitoring.

Exposure to traffic-related fine particulate matter air pollution (tr-PM2.5) has been associated with adverse health outcomes including preterm birth and low birthweight. In-vehicle exposure to tr-PM2.5 can contribute substantially to total tr-PM2.5 exposure. Because average commuting habits of women differ from men, a research gap is estimating in-vehicle tr-PM2.5 exposures for women commuters. For 46 women commuters in the Washington, D.C. metro area, we measured personal exposure to PM2.5 during all vehicle trips taken in a 48-h sampling period. We also measured 48-h integrated PM2.5 chemical constituents including black carbon and zinc. We identified trip times using vehicle monitors, specifically on-board diagnostics data loggers and dashboard cameras. For 386 trips, we estimated associations between PM2.5 exposure and trip characteristics using linear mixed models accounting for participant, day, and time of day. Additionally, we estimated associations between rush hour trip PM2.5 and 48-h integrated PM2.5 chemical constituents using linear models. Exposure to PM2.5 during trips was 1.9 µg/m3 (95% confidence interval (CI): 0.9, 2.9) higher than non-trip exposures and rush hour trip exposures were 3.2 µg/m3 (95% CI: 1.8, 4.6) higher than non-trip exposures on average. We did not find differences in PM2.5 exposure by trip length. Although concentrations of tr-PM2.5 chemical constituents were generally positively associated with rush hour trip PM2.5, associations were weak indicating that other settings contribute to total tr-PM2.5 exposure. Our study demonstrates the utility of combining vehicle monitors and personal PM2.5 monitors for estimating personal exposure to tr-PM2.5. Future work will investigate whether additional data collected by vehicle monitors, such as traffic and speed, can be leveraged to better understand tr-PM2.5 exposure among commuters.

College Students' Underestimation of Blood Alcohol Concentration from Hypothetical Consumption of Supersized Alcopops: Results from a Cluster-Randomized Classroom Study.

BACKGROUND: Supersized alcopops are a class of single-serving beverages popular among underage drinkers. These products contain large quantities of alcohol. This study examines the extent to which young adults recognize how intoxicated they would become from consuming these products. METHODS: The study sample included 309 undergraduates who had consumed alcohol within the past year. Thirty-two sections of a college English course were randomized to 1 of 2 survey conditions, based on hypothetical consumption of supersized alcopops or beer of comparable liquid volume. Students were provided an empty can of 1 of the 2 beverages to help them answer the survey questions. Equation-calculated blood alcohol concentrations (BACs)-based on body weight and sex-were compared to the students' self-estimated BACs for consuming 1, 2, and 3 cans of the beverage provided to them. RESULTS: In adjusted regression models, students randomized to the supersized alcopop group greatly underestimated their BAC, whereas students randomized to the beer group overestimated it. The supersized alcopop group underestimated their BAC by 0.04 (95% confidence interval [CI]: 0.034, 0.053), 0.09 (95% CI: 0.067, 0.107), and 0.13 g/dl (95% CI: 0.097, 0.163) compared to the beer group. When asked how much alcohol they could consume before it would be unsafe to drive, students in the supersized alcopop group had 7 times the odds of estimating consumption that would generate a calculated BAC of at least 0.08 g/dl, compared to those making estimates based on beer consumption (95% CI: 3.734, 13.025). CONCLUSIONS: Students underestimated the intoxication they would experience from consuming supersized alcopops. Revised product warning labels are urgently needed to clearly identify the number of standard drinks contained in a supersized alcopop can. Moreover, regulations are needed to limit alcohol content of single-serving products.

Alcohol retail sales licenses and sexually transmitted infections in Texas counties, 2008-2015.

BACKGROUND: Research suggests that reduced retail alcohol outlet density may be associated with lower prevalence of HIV and other sexually transmitted infections (STIs). On-premise sale of alcohol for immediate consumption is theorized as increasing social interactions that can lead to sexual encounters. OBJECTIVE: We examined associations between on- and off-premise retail alcohol sales licenses and number of newly diagnosed HIV and STI cases in Texas counties. METHODS: Retail alcohol sales license data were obtained from the Texas Alcoholic Beverage Commission. HIV and bacterial STI data were obtained from the Texas Department of State Health Services. Associations between retail alcohol sales licenses and STIs were estimated using spatial linear models and Poisson mixed effects models for over-dispersed count data. RESULTS: Adjusting for county-specific confounders, there was no evidence of residual spatial correlation. In Poisson models, each additional on-premise (e.g., bar and restaurant) alcohol license per 10,000 population in a county was associated with a 1.5% increase (95% CI: 0.4%, 2.6%) in the rate of HIV and a 2.4% increase (95% CI: 1.9%, 3.0%) in the rate of bacterial STIs, adjusting for potential confounders. In contrast, number of off-premise licenses (e.g., take-out stores) was inversely associated with the incidence of STI and HIV, although the association with HIV was not statistically significant. CONCLUSIONS: This study adds to the limited literature on the association between retail alcohol availability and STIs. Additional research is needed on the role of alcohol availability (and policies affecting availability) in the spread of HIV and other STIs.

Factors Associated with Self-Estimated Breath Alcohol Concentration Among Bar Patrons.

BACKGROUND: Few studies have examined the context in which drinkers underestimate their breath alcohol concentration (BrAC) in natural drinking environments. This study examined factors associated with bar patrons' self-estimated BrAC in high-risk college town settings. METHODS: Guided interview and BrAC data were collected from 510 participants recruited as they exited bars located close to large universities: 1 in Florida and 1 in Texas. RESULTS: Participants with the highest measured BrACs underestimated their BrAC levels the most. Findings from multivariable linear regression analysis indicated that BrAC (std ß = 0.014, p < 0.001), number of alcoholic drinks consumed (std ß = 0.006, p < 0.01), and perceived drunkenness (std ß = 0.024, p < 0.001) had significant positive associations with BrAC self-estimates, where the regression coefficients were scaled by values approximately equal to each variable's interquartile range. Among the 321 participants with BrAC levels ≥ 0.08 g/dl, 21.2% believed their BrAC was below the legal per se driving limit of 0.08 g/dl. Results from a logistic regression analysis indicated that higher levels of perceived drunkenness were associated with better self-recognition that one's BrAC level exceeded the legal driving threshold (OR = 3.312, p < 0.001). Further, participants under 26 years of age had reduced odds of recognizing that their BrAC was greater than 0.079 g/dl (OR = 0.245, p < 0.05). CONCLUSIONS: These findings highlight the inaccuracy of self-estimated BrAC when drinking, particularly among younger drinkers. Adjusting for BrAC, situational factors were strongly associated with self-estimated BrAC. Future research is needed to better understand how altering drinking environments may improve accuracy of BrAC self-estimates and deter driving after drinking.

A hierarchical modeling approach to estimate regional acute health effects of particulate matter sources.

Exposure to particulate matter (PM) air pollution has been associated with a range of adverse health outcomes, including cardiovascular disease hospitalizations and other clinical parameters. Determining which sources of PM, such as traffic or industry, are most associated with adverse health outcomes could help guide future recommendations aimed at reducing harmful pollution exposure for susceptible individuals. Information obtained from multisite studies, which is generally more precise than information from a single location, is critical to understanding how PM impacts health and to informing local strategies for reducing individual-level PM exposure. However, few methods exist to perform multisite studies of PM sources, which are not generally directly observed, and adverse health outcomes. We developed SHared Across a REgion (SHARE), a hierarchical modeling approach that facilitates reproducible, multisite epidemiologic studies of PM sources. SHARE is a two-stage approach that first summarizes information about PM sources across multiple sites. Then, this information is used to determine how community-level (i.e., county-level or city-level) health effects of PM sources should be pooled to estimate regional-level health effects. SHARE is a type of population value decomposition that aims to separate out regional-level features from site-level data. Unlike previous approaches for multisite epidemiologic studies of PM sources, the SHARE approach allows the specific PM sources identified to vary by site. Using data from 2000 to 2010 for 63 northeastern US counties, we estimated regional-level health effects associated with short-term exposure to major types of PM sources. We found that PM from secondary sulfate, traffic, and metals sources was most associated with cardiovascular disease hospitalizations. Copyright © 2017 John Wiley & Sons, Ltd.

Examining the dynamic, bidirectional associations between cognitive and physical functioning in older adults.

The delineation of the interrelationships between cognitive and physical functioning in older adults is critical to determining pathways to disability. By using longitudinal data from 395 initially high-functioning, community-dwelling older women in Baltimore, Maryland, from the Women's Health and Aging Study II (from 1994 to 2006), we simultaneously assessed associations of cognition with later physical functioning and associations of physical functioning with later cognition. The analysis included measures of global cognition and 2 cognitive domains (executive functioning and memory), as well as 2 measures of physical functioning (a Short Physical Performance Battery and a 4-meter test of usual walking speed). We found the strongest bidirectional associations of memory with physical functioning and less evidence of associations of physical functioning with executive functioning and global cognition. For a 1-standard deviation increase in walking speed, subsequent memory increased by 0.08 standard deviations (95% confidence interval: (0.03, 0.13)). For a 1-standard deviation increase in memory, subsequent walking speed increased by 0.07 standard deviations (95% confidence interval: 0.03, 0.10). Associations were similar in magnitude for models using a Short Physical Performance Battery. We did not find evidence that associations between cognitive and physical functioning varied over time. Our results suggest that cognition, and particularly memory, is associated with subsequent physical functioning and vice versa.

A scenario-based, randomized trial of patient values and functional prognosis on intensivist intent to discuss withdrawing life support.

OBJECTIVES: To evaluate the effect of 1) patient values as expressed by family members and 2) a requirement to document patients' functional prognosis on intensivists' intention to discuss withdrawal of life support in a hypothetical family meeting. DESIGN: A three-armed, randomized trial. SETTING: One hundred seventy-nine U.S. hospitals with training programs in critical care accredited by the Accreditation Council for Graduate Medical Education. SUBJECTS: Six hundred thirty intensivists recruited via e-mail invitation from a database of 1,850 eligible academic intensivists. INTERVENTIONS: Each intensivist was randomized to review 10, online, clinical scenarios with a range of illness severities involving a hypothetical patient (Mrs. X). In control-group scenarios, the patient did not want continued life support without a reasonable chance of independent living. In the first experimental arm, the patient wanted life support regardless of functional outcome. In the second experimental arm, patient values were identical to the control group, but intensivists were required to record the patient's estimated 3-month functional prognosis. MEASUREMENTS AND MAIN RESULTS: Response to the question: "Would you bring up the possibility of withdrawing life support with Mrs. X's family?" answered using a five-point Likert scale. There was no effect of patient values on whether intensivists intended to discuss withdrawal of life support (p = 0.81), but intensivists randomized to record functional prognosis were 49% more likely (95% CI, 20-85%) to discuss withdrawal. CONCLUSIONS: In this national, scenario-based, randomized trial, patient values had no effect on intensivists' decisions to discuss withdrawal of life support with family. However, requiring intensivists to record patients' estimated 3-month functional outcome substantially increased their intention to discuss withdrawal.

Characteristics of temper tantrums in preschoolers with disruptive behavior in a clinical setting.

The purpose of this study was to describe clinician-observed, naturally occurring temper tantrums in preschoolers ages 2 to 5.5 diagnosed with severe behavior problems. Participants were 24 mother-child dyads enrolled in an intensive outpatient treatment program. Clinicians timed and observed 330 temper tantrums, rated their intensity, and recorded occurrence of 16 behaviors, tantrum precipitants, and interventions; parents completed the Achenbach Child Behavior Checklist pre- and posttreatment. Data were analyzed using descriptive statistics, Pearson chi square, paired t tests, and generalized linear modeling. Mean tantrum duration was 3.4 minutes (range = 0.2 to 26.5 minutes); most tantrums were low in intensity. Noncompliance precipitated 52% of tantrums. Aggressive behaviors were more likely to occur early in tantrums, with distress behaviors occurring later. Parent surveys indicated perceptions of behavioral improvement but no change in tantrum behavior. Study findings corroborate those of previous studies using retrospective parent reports.

Is the relation between ozone and mortality confounded by chemical components of particulate matter? Analysis of 7 components in 57 US communities.

Epidemiologic studies have linked tropospheric ozone pollution and human mortality. Although research has shown that this relation is not confounded by particulate matter when measured by mass, little scientific evidence exists on whether confounding exists by chemical components of the particle mixture. Using mortality and particulate matter with aerodynamic diameter ≤2.5 µm (PM(2.5)) component data from 57 US communities (2000-2005), the authors investigate whether the ozone-mortality relation is confounded by 7 components of PM(2.5): sulfate, nitrate, silicon, elemental carbon, organic carbon matter, sodium ion, and ammonium. Together, these components constitute most PM(2.5) mass in the United States. Estimates of the effect of ozone on mortality were almost identical before and after controlling for the 7 components of PM(2.5) considered (mortality increase/10-ppb ozone increase, before and after controlling: ammonium, 0.34% vs. 0.35%; elemental carbon, 0.36% vs. 0.37%; nitrate, 0.27% vs. 0.26%; organic carbon matter, 0.34% vs. 0.31%; silicon, 0.36% vs. 0.37%; sodium ion, 0.21% vs. 0.18%; and sulfate, 0.35% vs. 0.38%). Additionally, correlations were weak between ozone and each particulate component across all communities. Previous research found that the ozone-mortality relation is not confounded by particulate matter measured by mass; this national study indicates that the relation is also robust to control for specific components of PM(2.5).

Does Older Age Modify Associations between Endocrine Disrupting Chemicals and Fecundability?

Urinary concentrations of several endocrine disrupting chemicals, including phthalate metabolites, bisphenol A (BPA), and benzophenone (BP)-type ultraviolet (UV) filters, have been associated with a longer time-to-pregnancy (TTP). Potential modification of these associations by couple's age has not been studied. TTP was defined as the number of prospectively observed menstrual cycles a couple attempted pregnancy until the occurrence of a human chorionic gonadotropic-detected pregnancy. Urinary concentrations of two BP-type UV filters and three phthalate metabolites were measured at baseline. Fecundability odds ratios (FORs) and 95% confidence intervals (CIs) were estimated for each chemical adjusting for age, body mass index, serum cotinine, creatinine, and accounting for right censoring and left truncation. Models evaluated effect modification between EDC concentrations and TTP by partner's age, dichotomized at 35 years. Separate models were run for male and female partners. No significant effect modification was observed for any EDC for either partner, but data were suggestive of a longer TTP among females aged ≥35 years, particularly for BP-2 (FOR = 0.61, 95% CI 0.36, 1.05) and 4-hydroxybenzophenone (FOR = 0.71, 95% CI: 0.46, 1.09) reflecting 39% and 29% reductions in fecundability, respectively. We saw no evidence of effect modification by couples' age on associations between TTP and urinary phthalate or BPA metabolite concentrations. Across the EDCs we examined, we found little evidence that age modifies TTP-exposure associations.

Sexual Assault, Campus Resource Use, and Psychological Distress in Undergraduate Women.

Undergraduate women are at high risk of experiencing sexual assault during their college years. Research has established a strong link between sexual victimization and psychological distress. Although the relationship between sexual victimization and distress has been established, little is known about how the use of university-affiliated sexual assault resources influences mental health outcomes for survivors. The aims of this cross-sectional study were to describe the characteristics of women who used campus survivor resources following a sexual assault during college, examine correlates of campus resource use, and examine correlates and predictors of mental health of women who have been sexually assaulted during college. An online anonymous survey was sent to undergraduate women at two public universities in a mid-Atlantic state. Participants were female, undergraduate students (N = 362) who had been sexually assaulted during their time at college. Few women (n = 98, 27.1%) used campus resources following a sexual assault. We found significant relationships between participants' use of campus survivor resources and experiencing a sexual assault prior to entering college, experiencing more severe sexual assaults, acknowledging the assault as a rape, feeling more self-blame, and experiencing more psychological distress. Campus resource use was significantly associated with poorer mental health outcomes. The cross-sectional nature of this study limited our ability to explore the reason for this. Further research is needed to explore the role campus resources play in supporting survivors during the recovery process. Given the high rate of sexual assaults on college campuses and the known negative psychological impact of sexual assault, it is imperative that campuses offer resources that are effective in meeting the needs of survivors.

Sexual Assault Survivors' Perceived Helpfulness of University-Affiliated Resources.

The goal of this study was to examine sexual assault survivors' use and perceived helpfulness of university-affiliated resources. Data were collected in online anonymous surveys from women (n = 98) at two universities who experienced a sexual assault during college and used university resources. Participants who perceived university-affiliated survivor resources as helpful had significantly better mental health outcomes than women who perceived resources as unhelpful. The most often used resources were mental health counseling (60.6%) and university health centers (24%). The most helpful resources were survivor advocates, peer counseling, and peer support groups.

Cigarette Use Before and After the 2009 Flavored Cigarette Ban.

PURPOSE: On September 22, 2009, the U.S. Food and Drug Administration's national ban on flavored cigarette products went into effect, barring the sale of flavored cigarettes with the exception of menthol. Flavored cigarettes largely appeal to and were disproportionately used by youth (under age 18 years). However, little research has evaluated the effects of the ban. This study examined past 30-day cigarette use among youth (12-17 years), young adults (18-25 years), adults (26-49 years), and older adults (≥50 years) before and after the implementation of this ban. METHODS: Analyses were conducted using 2002-2017 National Survey on Drug Use and Health (NSDUH) data (n = 893,226). Regression models-weighted for national representation-were used to examine past 30-day cigarette use before and after the flavored cigarette ban in different age groups, using a quasi-experimental design incorporating elements of interrupted time series and difference-in-differences design. This design was used to examine differences in pre- versus post-ban smoking within age groups and heterogeneous policy effects between age groups, to help adjust for the generally stronger tobacco control environment over time. RESULTS: The flavor ban was associated with statistically significant immediate increases as well as reductions over time in youth and young adult use of any cigarettes and menthol cigarettes, compared to older adults. In 2017, the predicted probability of youth and young adult cigarette smoking were reduced by 43% and 27%, respectively, compared to the model predicted probability in absence of the ban. No such effect was observed for older adults. The predicted probability of menthol use was reduced by 60% and 55% for youth and young adults, respectively. CONCLUSIONS: Findings support the effectiveness of flavored cigarette bans at reducing cigarette use among young people and suggest a substitution effect between flavored tobacco products.