Predicting dental caries outcomes in young adults using machine learning approach.

OBJECTIVES: To predict the dental caries outcomes in young adults from a set of longitudinally-obtained predictor variables and identify the most important predictors using machine learning techniques. METHODS: This study was conducted using the Iowa Fluoride Study dataset. The predictor variables - sex, mother's education, family income, composite socio-economic status (SES), caries experience at ages 9, 13, and 17, and the cumulative estimates of risk and protective factors, including fluoride, dietary, and behavioral variables from ages 5-9, 9-13, 13-17, and 17-23 were used to predict the age 23 D2+MFS count. The following machine learning models (LASSO regression, generalized boosting machines (GBM), negative binomial (NegGLM), and extreme gradient boosting models (XGBOOST)) were compared under 5-fold cross validation with nested resampling techniques. RESULTS: The prevalence of cavitated level caries experience at age 23 (mean D2+MFS count) was 4.75. The predictive analysis found LASSO to be the best performing model (compared to GBM, NegGLM, and XGBOOST), with a root mean square error (RMSE) of 0.70, and coefficient of determination (R2) of 0.44. After dichotomization of the predicted and observed values of the LASSO regression, the classification results showed accuracy, precision, recall, and ROC AUC of 83.7%, 85.9%, 93.1%, 68.2%, respectively. Previous caries experience at age 13 and age 17 and sugar-sweetened beverages intakes at age 13 and age 17 were found to be the four most important predictors of cavitated caries count at age 23. CONCLUSION: Our machine learning model showed high accuracy and precision in the prediction of caries in young adults from a longitudinally-obtained predictor variables. Our model could, in the future, after further development and validation with other diverse population data, be used by public health specialists and policy-makers as a screening tool to identify the risk of caries in young adults and apply more targeted interventions. However, data from a more diverse population are needed to improve the quality and generalizability of caries prediction.

Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs).

OBJECTIVE: To assess sudden unexpected infant death (SUID) investigations for structural inequities by race/ethnicity and geography. METHODS: The SUID Case Registry compiles data on death investigations. We analyzed cases from 2015 to 2018 (N = 3847) to examine likelihood of an incomplete death investigation, defined as missing autopsy, missing scene investigation, or missing detailed information about where and how the body was found. We also analyzed which specific components of death investigations led to the greatest number of incomplete investigations. RESULTS: Twenty-four percent of SUIDs had incomplete death investigations. Death scenes in rural places had 1.51 times the odds of incomplete death investigations (95% confidence interval [CI], 1.19-1.92) compared with urban areas. Scene investigations led by law enforcement were more likely to result in incomplete death investigations (odds ratio [OR] = 1.49; 95% CI, 1.18-1.88) than those led by medical examiners. American Indian/Alaska Native SUIDs were more likely than other racial groups to have an incomplete investigation (OR = 1.49; 95% CI, 0.92-2.42), more likely to occur in rural places ( P = .055), and more likely to be investigated by law enforcement ( P < .001). If doll reenactments had been performed, 358 additional cases would have had complete investigations, and if SUID investigation forms had been performed, 243 additional cases would have had complete investigations. American Indian/Alaska Native SUIDs were also more likely to be missing specific components of death investigations. CONCLUSION: To produce equitable public health surveillance data used in prevention efforts, it is crucial to improve SUID investigations, especially in rural areas and among American Indian/Alaska Native babies.

The association between playing professional American football and longevity.

Recent research concludes that professional American football players (hereafter, "football players") live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s-906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).

Predicting Dental Caries Outcomes in Young Adults Using Machine Learning Approach.

OBJECTIVES: To predict the dental caries outcomes in young adults from a set of longitudinally-obtained predictor variables and identify the most important predictors using machine learning techniques. METHODS: This study was conducted using the Iowa Fluoride Study dataset. The predictor variables - sex, mother's education, family income, composite socio-economic status (SES), caries experience at ages 9, 13, and 17, and the cumulative estimates of risk and protective factors, including fluoride, dietary, and behavioral variables from ages 5-9, 9-13, 13-17, and 17-23 were used to predict the age 23 D2+MFS count. The following machine learning models (LASSO regression, generalized boosting machines (GBM), negative binomial (NegGLM), and extreme gradient boosting models (XGBOOST)) were compared under 5-fold cross validation with nested resampling techniques. RESULTS: The prevalence of cavitated level caries experience at age 23 (mean D2+MFS count) was 4.75. The predictive analysis found LASSO to be the best performing model (compared to GBM, NegGLM, and XGBOOST), with a root mean square error (RMSE) of 0.70, and coefficient of determination (R2) of 0.44. After dichotomization of the predicted and observed values of the LASSO regression, the classification results showed accuracy, precision, recall, and ROC AUC of 83.7%, 85.9%, 93.1%, 68.2%, respectively. Previous caries experience at age 13 and age 17 and sugar-sweetened beverages intakes at age 13 and age 17 were found to be the four most important predictors of cavitated caries count at age 23. CONCLUSION: Our machine learning model showed high accuracy and precision in the prediction of caries in young adults from a longitudinally-obtained predictor variables. Our model could, in the future, after further development and validation with other diverse population data, be used by public health specialists and policy-makers as a screening tool to identify the risk of caries in young adults and apply more targeted interventions. However, data from a more diverse population are needed to improve the quality and generalizability of caries prediction.

Dental caries incidence and associated factors in young adults.

OBJECTIVES: To assess the caries incidence from late adolescence to early adulthood and to identify the factors associated with caries incidence. METHODS: This is a secondary analysis of longitudinal caries data of young adults aged 17-23 from the Iowa Fluoride Study cohort. The inclusion criteria required completion of dental exams at both ages 17 and 23 and having cumulative exposure (AUC) variables data for at least 8 out of the 11 time periods between ages 17 and 23. Mean imputation was used to handle the missing explanatory variable data. Multiple linear regressions were conducted using a generalized linear model to assess the effects of sociodemographic and behavioral/dietary variables on the age 17-23 adjusted cavitated caries (D2+ MFS) increment (AdjCI17-23 ). Multicollinearity was assessed using the variance inflation factor (VIF) and the final model was selected based on the Akaike Information Criterion (AIC) using backward selection and the net effects calculated. RESULTS: The mean AdjCI17-23 was 2.08 (SD = 4.02). The net effects (main effect plus interactions) of higher composite socioeconomic status, higher combined daily fluoride intake, higher frequency of milk intake, lower amount of sugar-sweetened beverages intake, and lower age 17 dental caries counts were associated with lower mean AdjCI17-23 . CONCLUSION: The incidence of caries from age 17 to 23 in this study was low. This study suggests and reinforces the need to continue to advocate for caries preventive strategies such as fluoride use, encouraging milk intake, and reducing sugar-sweetened beverage intakes.

Assessing the Acceptability of Less Invasive Caries Removal Techniques for treating Deep Carious Lesions: A Conjoint Survey among Dentists Practicing in a Midwestern American State.

This study identified factors that influence dentists' decisions regarding less invasive caries removal techniques such as stepwise removal (SW) and selective removal (SE) using a marketing research technique, conjoint analysis. A survey was sent to 1,434 dentists practicing in Iowa. Dentists were randomly assigned to receive a questionnaire to rate the likelihood they would use either SW/SE in hypothetical clinical scenarios. The scenarios were carefully created by conjoint design and included three relevant attributes: depth of lesion, hardness of carious dentin, and patient age. Descriptive and conjoint analyses were performed to assess trade-offs between these attributes, using SPSS. The study revealed that depth of lesion was the most important factor in the dentists' decisions (49 importance value) when choosing a SW to treat a deep carious lesion, followed by hardness of carious dentin and patient age (21 importance value). For the SE group, depth of the lesion was also the predominant factor when selecting a treatment. The study also identified that a high proportion of dentists (24.9%) indicated they would never consider using SW or SE under any circumstances. Our survey showed that depth of lesion was the most important reason to select a less invasive caries removal method. The high proportion of dentists indicating they would never consider selective caries removal (SE) techniques suggests that these less invasive options are underutilized.

Diastereoselective and Scalable Synthesis of 6-(S)-Hydroxycannabidivarin.

The synthesis of 6-(S)-hydroxycannabidivarin was required to assess its biological activity in the treatment of neurological disorders. A novel and scalable synthesis has been developed where the key step involves a Friedel-Crafts alkylation of phloroglucinol with (1S,2R,5R)-2-hydroxy-2-methyl-5-(prop-1-en-2-yl)cyclohex-3-en-1-ylbenzoate. Careful optimization of the reaction conditions identified trifluoromethanesulfonic acid in isopropyl acetate as the best catalyst/solvent combination, providing optimum regioselectivity, diastereoselectivity, and yield for this step. This enabled the multigram synthesis of 6-(S)-hydroxycannabidivarin in 10 steps from S-(+)-carvone.

Trajectories of Dental Caries From Childhood to Young Adulthood: Unsupervised Machine Learning Approach.

Objective: To determine the dental caries trajectories over the life course (from age 9 to 23) using an unsupervised machine learning approach. Methods: This is a longitudinal study of caries trajectories over a life course using data from 1,382 individuals from the Iowa Fluoride Study birth cohort. The trajectory analysis of caries in the permanent dentition at ages 9, 13, 17 and 23 was performed using the unsupervised machine learning algorithm known as K-means for Longitudinal Data (KmL), a k-means based clustering algorithm implemented in R specifically designed for analyzing longitudinal data. The trajectory grouping was performed by assessing the distances of the individual trajectories from the centroid and the prediction of the "best" partition was performed based on the Calinsky & Harabatz criterion. The number of cluster partitions assessed was 2 to 6. The number of re-runs with different starting conditions for each number of clusters was 20. Results: The trajectory analysis identified three trajectory groups with 70.5%, 21.1%, and 8.4% of participants in the low, medium, and high caries trajectory groups, respectively. The mean D2+MFS counts of the low caries trajectory groups at ages 9, 13, 17, and 23 were 0.23, 0.37, 1.10, and 1.56, respectively. The mean D2+MFS counts of the medium caries trajectory groups at ages 9, 13, 17, and 23 were 0.92, 2.09, 6.24, and 9.55, respectively. The mean D2+MFS counts of the high caries trajectory groups at ages 9, 13, 17, and 23 were 1.49, 4.80, 12.91, and 22.52, respectively. There were steeper increases in the D2+MFS scores of the three trajectory groups between age 13 and 17, with less steep but also strongly positive slopes from age 17 to 23, suggesting that the period from age 13 to 17 is the highest risk period. Conclusion: There was an increase in the trajectory slopes after age 13 which might be due to changes in risk factors. The next step in this study will be to identify those factors that predict trajectory group membership by modeling their relationships using supervised machine learning techniques.

Family deaths in the early life course and their association with later educational attainment in a longitudinal cohort study.

Due to structural racism and pathways between racism and health, Black and Native American people die at younger ages than white people. This means that those groups are likely to experience deaths of family members at younger ages. Evidence is mixed about whether family deaths affect educational attainment. We aim to 1) estimate the prevalence of family deaths by age and race 2) estimate the effect of a family death on later educational attainment and 3) analyze whether the effect of a family death varies by age, socioeconomic status, gender, and race. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a nationally representative sample of U.S. adolescents in grades 7-12 at baseline in 1994-1995. Add Health has a large and racially diverse sample and records family deaths across the entire life course starting from birth. Participants were included in this analysis if they reported their educational attainment in Wave IV (N = 14,796). The racial group with the lowest proportion experiencing a sibling or parent death in the first 23 years of their lives was white participants (11.7%), followed by Asian (12.5%), Hispanic (15.0%), Black (24.3%) and Native American participants (30.3%). In adjusted models, those who experienced a family death had 0.60 times the odds (95% CI 0.51-0.71) of achieving a bachelor's degree compared to those without a family death. Mother deaths, father deaths, and sibling deaths were each harmful for obtaining a college degree and their effects were similar in magnitude. The age range when the effect of a family death was strongest was 10-13 years old (OR = 0.52 95% CI 0.40-0.67). The effect of a family death on college degree attainment did not vary by baseline parent education, participant sex, or race/ethnicity.

Integrating patient-centered caries management in dental education-A practical approach.

Caries management is undergoing an evolution in dental education. This is part of a larger change in thinking focused on the person/patient as well as procedures to bring health to people. This perspective attempts to tell the story of the dental education culture regarding caries management from perspectives of evidence-based care; caries as a disease of a person, not only a tooth; and the management of high-risk and low-risk individuals. Culturally and organizationally, the integration of basic, procedural, behavioral, and demographic perspectives for dental caries has happened at different rates for some decades. The involvement of students, teaching faculty, course directors, and administration is essential in this process.

Generalized permanent dentition fluorosis severity becomes less evident over time among a birth cohort.

Objectives: There are relatively few cohort studies which have examined changes in fluorosis appearance over time, and none of these have assessed changes in generalized fluorosis. In this analysis, we quantified and assessed changes in multiple measures of generalized fluorosis severity through childhood, adolescence, and young adulthood. Methods: Participants were from the Iowa Fluoride Study, a birth cohort recruited from 1992 to 1995. Permanent dentition fluorosis exams were carried out at ages 9, 13, 17, and 23 years using the Fluorosis Risk Index (FRI). Generalized fluorosis was assessed using mean FRI scores at the tooth- and person-level as well as a five-category measure of generalized fluorosis. Generalized fluorosis prevalence and severity was summarized at each time point and differences in adjacent time points were assessed using gamma statistics, signed-rank tests, and plotting changes in generalized fluorosis between adjacent time points. Results: We observed a statistically significant decline in the percentage of non-zero mean FRI scores at later exam ages at both the person- and tooth-levels. Based on our five-category generalized fluorosis measure, there were 34.0%-54.1% of participants with generalized fluorosis at baseline for each tooth group, and these percentages declined to 8.9%-27.2% at the age 23-year exam. Conclusions: We observed a statistically significant decline in generalized fluorosis severity scores and overall prevalence at later exam ages across all three measures of generalized fluorosis severity. This trend should be accounted for when estimating the prevalence of fluorosis in a population using fluorosis severity data collected in children and adolescents.

Childhood Growth and Socioeconomic Outcomes in Early Adulthood Evidence from the Inter-War United States.

Childhood malnutrition and its later life effects were important concerns in European and North American social policy in the early twentieth century. However, there have been few studies of the long-term socioeconomic consequences of malnutrition in childhood. We use a unique longitudinal dataset to provide credible causal estimates of the effects of childhood nutrition on early-adult educational and employment outcomes. Our dataset includes 2,499 children in Saint Paul, Minnesota who were weighed and measured in a national children's health survey in 1918/1919 at 0-6 years of age. We observe those same people in the 1920, 1930 and 1940 U.S. censuses allowing us to measure childhood socioeconomic status (1920), adolescent school attendance (1930) and early-adult wages, and employment and educational attainment (1940). Examining variation between biological siblings, we are able to obtain credibly causal estimates of the relationship between childhood stature and weight and later life outcomes, largely canceling out the bias otherwise resulting from their joint correlation with genes and socioeconomic background. Because the initial survey located children within households, we identify the effect of differences in early childhood nutrition from differences between male siblings. Consistent with contemporary evidence from developing countries we find that being taller and heavier in early childhood is associated with better educational and labor market outcomes. Identifying all effects within families to control for socioeconomic background and family structure we find a standard deviation increase in BMI in early childhood was associated with a 3% increase in weekly earnings and that boys who were heavier for their age at the initial survey were 10% less likely to be unemployed in 1940. Taken together, these results confirm the importance of investments in early life health for later-life outcomes.

Describing and explaining age, period, and cohort trends in Americans' vocabulary knowledge.

For a quarter of a century researchers have been documenting and trying to explain trends in Americans' vocabulary knowledge using data from the General Social Survey (GSS) and its WORDSUM test. Trends in Americans' vocabulary knowledge have important practical implications-for example, for educational policy and practice-and speak to the American workforce's competitiveness in the global knowledge economy. We contribute to this debate by analyzing 1978-2018 GSS data using an improved analytical approach that is consistent with theoretical notions of cohort effects and that permits simultaneously estimating inter-cohort average differences and intra-cohort life-course changes. We find that WORDSUM scores peak around age 35 and gradually decline in older ages; the scores were significantly lower in the 1980s and higher in the late 2000s and 2010s; and the 1940-1954 birth cohorts and the 1965 and later birth cohorts had notably higher and lower scores, respectively, than the expectation based on age and period main effects. We provide new evidence that such cohort differences tend to persist over the life course. Interestingly, the effects of increasing educational attainment and decreasing reading behaviors seemed to cancel out, leading to a relatively flat overall period trend. Trends in television viewing and word obsolescence did not appear to affect age, period, or cohort trends in WORDSUM scores. Supplementary Information: The online version contains supplementary material available at 10.1007/s11113-023-09771-5.

Estimating the Long-Term Causal Effects of Attending Historically Black Colleges or Universities on Depressive Symptoms.

Racism is embedded in society, and higher education is an important structure for patterning economic and health outcomes. Historically Black Colleges and Universities (HBCUs) were founded on antiracism while predominantly White institutions (PWIs) were often founded on white supremacy. This contrast provides an opportunity to study the association between structural racism and health among Black Americans. We used the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate the long-term causal effect of attending an HBCU (vs. PWI) on depressive symptoms among Black students in the United States from 1994-2018. While we found no overall association with attending an HBCU (vs. PWI) on depressive symptoms, we found that this association varied by baseline mental health and region, and across time. For example, among those who attended high school outside of the South, HBCU attendance was protective against depressive symptoms 7 years later, and the association was strongest for those with higher baseline depressive symptoms. We recommend equitable state and federal funding for HBCUs, and that PWIs implement and evaluate antiracist policies to improve mental health of Black students.

Patterns of fluoride intake from 6 to 17 years of age: The Iowa Fluoride Study.

OBJECTIVES: This article reports on estimated daily fluoride intake from water, other beverages and selected foods, dentifrice, and dietary fluoride supplements by both individual sources, and all sources combined, among 787 children participating in the Iowa Fluoride Study (IFS) from 6 to 17 years of age. METHODS: Total daily fluoride intake (mg F) and fluoride intake per kilogram bodyweight (mg F/kg bw) were estimated using responses to questionnaires sent every 3-6 months. Dietary assessments included frequencies and amounts of beverage intake for the previous week from water, milk, ready-to-drink beverages, beverages made by adding water to concentrate or powder, and selected foods with substantial water content. Descriptive statistics and bivariate and multivariable analyses with linear mixed models were used to assess associations with each of mg F and mg F/kg bw. RESULTS: Mean combined dietary fluoride (mg F) from all sources examined in the study increased slightly with age, whereas the fluoride intake per kg bw decreased with age. Age, sex, and socioeconomic status were significantly associated with fluoride intake (mg F and mg F/kg bw). Each year increase in age was associated with a 0.02-mg increase in fluoride consumption, on average, after adjusting for the effects of covariates. CONCLUSIONS: Daily mean fluoride intakes from single and combined sources were relatively stable, while the intake of fluoride per kg bw decreased from 6 to 17 years of age. Fluoridated water was the major source of ingested fluoride, contributing over 50% of total daily intake at all ages.

Early life exposure to cigarette smoking and adult and old-age male mortality: Evidence from linked US full-count census and mortality data.

BACKGROUND: Smoking is a leading cause of premature death across contemporary developed nations, but few longitudinal individual-level studies have examined the long-term health consequences of exposure to smoking. OBJECTIVE: We examine the effect of fetal and infant exposure to exogenous variation in smoking, brought about by state-level cigarette taxation, on adulthood and old-age mortality (ages 55-73) among cohorts of boys born in the United States during the 1920s and 1930s. METHODS: We use state-of-the-art methods of record linkage to match 1930 and 1940 US full-count census records to death records, identifying early life exposure to the implementation of state-level cigarette taxes through contemporary sources. We examine a population of 2.4 million boys, estimating age at death by means of OLS regression, with post-stratification weights to account for linking selectivity. RESULTS: Fetal or infant exposure to the implementation of state cigarette taxation delayed mortality by about two months. Analyses further indicate heterogenous effects that are consistent with theoretical expectations; the largest benefits are enjoyed by individuals with parents who would have been affected most by the tax implementation. CONCLUSIONS: Despite living in an era of continuously increasing cigarette consumption, cohorts exposed to a reduction in cigarette smoking during early life enjoyed a later age at death. While it is not possible to comprehensively assess the treatment effect on the treated, the magnitude of the effect should not be underestimated, as it is larger than the difference between having parents belonging to the highest and lowest socioeconomic groups. CONTRIBUTION: The study provides the first estimates of long-run health effects from early life exposure to cigarette smoking.

Childhood lead exposure is associated with lower cognitive functioning at older ages.

The Flint, Michigan water crisis renewed concern about lead toxicity in drinking water. While lead in drinking water has been shown to negatively affect cognition among children, much less is known about its long-term consequences for late-life cognition. Using a nationally representative sample of U.S. older adults linked to historical administrative data from 1940, we find that older adults who lived as children in cities with lead pipes and acidic or alkaline water-the conditions required for lead to leach into drinking water-had worse cognitive functioning but not steeper cognitive decline. About a quarter of the association between lead and late-life cognition was accounted for by educational attainment. Within the next 10 years, American children exposed to high levels of lead during the 1970s will enter older ages. Our evidence highlights the need for stronger actions to identify interventions to mitigate long-term damage among people at high risk.

"You're Not from Around Here:" Regional Naming and Life Outcomes.

We examine the socioeconomic consequences of discrimination against people of Southern origins during the U.S. Great Migration of the first half of the 20th century. We ask whether people living in the American North and Midwest in 1940 fared worse with respect to education, occupation, and income if they were perceived to be of Southern origins. We also assess variation in these effects across racial groups and across actual region of origin groups. Using linked data from the 1920 and 1940 U.S. Censuses, we compare the life outcomes of about half a million pairs of brothers who differed with respect to the regional origin implied by their first names. For both whites and blacks, we find statistically significant associations between outcomes and the regional origin implied by names; regardless of where they were born, men living in the North or Midwest in 1940 did worse if their names implied Southern origins. However, these associations are entirely confounded by family-specific cultural, socioeconomic, and other factors that shaped both family naming practices and life outcomes. This finding-that regional discrimination in the early 20th century U.S. did not happen based on names-contrasts sharply with findings from research in more recent years that uses names as proxies for people's risk of exposure to various forms of discrimination. Whereas names are a basis for discrimination in modern times, they were not a basis for regional discrimination in an era in which people had more immediate and direct evidence about regional origins.