Assessing variability of aerosols generated from e-Cigarettes.

While some in vitro and in vivo experiments have studied the toxic effects of e-cigarette (e-cig) components, the typical aerosol properties released from e-cigarettes have not been well characterized. In the present study, we characterized the variability in mass concentration and particle size distribution associated with the aerosol generation of different devices and e-liquid compositions in an experimental setup. The findings of this study indicate a large inter-day variability in the experiments, likely due to poor quality control in some e-cig devices, pointing to the need for a better understanding of all the factors affecting exposures in in vitro and in vivo experiments, and the development of standardized protocols for generation and measurement of e-cig aerosols.

Maternal exposure to polycyclic aromatic hydrocarbons in South Texas, evaluation of silicone wristbands as personal passive samplers.

BACKGROUND: Prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) is associated with adverse health effects in children. Valid exposure assessment methods with accurate spatial and temporal resolution across pregnancy is a critical need for advancing environmental health studies. OBJECTIVE: The objective of this study was to quantify maternal PAH exposure in pregnant women residing in McAllen, Texas where the prematurity rate and childhood asthma prevalence rates are high. A secondary objective was to compare PAH levels in silicone wristbands deployed as passive samplers with concentrations measured using standardized active air-sampling techniques. METHODS: Participants carried a backpack that contained air-sampling equipment (i.e., filter and XAD sorbent) and a silicone wristband (i.e., passive sampler) for three nonconsecutive 24-h periods. Filters, XAD tubes, and wristbands were analyzed for PAHs. RESULTS: The median level of exposure for the sum of 16 PAHs measured via active sampling over 24 h was 5.54 ng/m3 (filters) and 43.82 ng/m3 (XADs). The median level measured in wristbands (WB) was 586.82 ng/band. Concentrations of the PAH compounds varied across sampling matrix type. Phenanthrene and fluorene were consistently measured for all participants and in all matrix types. Eight additional volatile PAHs were measured in XADs and WBs; the median level of exposure for the sum of these eight PAHs was 342.98 ng/m3 (XADs) and 632.27 ng/band. The silicone wristbands (WB) and XAD sorbents bound 1-methynaphthalyne, 2-methylnaphthalene, biphenyl following similar patterns of detection. SIGNIFICANCE: Since prior studies indicate linkages between PAH exposure and adverse health outcomes in children at the PAH levels detected in our study, further investigation on the associated health effects is needed. Data reflect the ability of silicone wristbands to bind smaller molecular weight, semivolatile PAHs similar to XAD resin. Application of wristbands as passive samplers may be useful in studies evaluating semivolatile PAHs.

Multigenerational Epigenetic Regulation of Allergic Diseases: Utilizing an Experimental Dust Mite-Induced Asthma Model.

Environmental exposures have been linked to increased asthma risk, particularly during pregnancy and in early life. Here we use a mouse model of allergic lung disease to examine the effects of pre- and perinatal house dust mite (HDM) allergen exposure on offspring phenotypic and transcriptional outcomes in three generations. We show that maternal HDM exposure (F0) acts synergistically with adult HDM exposure, leading to enhanced airway hyperresponsiveness (AHR) and lung inflammation when compared to mice exposed solely in adulthood. Additionally, a subset of F1 males were not challenged in adulthood, and used to generate F2 progeny, which was then used to generate F3 progeny. Upon adult challenge to HDM, F2, and F3 males generated from the maternal HDM (F0) exposure lineage displayed increased airway reactivity and inflammation when compared to mice exposed solely in adulthood. These findings indicate that maternal allergen exposure is capable of enhancing either susceptibly to or severity of allergic airway disease. To examine the role of epigenetic inheritance of asthma susceptibility induced by maternal HDM exposure, we utilized a genome-wide MeDIP-seq and hMeDIP-seq analysis to identify genes differentially methylated (DMG) and hydroxymethylated (DHG), and their association with the enhanced AHR. In addition, we validated the relationship between DNA methylation and mRNA expression of the DMGs and DHGs in the male sub-generations (F1-F3). We found the expression of Kchn1, Nron, and Spag17 to be differentially hydroxymethylated and upregulated in the F1 exposed to HDM both in early life and in adulthood when compared to F1 mice exposed solely in adulthood. Kcnh1 remained upregulated in the F2 and F3 from the maternal HDM (F0) exposure lineage, when compared to F1 mice exposed solely in adulthood. In summary, we demonstrated that maternal HDM exposure in early life can alter the gene expression and phenotype of offspring upon adult HDM exposure, resulting in more severe disease. These effects persist at least two generations past the initial insult, transmitted along the paternal line.

Application of the navigation guide systematic review methodology to evaluate prenatal exposure to particulate matter air pollution and infant birth weight.

Low birth weight is an important risk factor for many co-morbidities both in early life as well as in adulthood. Numerous studies report associations between prenatal exposure to particulate matter (PM) air pollution and low birth weight. Previous systematic reviews and meta-analyses report varying effect sizes and significant heterogeneity between studies, but did not systematically evaluate the quality of individual studies or the overall body of evidence. We conducted a new systematic review to determine how prenatal exposure to PM2.5, PM10, and coarse PM (PM2.5-10) by trimester and across pregnancy affects infant birth weight. Using the Navigation Guide methodology, we developed and applied a systematic review protocol [CRD42017058805] that included a comprehensive search of the epidemiological literature, risk of bias (ROB) determination, meta-analysis, and evidence evaluation, all using pre-established criteria. In total, 53 studies met our inclusion criteria, which included evaluation of birth weight as a continuous variable. For PM2.5 and PM10, we restricted meta-analyses to studies determined overall as "low" or "probably low" ROB; none of the studies evaluating coarse PM were rated as "low" or "probably low" risk of bias, so all studies were used. For PM2.5, we observed that for every 10 µg/m3 increase in exposure to PM2.5 in the 2nd or 3rd trimester, respectively, there was an associated 5.69 g decrease (I2: 68%, 95% CI: -10.58, -0.79) or 10.67 g decrease in birth weight (I2: 84%, 95% CI: -20.91, -0.43). Over the entire pregnancy, for every 10 µg/m3 increase in PM2.5 exposure, there was an associated 27.55 g decrease in birth weight (I2: 94%, 95% CI: -48.45, -6.65). However, the quality of evidence for PM2.5 was rated as "low" due to imprecision and/or unexplained heterogeneity among different studies. For PM10, we observed that for every 10 µg/m3 increase in exposure in the 3rd trimester or the entire pregnancy, there was a 6.57 g decrease (I2: 0%, 95% CI: -10.66, -2.48) or 8.65 g decrease in birth weight (I2: 84%, 95% CI: -16.83, -0.48), respectively. The quality of evidence for PM10 was rated as "moderate," as heterogeneity was either absent or could be explained. The quality of evidence for coarse PM was rated as very low/low (for risk of bias and imprecision). Overall, while evidence for PM2.5 and course PM was inadequate primarily due to heterogeneity and risk of bias, respectively, our results support the existence of an inverse association between prenatal PM10 exposure and low birth weight.

In utero ultrafine particulate matter exposure causes offspring pulmonary immunosuppression.

Early life exposure to fine particulate matter (PM) in air is associated with infant respiratory disease and childhood asthma, but limited epidemiological data exist concerning the impacts of ultrafine particles (UFPs) on the etiology of childhood respiratory disease. Specifically, the role of UFPs in amplifying Th2- and/or Th17-driven inflammation (asthma promotion) or suppressing effector T cells (increased susceptibility to respiratory infection) remains unclear. Using a mouse model of in utero UFP exposure, we determined early immunological responses to house dust mite (HDM) allergen in offspring challenged from 0 to 4 wk of age. Two mice strains were exposed throughout gestation: C57BL/6 (sensitive to oxidative stress) and BALB/C (sensitive to allergen exposure). Offspring exposed to UFPs in utero exhibited reduced inflammatory response to HDM. Compared with filtered air (FA)-exposed/HDM-challenged mice, UFP-exposed offspring had lower white blood cell counts in bronchoalveolar lavage fluid and less pronounced peribronchiolar inflammation in both strains, albeit more apparent in C57BL/6 mice. In the C57BL/6 strain, offspring exposed in utero to FA and challenged with HDM exhibited a robust response in inflammatory cytokines IL-13 and Il-17. In contrast, this response was lost in offspring exposed in utero to UFPs. Circulating IL-10 was significantly up-regulated in C57BL/6 offspring exposed to UFPs, suggesting increased regulatory T cell expression and suppressed Th2/Th17 response. Our results reveal that in utero UFP exposure at a level close to the WHO recommended PM guideline suppresses an early immune response to HDM allergen, likely predisposing neonates to respiratory infection and altering long-term pulmonary health.

Maternal exposure to PM2.5 in south Texas, a pilot study.

In this study, we characterized personal exposure to fine particulate matter (PM2.5), black carbon (BC), and nicotine in pregnant women in Hidalgo County, where the hospitalization rates of childhood asthma are the highest in the state of Texas. The measurements were conducted over three non-consecutive sampling days for 17 participants in their third trimester. Measurements were partitioned into four microenvironments, i.e., Residential, Vehicular, Commercial, and Other, on the basis of GPS coordinates and temperature and humidity measurements. The daily average PM2.5 mass concentration was 24.2 (standard deviation=22.0) µg/m3, with the highest daily mass concentration reaching 126.0µg/m3. The daily average BC concentration was 1.44 (SD=0.82) µg/m3, ranging from 0.5 to 5.4µg/m3. Hair nicotine concentrations were all near the detection level (i.e., 49.2pg/mg), indicating that the participants were not routinely exposed to tobacco smoke. The Residential microenvironment contributed dominantly to the mass concentration since the participants chiefly remained at home and cooking activities contributed significantly to the total PM2.5. When compared to an ambient monitoring station, the person-specific PM2.5 was frequently more than double the ambient measurement (10.4µg/m3 overall), revealing that even in regions where ambient concentrations are below national standards, individuals may be still be exposed to elevated PM2.5 mass concentrations.

Characteristics Associated with HPV Diagnosis and Perceived Risk for Cervical Cancer Among Unmarried, Sexually Active College Women.

Human papillomavirus (HPV) has been identified as the leading cause of cervical cancer. While HPV risk factors have been well studied, less is known about those with HPV and their perceptions about health ramifications. The purposes of this study were to examine unmarried college student women's (1) HPV diagnosis status and (2) perceived risk of getting cervical cancer in the next 5 years. Data were analyzed from 1106 unmarried, sexually active college women aged 18 to 26. Binary logistic regression compared HPV-related knowledge, vaccination-related perceptions, mandate support, healthcare utilization, sexual behaviors, and personal characteristics. Multinomial logistic regression was performed to assess the degree to which these factors were associated with perceived risk of cervical cancer diagnosis. Relative to those not diagnosed with HPV, participants who had more lifetime sex partners (P < 0.001), unprotected sex during last intercourse (P = 0.003), Pap test in the past year (P < 0.001), and perceived themselves to be at higher risk for cervical cancer (P < 0.001) were significantly more likely to be diagnosed with HPV. Those with HPV were more likely to support HPV vaccination mandates (P = 0.036) and have fewer friends vaccinated (P = 0.002). Participants who were uninsured (P = 0.011), diagnosed with HPV (P < 0.001), and had a family member (P < 0.001) or friend (P < 0.001) with cervical cancer were more likely to perceive themselves at risk for developing cervical cancer in the next 5 years. Findings indicate women with HPV, despite engaging in risky sexual behaviors, acknowledge their cervical cancer risk and may be strong advocates for HPV vaccination mandates to protect youth against this preventable virus.

HPV Vaccination Status and Mandate Support for School-Aged Adolescents Among College Females.

The purpose of this study was to describe college-aged females' human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire during February to March 2011. This descriptive study utilizes χ2 tests and t-tests to compare participant responses. HPV-related knowledge scores were 8.08 out of 11 points. Those who initiated HPV vaccination were significantly younger, single, engaged in sex, were sexually active, and had a Pap test. Participants who had more friends receiving the vaccine were significantly more likely to support mandates for 9-11 and 12-17 years and were more likely to complete the HPV vaccination cycle. Findings suggest the importance of educational programs adopted and delivered by school nurses, which aim to improve student knowledge and reduce misconceptions related to the HPV vaccine and vaccination mandates.

Factors Associated with College Students' Intentions to Vaccinate Their Daughters Against HPV: Protecting the Next Generation.

Human papillomavirus (HPV) is a contemporary public health concern because of its association with cervical cancer. Despite evidence about HPV vaccination benefits, debate surrounds whether or not to vaccinate American youth. While no nationwide mandate exists, understanding the behaviors and intentions of future parents may provide insight about our ability to protect the next generation of school-aged youth. The purposes of this study were to examine factors associated with unmarried college students' intentions to: (1) vaccinate their daughters against HPV and (2) give their daughters the choice about whether or not to be vaccinated. Data were analyzed from 1606 college students aged 18-26 using an internet-delivered questionnaire. Two binary logistic regression analyses were performed identifying predictor variables associated with participants' intentions when having daughters in the future to vaccinate them against HPV and whether or not they would let their daughters decide to get the vaccination. Relative to those who did not intend to vaccinate their daughters against HPV, participants who were female (OR 1.55, P = 0.018), sexually active (OR 1.62, P = 0.001), diagnosed with HPV (OR 2.64, P < 0.001), received a flu shot in the past 12 months (OR 1.63, P = 0.002), perceived the HPV vaccine to be safe (OR 1.19, P < 0.001), and supported HPV vaccination mandates for school-aged youth (OR 2.58, P < 0.001) were more likely to report intentions of vaccinating their daughters against HPV. Participants who were sexually active (OR 1.45, P = 0.002) and perceived the HPV vaccine to be safe (OR 1.05, P = 0.012) were more likely to report they would allow their daughters to choose whether to be vaccinated against HPV. Until HPV vaccination mandates are enacted, parental support of vaccines are among the most effective way of increasing vaccine uptake. Identifying HPV vaccination support among future parents has potential to inform parent vaccination education programs related and advocacy for HPV vaccination policies.

Texercise select effectiveness: an examination of physical activity and nutrition outcomes.

Given the role of physical activity (PA) and good nutrition to delay the onset and progression of most chronic conditions, effective interventions are needed to influence lifestyle behaviors of community-dwelling populations. The purpose of this study is to examine the effectiveness of Texercise Select to improve health indicators, PA, and dietary behaviors, and confidence to engage in healthful behaviors. Texercise Select, a 12-week exercise program, was delivered. Baseline and 12-week follow-up assessments were collected from 220 participants with baseline data who were aged 45 years and older for this non-randomized one-group pre-post design trial. Linear mixed models were fitted for continuous outcome variables and GEE models with logit link function for binary outcome variables. Significant improvements (P < 0.05) were seen in physical activity scores (d = 0.64 for aerobic activity), weekly fruit/vegetable consumption (d = 0.31), daily water consumption (d = 0.29), as well as PA- and nutrition-related confidence (d =0.38 and 0.21, respectively) and social support (d =0.45). Programs rooted in best practices show promise for positively impacting large numbers of participants and becoming sustainably embedded in communities over time.

Motivations, Barriers, and Behaviors Related to Obtaining and Discussing Family Health History: A Sex-Based Comparison Among Young Adults.

BACKGROUND: Genetic predisposition is a risk factor for many chronic diseases, yet little is known about the frequency in which college students seek out their family health history or with whom they communicate relevant information. PURPOSE: This study examines motivations and barriers associated with obtaining one's family health history and discussing it with others. METHODS: Data were analyzed from 625 college students using an internet-delivered questionnaire, which comprised of questions about intentions and motivations to obtain and share family health history as well as barriers encountered when obtaining family health history. Responses were bifurcated by participants' sex. Chi-squared and t statistics were used to identify response differences by sex. RESULTS: Females were significantly more likely than males to be motivated to obtain their family health history, and more likely to have shared their family health history with others; state that they would share their family health history with others; and express a preference for sharing their family health history with a wider range of people. DISCUSSION: Educational interventions and improved student health services could be effective mechanisms to increase college students' knowledge, awareness, and perceived importance of obtaining their family health history.

Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps.

BACKGROUND: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. OBJECTIVE: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. METHODS: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. RESULTS: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen's kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. CONCLUSIONS: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice.

Texercise Effectiveness: Impacts on Physical Functioning and Quality of Life.

This study examines the effectiveness of Texercise Select, a 12-week lifestyle program to improve physical functioning (as measured by gait speed) and quality of life. Baseline and 12-week follow-up assessments were collected from 220 enrollees who were older (mean = 75 years), predominantly female (85%), White (82%), and experiencing multiple comorbidities (mean = 2.4). Linear mixed-models were fitted for continuous outcome variables and GEE models with logit link function for binary outcome variables. At baseline, over 52% of participants had Timed Up-and-Go (TUG) test times of 12 s or more, which indicates below-normal performance. On average, participants showed significant reductions in TUG test scores at the postintervention (11% reduction, p < .001). Participants also showed significant improvements in general health status (p = .002), unhealthy physical days (p = .032), combined unhealthy physical and mental days (p = .006), and days limited from usual activity (p = .045). Findings suggest that performance indicators can be objectively collected and integrated into evaluation designs of community-based, activity-rich lifestyle programs.

Psychosocial correlates of smokeless tobacco use among Indiana adolescents.

Adolescent tobacco use is influenced by intrapersonal (e.g., impulse control) and external factors, such as behaviors of friends and peers. The relationships of these factors to smokeless tobacco (ST) use are not yet fully understood. This is especially true as it pertains to the simultaneous examination of psychological and normative perceptions. Using constructs of the Biopsychosocial Model, this study investigates factors associated with lifetime ST use among middle and high school students. Data were analyzed from 938 Indiana middle and high school students. Binary sequential logistic regression was performed to examine the relationship of personal characteristics and psychosocial measures to adolescent lifetime ST use. Approximately 9 % reported having ever used ST, among which 78.6 % were male. Females and younger students were less likely to have used ST in their lifetime, whereas participants with a sibling smoker and those who compared their life to the lives of others were more likely to report lifetime ST usage. In the presence of psychological and normative variables, sex, age, and comparing one's life to others remained significant. Additionally, participants who perceived higher friend approval of substance use were significantly more likely to report lifetime ST use. Understanding the normative perceptions of adolescents may lend insight into the drivers of ST use adolescent subgroups and, which may enable community and school officials to tailor interventions to prevent ST initiation and promote cessation.

Support for HPV vaccination mandates for both females and males.

OBJECTIVES: To examine college students' support for HPV vaccination mandates for school-aged youth and examine perceptions and behavioral factors associated with vaccine mandate support for both boys and girls. METHODS: Data were collected from 1322 college students by an Internet-delivered questionnaire. Bivariate analyses and logistic regression were performed. RESULTS: Relative to those who did not support HPV vaccination mandates for school-aged boys and girls, females (p = .038), non-white participants (p = .001), those who generally supported HPV vaccination mandates (p < .01), and those who had had sexual intercourse (p = .005) were significantly more likely to support HPV mandates for both sexes. CONCLUSIONS: Identifying those who support HPV vaccination mandates is important for increasing vaccine uptake and reducing HPV-related cancers.

Obesity and perceived severity of obstructive sleep apnea-related conditions.

This study examined risk factors and perceived severity of obstructive sleep apnea-related conditions among college students based on weight categories. Data collected from 1399 college students were analyzed using multinomial and binary logistic regressions. Overweight and obese participants were more likely to snore and report familial risk for cardiovascular disease compared with their normal weight counterparts. Relative to normal weight participants, obese participants perceived snoring (odds ratio [OR] = 1.10), irritability (OR = 1.16), and high blood pressure (OR = 1.21) as more severe; they perceived erectile dysfunction (OR = 0.89) and cardiovascular disease (OR = 0.71) as less severe. Efforts are needed to identify obstructive sleep apnea risk and create systems for weight loss interventions, screening, and diagnosis.

Correlates of high school freshman girls' reported reasons for engaging in sexual intercourse.

BACKGROUND: Intrapersonal and external factors, including social pressures and the desire for acceptance from peers, influence sexual activity among adolescents. This study examined how personal characteristics, risky behaviors, normative beliefs, household factors, and engagement in extracurricular activities were related to high school freshman girls' reported reasons for having sexual intercourse. METHODS: Baseline data were analyzed from 158 girls enrolled in high school-based abstinence-only-until-marriage education programs during their freshman year. Binary logistic regression was performed to identify factors associated with Pressures and Reasons for Engaging in Sex Scale (PRESS) scores. RESULTS: Results indicate that girls with high PRESS scores were significantly more likely to have had sex (OR = 4.29), consumed alcohol within the previous year (OR = 6.13), reported strict household rules (OR = 1.49), and thought more girls their age had sex (OR = 1.67). CONCLUSION: School- and family-based interventions should be developed to encourage and strengthen parent-teen communication within the household and reinforce self-worth and positive self-perceptions among adolescent girls.

Cancer prevention among adults aged 45-64 years: setting the stage.

As part of setting the stage for this supplement to the American Journal of Preventive Medicine, a life-course perspective is presented to assist in understanding the importance of cancer prevention for adults in midlife, a period roughly spanning 20 years between ages 45 and 64 years. Drawing on disciplinary perspectives from the social sciences and public health, several life-course themes are delineated in this article: how specific life transitions present unique opportunities for interventions to inform policy and practice that can improve population health outcomes; how interventions can be focused on those at particular life stages or on the entire life course; and how the onset and progression of chronic conditions such as cancer are dependent on a complex interplay of critical and sensitive periods, and trajectory and accumulation processes. A translational research framework is applied to help promote the movement of applied public health interventions for cancer prevention into practice. Also explored are differences that can affect people at midlife relative to other age cohorts. Specifically, cancer-related risks and care networks are examined, with examples of public health strategies that can be applied to cancer prevention and control. As a conclusion, select methodologic issues and next steps for advancing research and practice are identified.

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.