The Burden of Injuries Associated With E-Bikes, Powered Scooters, Hoverboards, and Bicycles in the United States: 2019‒2022.

Objectives. To describe the national burden of injuries associated with e-bikes, bicycles, hoverboards, and powered scooters (micromobility devices) in the United States. Methods. We compared patterns and trends for 1 933 296 estimated injuries associated with micromobility devices from 2019 to 2022 using National Electronic Injury Surveillance System data. Results. The population-based rates of e-bike and powered scooter injuries increased by 293.0% and 88.0%, respectively. When reported, powered scooter injuries had the highest proportion for alcohol use (9.0%) compared with other modes, whereas e-bike injuries had the highest proportion for motor vehicle involvement (35.4%). Internal injuries were more likely among e-bike diagnoses than hoverboard and bicycle (P < .05), but fractures and concussions were more likely among hoverboard diagnoses compared with all other devices (P < .05). When helmet use was identified in clinical notes (20.3%), helmet usage was higher among e-bike injuries (43.8%) compared with powered scooter (34.8%) and hoverboard (30.3%) injuries but lower compared with bicycle injuries (48.7%). Conclusions. The incidence of severe e-bike and powered scooter injuries increased over the 4-year period. Public health stakeholders should focus on improved surveillance and prevention of injuries associated with electric micromobility devices. (Am J Public Health. Published online ahead of print September 12, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307820).

Using geographic effect measure modification to examine socioeconomic-related surface temperature disparities in New York City.

BACKGROUND: Lower socioeconomic (SES) communities are more likely to be situated in urban heat islands and have higher heat exposures than their higher SES counterparts, and this inequality is expected to intensify due to climate change. OBJECTIVES: To examine the relationship between surface temperatures and SES in New York City (NYC) by employing a novel analytical approach. Through incorporating modifiable features, this study aims to identify potential locations where mitigation interventions can be implemented to reduce heat disparities associated with SES. METHODS: Using the 2013-2017 American Community Survey, U.S Landsat-8 Analysis Ready Data surface temperatures (measured on 8/12/2016), and the NYC Land Cover Dataset at the census tract level (2098 tracts), this study examines the association between two components of tract-level SES (percentage of individuals living below the poverty line and the percentage of individuals without a high school degree) and summer day surface temperature in NYC. First, we examine this association with an unrestricted NYC linear regression, examining the city-wide association between the two SES facets and summer surface temperature, with additional models adjusting for altitude, shoreline, and nature-cover. Then, we assess geographic effect measure modification by employing the same models to three supplemental regression model strategies (borough-restricted and community district-restricted linear regressions, and geographically weighted regression (GWR)) that examined associations within smaller intra-city areas. RESULTS: All regression strategies identified areas where lower neighborhood SES composition is associated with higher summer day surface temperatures. The unrestricted NYC regressions revealed widespread disparities, while the borough-restricted and community district-restricted regressions identified specific political boundaries within which these disparities existed. The GWR, addressing spatial autocorrelation, identified significant socioeconomic heat disparities in locations such as northwest Bronx, central Brooklyn, and uptown Manhattan. These findings underscore the need for targeted policies and community interventions, including equitable urban planning and cooling strategies, to mitigate heat exposure in vulnerable neighborhoods. IMPACT STATEMENT: This study redefines previous research on urban socioeconomic disparities in heat exposure by investigating both modifiable (nature cover) and non-modifiable (altitude and shoreline) built environment factors affecting local temperatures at the census tract level in New York City. Through a novel analytical approach, the research aims to highlight intervention opportunities to mitigate heat disparities related to socioeconomic status. By examining the association between surface temperatures and socioeconomic status, as well as investigating different geographic and governmental scales, this study offers actionable insights for policymakers and community members to address heat exposure inequalities effectively across different administrative boundaries. The objective is to pinpoint potential sites for reducing socioeconomic heat exposure disparities at various geographic and political levels.

Use of Generative AI to Identify Helmet Status Among Patients With Micromobility-Related Injuries From Unstructured Clinical Notes.

Importance: Large language models (LLMs) have potential to increase the efficiency of information extraction from unstructured clinical notes in electronic medical records. Objective: To assess the utility and reliability of an LLM, ChatGPT-4 (OpenAI), to analyze clinical narratives and identify helmet use status of patients injured in micromobility-related accidents. Design, Setting, and Participants: This cross-sectional study used publicly available, deidentified 2019 to 2022 data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System, a nationally representative stratified probability sample of 96 hospitals in the US. Unweighted estimates of e-bike, bicycle, hoverboard, and powered scooter-related injuries that resulted in an emergency department visit were used. Statistical analysis was performed from November 2023 to April 2024. Main Outcomes and Measures: Patient helmet status (wearing vs not wearing vs unknown) was extracted from clinical narratives using (1) a text string search using researcher-generated text strings and (2) the LLM by prompting the system with low-, intermediate-, and high-detail prompts. The level of agreement between the 2 approaches across all 3 prompts was analyzed using Cohen κ test statistics. Fleiss κ was calculated to measure the test-retest reliability of the high-detail prompt across 5 new chat sessions and days. Performance statistics were calculated by comparing results from the high-detail prompt to classifications of helmet status generated by researchers reading the clinical notes (ie, a criterion standard review). Results: Among 54 569 clinical notes, moderate (Cohen κ = 0.74 [95% CI, 0.73-0.75) and weak (Cohen κ = 0.53 [95% CI, 0.52-0.54]) agreement were found between the text string-search approach and the LLM for the low- and intermediate-detail prompts, respectively. The high-detail prompt had almost perfect agreement (κ = 1.00 [95% CI, 1.00-1.00]) but required the greatest amount of time to complete. The LLM did not perfectly replicate its analyses across new sessions and days (Fleiss κ = 0.91 across 5 trials; P < .001). The LLM often hallucinated and was consistent in replicating its hallucinations. It also showed high validity compared with the criterion standard (n = 400; κ = 0.98 [95% CI, 0.96-1.00]). Conclusions and Relevance: This study's findings suggest that although there are efficiency gains for using the LLM to extract information from clinical notes, the inadequate reliability compared with a text string-search approach, hallucinations, and inconsistent performance significantly hinder the potential of the currently available LLM.

Clinical trauma severity of indoor and outdoor injurious falls requiring emergency medical service response.

BACKGROUND: Injurious falls represent a significant public health burden. Research and policies have primarily focused on falls occurring indoors despite evidence that outdoor falls account for 47-58% of all falls requiring some medical attention. This study described the clinical trauma severity of indoor versus outdoor injurious falls requiring Emergency Medical Services (EMS) response. METHODS: Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset, we identified the location of patients injured from falls that required EMS response. We classified injury severity using (1) the Revised Trauma Score for Triage (T-RTS): ≤ 11 indicated the need for transport to a Trauma Center; (2) Glasgow Coma Scale (GCS): ≤ 8 and 9-12 indicated severe and moderate neurologic injury; and (3) patient clinical acuity by EMS: Dead, Critical, Emergent, Low. RESULTS: Of 1,854,909 encounters for patients with injurious falls, the vast majority occurred indoors (n = 1,596,860) compared to outdoors (n = 152,994). For patients who fell indoors vs outdoors on streets or sidewalks, the proportions were comparable for moderate or severe GCS scores (3.0% vs 3.9%), T-RTS scores indicating need for transport to a Trauma Center (5.2% vs 5.9%) and EMS acuity rated as Emergent or Critical (27.7% vs 27.1%). Injurious falls were more severe among male patients compared to females and males injured by falling on streets or sidewalks had higher percentages for moderate or severe GCS scores (5.2% vs 1.9%) and T-RTS scores indicating the need for transport to a Trauma Center (7.3% vs 3.9%) compared to falling indoors. Young and middle-aged patients who fell on streets or sidewalks had higher proportions for a T-RTS score indicating the need for Trauma Center care compared to those in this subgroup who fell indoors. Yet older patients injured by falling indoors were more likely to have a T-RTS score indicating the need for transport to a Trauma Center than older patients who fell on streets or sidewalks. CONCLUSIONS: There was a similar proportion of patients with severe injurious falls that occurred indoors and outdoors on streets or sidewalks. These findings suggest the need to determine outdoor environmental risks for outdoor falls to support location-specific interventions.

Postpartum Obesity Is Associated With Increases in Child Adiposity in Midchildhood in a Cohort of Black and Dominican Youth.

Background: Obesity disproportionately affects marginalized and low-income populations. Birth parent obesity from the prenatal period and childhood has been associated with child obesity. It is unknown whether prenatal or postnatal birth parent obesity has differential effects on subsequent changes in adiposity and metabolic health in children. Objectives: We evaluated how birth parent obesity 7 y after delivery was associated with child body composition changes and cardiometabolic health in midchildhood and further assessed the influence of the perinatal and postpartum period on associations. Methods: Black and Dominican pregnant individuals were enrolled, and dyads (n = 319) were followed up at child age 7 and 9 y. Measures included, height, weight, waist circumference (WC), and percent body fat (BF%). Multiple linear regression was used to relate postpartum weight status with child outcomes accounting for attrition, and a series of secondary analyses were conducted with additional adjustment for perinatal weight status, gestational weight gain (GWG), and/or long-term weight retention to evaluate how these factors influenced associations. Results: Almost one-quarter (23%) of birth parents and 24.1% children were classified with obesity at child age 7 y, while at 9 y, 30% of children had obesity. Birth parent obesity at child age 7 y was associated with greater changes, from ages 7 to 9 y, in child BMI z-score (ß: 0.13; 95% CI: 0.02, 0.24) and BF% (ß: 1.15; 95% CI: 0.22, 2.09) but not obesity at age 9 y. All observed associations crossed the null after additional adjustment for prenatal factors. Conclusions: Birth parent obesity at 7-y postpartum is associated with greater gains in child BMI z-score and BF% in midchildhood. These associations diminish after accounting for prenatal size, suggesting a lasting impact of the perinatal environment and that interventions supporting families from the prenatal period through childhood are needed.

Neighborhood Archetypes and Cardiovascular Health in Black Breast Cancer Survivors.

Background: Maintaining cardiovascular health (CVH) is critical for breast cancer (BC) survivors, particularly given the potential cardiotoxic effects of cancer treatments. Poor CVH among Black BC survivors may be influenced by various area-level social determinants of health, yet the impact of neighborhood archetypes in CVH among this population remains understudied. Objectives: This study aimed to characterize the neighborhood archetypes where Black BC survivors resided at diagnosis and evaluate their associations with CVH. Methods: We assessed CVH 24 months post-diagnosis in 713 participants diagnosed between 2012 and 2017 in the Women's Circle of Health Follow-Up Study, a population-based study of Black BC survivors in New Jersey. Neighborhood archetypes, identified via latent class analysis based on 16 social and built environment features, were categorized into tertiles. Associations between neighborhood archetypes and CVH scores were estimated using polytomous logistic regression. Results: CVH scores were assessed categorically (low, moderate, and optimal) and as continuous variables. On average, Black BC survivors achieved only half of the recommended score for optimal CVH. Among the 4 identified archetypes, women in the Mostly Culturally Black and Hispanic/Mixed Land Use archetype showed the lowest CVH scores. Compared to this archetype, Black BC survivors in the Culturally Diverse/Mixed Land Use archetype were nearly 3 times as likely to have optimal CVH (relative risk ratio: 2.92; 95% CI: 1.58-5.40), with a stronger association observed in younger or premenopausal women. No significant CVH differences were noted for the other 2 archetypes with fewer built environment features. Conclusions: Neighborhood archetypes, integrating social and built environment factors, may represent crucial targets for promoting CVH among BC survivors.

Racial and ethnic disparities in robot-assisted radical prostatectomy: testing the physician-level segregated and differential treatment hypotheses.

BACKGROUND: Mechanisms underlying racial and ethnic disparities in robot-assisted radical prostatectomy (RARP) vs open radical prostatectomy (ORP) are unclear. We sought to test 2 physician-level hypotheses: 1) Segregated Treatment and 2) Differential Treatment. METHODS: This observational study used the New York State Cancer Registry linked to discharge records and included patients undergoing radical prostatectomy for localized prostate cancer from October 1, 2008 to December 31, 2018. For hypothesis 1, we examined the association between patient race and ethnicity and treating surgeon RARP use (high-use surgeons, low-use surgeons, and surgeons at non-RARP facilities). For hypothesis 2, we determined the association between patient race and ethnicity and receipt of RARP when matching on treating surgeon, age, year of procedure, and Gleason group. We explored the role of insurance in both analyses. RESULTS: This study included 18 926 patients (8.0% Hispanic, 16.9% non-Hispanic Black, 75.1% non-Hispanic White), with a mean age of 60.4 ± 7.1 years. Compared with non-Hispanic White patients, Hispanic and non-Hispanic Black patients had higher odds of being treated by low-RARP-use surgeons (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.20 to 3.88; OR = 1.76, 95% CI = 1.06 to 2.94, respectively) and by surgeons at non-RARP facilities (OR = 4.19, 95% CI = 2.18 to 8.07; OR = 4.60, 95% CI = 2.58 to 8.23, respectively). In the matched cohorts, Hispanic and non-Hispanic Black patients were less likely to receive RARP than non-Hispanic White patients (OR = 0.78, 95% CI = 0.62 to 0.98; OR = 0.75, 95% CI = 0.57 to 1.00, respectively). These associations were partially attenuated after accounting for insurance. CONCLUSIONS: Racial and ethnic disparities in RARP use are related to patients being treated by different surgeons and treated differently by the same surgeons. Identifying and addressing multilevel barriers to equitable surgical treatment is needed to reduce disparities among prostate cancer patients.

Home and school pollutant exposure, respiratory outcomes, and influence of historical redlining.

BACKGROUND: The discriminatory and racist policy of historical redlining in the United States during the 1930s played a role in perpetuating contemporary environmental health disparities. OBJECTIVE: Our objectives were to determine associations between home and school pollutant exposure (fine particulate matter [PM2.5], NO2) and respiratory outcomes (Composite Asthma Severity Index, lung function) among school-aged children with asthma and examine whether associations differed between children who resided and/or attended school in historically redlined compared to non-redlined neighborhoods. METHODS: Children ages 6 to 17 with moderate-to-severe asthma (N = 240) from 9 US cities were included. Combined home and school exposure to PM2.5 and NO2 was calculated based on geospatially assessed monthly averaged outdoor pollutant concentrations. Repeated measures of Composite Asthma Severity Index and lung function were collected. RESULTS: Overall, 37.5% of children resided and/or attended schools in historically redlined neighborhoods. Children in historically redlined neighborhoods had greater exposure to NO2 (median: 15.4 vs 12.1 parts per billion) and closer distance to a highway (median: 0.86 vs 1.23 km), compared to those in non-redlined neighborhoods (P < .01). Overall, PM2.5 was not associated with asthma severity or lung function. However, among children in redlined neighborhoods, higher PM2.5 was associated with worse asthma severity (P < .005). No association was observed between pollutants and lung function or asthma severity among children in non-redlined neighborhoods (P > .005). CONCLUSIONS: Our findings highlight the significance of historical redlining and current environmental health disparities among school-aged children with asthma, specifically, the environmental injustice of PM2.5 exposure and its associations with respiratory health.

Prevalence of indications of alcohol and drug use among patients treated for injurious falls by Emergency Medical Services.

Objective: To describe the distribution of alcohol and drug involvement in injurious falls by location and subtype of fall. Methods: Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset we identified 1,854,909 patients injured from falls requiring an Emergency Medical Services (EMS) response and determined the fall location (e.g. indoors or on street/sidewalk) and the EMS clinician's notation of alcohol or drug involvement. We analyzed substance involvement by fall subtype, location of fall and patient demographics. Results: Overall, for 7.4% of injurious falls there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use; alcohol use alone for 18.5% of falls, drugs alone for 1.7% of falls and alcohol and drugs for 0.9% of falls. Substance use prevalence was highest, at 30.3%, in the age group 21 to 64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors; alcohol use alone for 26.3%, drugs alone for 2.6%, and alcohol and drugs for 1.4%. Reported substance use involvement was more frequent for men compared to women for each location type. Conclusions: Overall, 1-in-5 injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

Comparing alcohol involvement among injured pedalcycle and motorcycle riders across three national public-use datasets.

BACKGROUND: Annually since 2008; over 38% of fatally injured motorcycle riders and 20% of pedalcyclists involved in traffic crashes were under the influence of alcohol, yet public health surveillance of alcohol involvement in these injuries is underdeveloped. This study determined alcohol involvement among fatally and non-fatally injured pedalcycle and motorcycle riders and compared findings across three national public-use datasets. METHODS: Using the 2019 National Emergency Medical Services Information System (NEMSIS), the Fatality Analysis Reporting System (FARS), and National Electronic Injury Surveillance System (NEISS) datasets, we identified alcohol involvement in fatal and non-fatal injuries to pedalcycle and motorcycle riders (≥21 years). Alcohol involvement was positive based on the clinician's evaluation of alcohol at the scene (NEMSIS) or within the ED record (NEISS); or when Blood Alcohol Content (BAC) values were ≥.01 (FARS). Pedalcycle and motorcycle injuries were identified across datasets using: 1) ICD10 codes for pedalcycle (V10-V19) or motorcycle (V20-V29) within the cause of injury and EMS respondent's impression of the encounter variables (NEMSIS); 2) product codes for bicycles or moped/power-assisted cycle/minibike/two-wheeled, powered, off-road vehicles (NEISS); and 3) American National Standard Institute's classifications for pedalcycle and motorcycle in the person and vehicle type variables (FARS). The descriptive epidemiology was compared across datasets. RESULTS: There were 26,295 pedalcyclist and 50,122 motorcycle rider injuries resulting in an EMS response within NEMSIS data; 10.2% and 8.5% of these injuries respectively involved alcohol. These estimates were greater than the 7.3% of pedalcyclist and 6.1% of moped/power-assisted cycle/minibike/two-wheeled, powered, off-road vehicle injuries involving alcohol among patients who presented to an ED within the NEISS dataset. Based on FARS data, alcohol was involved in 27.0% of pedalcyclist and 42.0% of motorcyclist fatal injuries. Regardless of the data source, pedalcyclist and motorcycle fatal and non-fatal injuries were more likely to involve alcohol among middle-aged adults compared to older and early aged adults, and for men compared to women, with proportions that were generally 3-8% higher for men. CONCLUSIONS: Measures for pedalcycle and motorcycle injuries and alcohol involvement vary substantially across national public-use datasets. Standardized, valid, and feasible methods are needed to accurately inform injury prevention efforts.

Population-Level Surveillance of Domestic Assaults in the Home Using the National Emergency Medical Services Information System (NEMSIS).

Violence in the home, including partner violence, child abuse, and elder abuse, is pervasive in the United States. An informatics approach allowing automated analysis of administrative data to identify domestic assaults and release timely and localized data would assist preventionists to identify geographic and demographic populations of need and design tailored interventions. This study examines the use of an established national dataset, the NEMSIS 2019, as a potential annual automated data source for domestic assault surveillance. An algorithm was used to identify individuals who utilized emergency medical services (EMS) for a physical assault in a private residence (N = 176,931). Descriptive analyses were conducted to define the identified population and disposition of patients. A logistic regression was performed to predict which characteristics were associated with consistent domestic assault identification by the on-scene EMS clinician and dispatcher. The sample was majority female (52.2%), White (44.7%), urban (85.5%), and 21-29 years old (24.4%). A disproportionate number of those found dead on scene were men (74.5%), and female patients more often refused treatment (57.8%) or were treated and then released against medical advice (58.4%). Domestic assaults against children and seniors had higher odds of being consistently identified by both the dispatcher and EMS clinician than those 21-49, and women had lower odds of consistent identification than men. While a more specific field to identify the type of domestic assault (e.g., intimate partner) would help inform specialized intervention planning, these data indicate an opportunity to systematically track domestic assaults in communities and describe population-specific needs.

Clinical Trauma Severity of Indoor and Outdoor Injurious Falls Requiring Emergency Medical Service Response.

Background: Injurious falls represent a significant public health burden. Research and polices have primarily focused on falls occurring indoors despite evidence that outdoor falls account for 47-58% of all falls requiring some medical attention. This study compared the clinical trauma severity of indoor versus outdoor injurious falls requiring Emergency Medical Services (EMS) response. Methods: Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset, we identified the location of patients injured from falls that required EMS response. We classified injury severity using 1) the Revised Trauma Score for Triage (T-RTS): ≤ 11 indicated the need for transport to a Trauma Center; 2) Glasgow Coma Scale (GCS): ≤8 and 9-12 indicated moderate and severe neurologic injury; and 3) patient clinical acuity by EMS: Dead, Critical, Emergent, Low. Results: Of 1,854,909 encounters for patients with injurious falls, the vast majority occurred indoors (n=1,596,860) compared to outdoors (n=152,994). The proportions of patients with moderate or severe GCS scores, were comparable between those with indoor falls (3.0%) and with outdoor falls on streets or sidewalks (3.8%), T-RTS scores indicating need for transport to a Trauma Center (5.2% vs 5.9%) and EMS acuity rated as Emergent or Critical (27.7% vs 27.1%).Injurious falls were more severe among male patients compared to females: and males injured by falling on streets or sidewalks had higher percentages for moderate or severe GCS scores (4.8% vs 3.6%) and T-RTS scores indicating the need for transport to a Trauma Center (7.3% vs 6.5%) compared to indoor falls. Young and middle-aged patients whose injurious falls occurred on streets or sidewalks were more likely to have a T-RTS score indicating the need for Trauma Center care compared to indoor falls among this subgroup. Yet older patients injured by falling indoors were more likely to have a T-RTS score indicating the need for Trauma Center than older patients who fell on streets or sidewalks. Conclusions: There was a similar proportion of patients with severe injurious falls that occurred indoors and on streets or sidewalks. These findings suggest the need to determine outdoor environmental risks for outdoor falls to support location-specific interventions.

Disadvantaged groups have greater spatial access to pharmacies in New York state.

BACKGROUND: The accessibility of pharmacies has been associated with overall health and wellbeing. Past studies have suggested that low income and racial minority communities are underserved by pharmacies. However, the literature is inconsistent in finding links between area-level income or racial and ethnic composition and access to pharmacies. Here we aim to assess area-level spatial access to pharmacies across New York State (NYS), hypothesizing that Census Tracts with higher poverty rates and higher percentages of Black and Hispanic residents would have lower spatial access. METHODS: The population weighted mean shortest road network distance (PWMSD) to a pharmacy in 2018 was calculated for each Census Tract in NYS. This statistic was calculated from the shortest road network distance to a pharmacy from the centroid of each Census block within a tract, with the mean across census blocks weighted by the population of the census block. Cross-sectional analyses were conducted to assess links between Tract-level socio demographic characteristics and Tract-level PWMSD to a pharmacy. RESULTS: Overall the mean PWMSD to a pharmacy across Census tracts in NYS was 2.07 Km (SD = 3.35, median 0.85 Km). Shorter PWMSD to a pharmacy were associated with higher Tract-level % poverty, % Black/African American (AA) residents, and % Hispanic/Latino residents and with lower Tract-level % of residents with a college degree. Compared to tracts in the lowest quartile of % Black/AA residents, tracts in the highest quartile had a 70.7% (95% CI 68.3-72.9%) shorter PWMSD to a pharmacy. Similarly, tracts in the highest quartile of % poverty had a 61.3% (95% CI 58.0-64.4%) shorter PWMSD to a pharmacy than tracts in the lowest quartile. CONCLUSION: The analyses show that tracts in NYS with higher racial and ethnic minority populations and higher poverty rates have higher spatial access to pharmacies.

Rhinorrhea and watery eyes in infancy and risk of attention-deficit hyperactivity disorder in school-age children.

Increased parasympathetic nervous system (PNS) activity is associated with attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms, but not hyperactive-impulsive symptoms, and may contribute to inattentive subtype etiology. Guided by prior work linking infant rhinorrhea and watery eyes without a cold (RWWC) to PNS dysregulation, we examined associations between infant RWWC and childhood ADHD symptoms in a longitudinal cohort of Black and Latinx children living in the context of economic disadvantage (N = 301 youth: 158 females, 143 males). Infant RWWC predicted higher inattentive (relative risk [RR] 2.16, p < .001) but not hyperactive-impulsive (RR 1.53, p = .065) ADHD symptoms (DuPaul scale), administered to caregivers at child age 8-14 years. Stratified analyses revealed that these associations were present in females but not males, who were three times more likely to have higher ADHD current total symptoms if they had infant RWWC than if they did not. Additionally, associations between RWWC and inattention symptoms were observed only in females. RWWC may thus serve as a novel risk marker of ADHD inattentive-type symptoms, especially for females.

Defining Spatial Epidemiology: A Systematic Review and Re-orientation.

BACKGROUND: Spatial epidemiology has emerged as an important subfield of epidemiology over the past quarter century. We trace the origins of spatial epidemiology and note that its emergence coincided with technological developments in spatial statistics and geography. We hypothesize that spatial epidemiology makes important contributions to descriptive epidemiology and analytic risk-factor studies but is not yet aligned with epidemiology's current focus on causal inference and intervention. METHODS: We conducted a systematic review of studies indexed in PubMed that used the term "spatial epidemiolog*" in the title, abstract, or keywords. Excluded articles were not written in English, examined disease in animals, or reported biologic pathogen distribution only. We coded the included papers into five categories (review, demonstration of method, descriptive, analytic, and intervention) and recorded the unit of analysis (i.e., individual vs. ecological). We additionally examined articles coded as analytic ecologic studies using scales for lexical content. RESULTS: A total of 482 articles met the inclusion criteria, including 76 reviews, 117 demonstrations of methods, 122 descriptive studies, 167 analytic studies, and 0 intervention studies. Demonstration studies were most common from 2006 to 2014, and analytic studies were most common after 2015. Among the analytic ecologic studies, those published in later years used more terms relevant to spatial statistics (incidence rate ratio =1.3; 95% confidence interval [CI] = 1.1, 1.5) and causal inference (incidence rate ratio =1.1; 95% CI = 1.1, 1.2). CONCLUSIONS: Spatial epidemiology is an important and growing subfield of epidemiology. We suggest a re-orientation to help align its practice with the goals of contemporary epidemiology.

Inverse associations of cord blood mitochondrial DNA copy number with childhood adiposity.

OBJECTIVE: The objective of this study was to examine associations between umbilical cord mitochondrial DNA copy number (mtDNAcn) and adiposity across childhood. METHODS: In a prospective birth cohort of Dominican and African American children from New York City, New York (1998-2006), mtDNAcn was measured in cord blood. Children (N = 336) were evaluated for their height, weight, and bioimpedance at age 5, 7, 9, and 11 years. We used linear mixed-effects models to assess associations of mtDNAcn tertiles in cord blood with child BMI, BMI z scores, fat mass index, and body fat percentage. Latent class growth models and interactions between mtDNAcn and child age or child age2 were used to assess associations between age and adiposity trajectories. RESULTS: BMI was, on average, 1.5 kg/m2 higher (95% CI: 0.58, 2.5) in individuals with mtDNAcn in the low- compared with the middle-mtDNAcn tertile. Results were similar for BMI z score, fat mass index, and body fat percentage. Moreover, children in the low-mtDNAcn group had increased odds of being in an "increasing" or "high-stable" adiposity class. CONCLUSIONS: Lower mtDNAcn at birth may predict greater childhood adiposity, highlighting the potential key role of perinatal mitochondrial function in adiposity during development.

Sex-Specific Depressive Symptom Trajectories Among Adolescents in Los Angeles County, 2013 to 2017.

Objective: After remaining stable for many years, the prevalence of depression among adolescents increased over the past decade, particularly among girls. In this study, we used longitudinal data from a cohort of high school students to characterize sex-specific trajectories of depressive symptoms during this period of increasing prevalence and widening gender gap in adolescent depression. Method: Using data from the Health and Happiness Cohort, a longitudinal 8-wave study of high school students residing in Los Angeles County from 2013 to 2017 (N = 3,393), we conducted a multiple-group, latent class growth analysis by sex to differentiate developmental trajectories in depressive symptoms scores measured by the Center for Epidemiological Studies- Depression (CES-D) scale (range, 0-60). Results: A 4-class solution provided the best model fit for both girls and boys. Trajectories among girls included low stable (35.1%), mild stable (42.8%), moderate decreasing (16.2%), and high arching (5.9%). Trajectories among boys included low stable (49.2%), mild increasing (34.7%), moderate decreasing (12.2%), and high increasing (3.9%). Average scores consistently exceeded or crossed the threshold for probable depression (≥16). Across comparable sex-specific trajectory groups, the average CES-D scores of girls were higher than those of boys, whose average scores increased over time. Conclusion: In a diverse cohort of students in Los Angeles County, depressive symptom trajectories were comparable to prior time periods but with a higher proportion of students in trajectories characterized by probable depression. Trajectories differed by sex, suggesting that future research should consider differential severity and onset of depression between boys and girls.

Patterns of B-cell lymphocyte expression changes in pre- and post-malignant prostate tissue are associated with prostate cancer progression.

BACKROUND: Inflammation characterized by the presence of T and B cells is often observed in prostate cancer, but it is unclear how T- and B-cell levels change during carcinogenesis and whether such changes influence disease progression. METHODS: The study used a retrospective sample of 73 prostate cancer cases (45 whites and 28 African Americans) that underwent surgery as their primary treatment and had a benign prostate biopsy at least 1 year before diagnosis. CD3+, CD4+, and CD20+ lymphocytes were quantified by immunohistochemistry in paired pre- and post-diagnostic benign prostate biopsy and tumor surgical specimens, respectively. Clusters of similar trends of expression across two different timepoints and three distinct prostate regions-benign biopsy glands (BBG), tumor-adjacent benign glands (TAG), and malignant tumor glandular (MTG) regions-were identified using Time-series Anytime Density Peaks Clustering (TADPole). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of time to biochemical recurrence associated with region-specific lymphocyte counts and regional trends. RESULTS: The risk of biochemical recurrence was significantly reduced in men with an elevated CD20+ count in TAG (HR = 0.81, p = 0.01) after adjusting for covariates. Four distinct patterns of expression change across the BBG-TAG-MTG regions were identified for each marker. For CD20+, men with low expression in BBG and higher expression in TAG compared to MTG had an adjusted HR of 3.06 (p = 0.03) compared to the reference group that had nominal differences in CD20+ expression across all three regions. The two CD3+ expression patterns that featured lower CD3+ expression in the BBG compared to the TAG and MTG regions had elevated HRs ranging from 3.03 to 4.82 but did not reach statistical significance. CONCLUSIONS: Longitudinal and spatial expression patterns of both CD3+ and CD20+ suggest that increased expression in benign glands during prostate carcinogenesis is associated with an aggressive disease course.

Examining racial and ethnic heat exposure disparities in New York City (NYC) across different spatial and political scales through geographic effect measure modification.

Structural racism in the United States has resulted in neighborhoods with higher proportions of non-Hispanic Black (Black) or Hispanic/Latine residents having more features that intensify, and less that cool, the local-heat environment. This study identifies areas of New York City (NYC) where racial/ethnic heat exposure disparities are concentrated. We analyzed data from the 2013-2017 American Community Survey, U.S Landsat-8 Analysis Ready Data on summer surface temperatures, and NYC Land Cover Dataset at the census tract-level (n = 2098). Four cross-sectional regression modeling strategies were used to estimate the overall City-wide association, and associations across smaller intra-city areas, between tract-level percent of Black and percent Hispanic/Latine residents and summer day surface temperature, adjusting for altitude, shoreline, and nature-cover: overall NYC linear, borough-specific linear, Community District-specific linear, and geographically weighted regression models. All three linear regressions identified associations between neighborhood racial and ethnic composition and summer day surface temperatures. The geographically weighted regression models, which address the issue of spatial autocorrelation, identified specific locations (such as northwest Bronx, central Brooklyn, and uptown Manhattan) within which racial and ethnic disparities for heat exposures are concentrated. Through examining the overall effects and geographic effect measure modification across spatial scales, the results of this study identify specific geographic areas for intervention to mitigate heat exposure disparities experienced by Black and Hispanic/Latine NYC residents.