Longer time-to-treatment but better survival for colorectal cancer patients presumptively not diagnosed in a hospital.

PURPOSE: To evaluate time-to-treatment and survival time in colorectal cancer (CRC) patients who presumptively were not diagnosed in a hospital. METHODS: Colorectal tumor-level data from Georgia Cancer Registry (GCR) was merged with American Hospital Association data for 2010-2015 using hospital identification number. Patients with tumors lacking a diagnosis hospital in the GCR were classified as presumptive non-hospital diagnosis (PNHD). Cox proportional hazard models were used to model PNHD and time-to-treatment and time-to-death following cancer diagnosis, stratified by race and controlling for personal and tumor characteristics. RESULTS: PNHD (n = 6,885, 29.6%) was associated with a lower likelihood of treatment at a given point in time (i.e., longer time-to-treatment), but did not differ for Black (HR = 0.77, 95% CI: 0.73, 0.82) and White (HR = 0.73, 95% CI: 0.71, 0.76) patients. Time-to-death was longer (i.e., better survival) with PNHD, which also did not differ for Black (HR = 0.70, 95% CI: 0.64, 0.76) and White (HR = 0.71, 95% CI: 0.67, 0.75) patients. These results were not explained by confounding factors or differences in tumor stage at diagnosis. CONCLUSIONS: These observations warrant further research to understand whether there are potentially modifiable factors associated with the diagnosing location that can be used to benefit patient treatment trajectory and survival.

Complexity of the Basic Reproduction Number (R0).

The basic reproduction number (R0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents. R0 is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R0 easily misrepresented, misinterpreted, and misapplied. R0 is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R0 cannot be modified through vaccination campaigns. R0 is rarely measured directly, and modeled R0 values are dependent on model structures and assumptions. Some R0 values reported in the scientific literature are likely obsolete. R0 must be estimated, reported, and applied with great caution because this basic metric is far from simple.

Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000-2013.

BACKGROUND: Vaccine hesitancy continues to be an issue throughout the United States, as numerous vaccine hesitant parents are choosing to exempt their children from school-entry vaccination requirements for nonmedical reasons, despite the safety and effectiveness of vaccines. We conduct an analysis of how vaccine refusal, measured by the use of nonmedical exemptions (based on personal or religious beliefs) from vaccination (NMEs), evolved across space and over time in California. METHODS: Using school-entry data from the California Department of Public Health, we examined NMEs for students entering kindergarten in California from 2000 to 2013. We conduct global and local spatial autocorrelation analysis to determine whether NME use became more geographically clustered over the study period and whether the location of local clusters of high use were temporally stable. We conducted a grouping analysis that identified the general temporal trends in NME use over the time period. RESULTS: The use of NMEs increased from 0.73% of all kindergarteners in 2000 to 3.09% in 2013 and became more geographically clustered over the study period. Local geographic clusters of high use were relatively isolated early in the study period, but expanded in size over time. The grouping analysis showed that regions with high NME use early in the study period were generally few (15% of all US Census tracts) and relatively isolated. Regions that had low initial NME use and moderate to large increases over the study period were located in close proximity to the initial high use regions. The grouping analysis also showed that roughly half of all tracts had 0% or very low NME use throughout the study period. CONCLUSIONS: We found an observable spatial structure to vaccine refusal and NME use over time, which appeared to be a self-reinforcing process, as well as a spatially diffusive process. Importantly, we found evidence that use of NMEs in the initially isolated regions appeared to stimulate vaccine refusal in geographically proximal regions. Thus, our results suggest that efforts aimed at decreasing future NME use may be most effective if they target regions where NME use is already high, as well as the nearby regions.

Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California.

OBJECTIVES: We examined the variability in the percentage of students with personal belief exemptions (PBEs) from mandatory vaccinations in California schools and communities according to income, education, race, and school characteristics. METHODS: We used spatial lag models to analyze 2007-2013 PBE data from the California Department of Public Health. The analyses included school- and regional-level models, and separately examined the percentage of students with exemptions in 2013 and the change in percentages over time. RESULTS: The percentage of students with PBEs doubled from 2007 to 2013, from 1.54% to 3.06%. Across all models, higher median household income and higher percentage of White race in the population, but not educational attainment, significantly predicted higher percentages of students with PBEs in 2013. Higher income, White population, and private school type significantly predicted greater increases in exemptions from 2007 to 2013, whereas higher educational attainment was associated with smaller increases. CONCLUSIONS: Personal belief exemptions are more common in areas with a higher percentage of White race and higher income.

Variation in Vaccination Data Available at School Entry Across the United States.

OBJECTIVES: To compile substate-level data on US school-age children's vaccination rates. METHODS: For states that did not have suitable data online, in 2015 we submitted information requests to the state health department and followed up with the state's Freedom of Information Act when necessary. RESULTS: The accessibility, scale, and types of vaccination data varied considerably. Whereas 26 states provided data online, 14 released data only after a Freedom of Information Act request. School or school-district data were available for 24 states, 19 at the county level, 2 at the health department level, and 6 provided no substate-level data. CONCLUSIONS: Effective vaccination policy requires a robust understanding of vaccination behavior. Some states make it difficult to access data or provide low-resolution data of limited value for identifying vaccination behavior.

An approach for estimating vaccination coverage for communities using school-level data and population mobility information.

Childhood vaccination data are made available at a school level in some U.S. states. These data can be geocoded and may be considered as having a high spatial resolution. However, a school only represents the destination location for the set of students that actually reside and interact within some larger areal region, creating a spatial mismatch. Public school districts are often used to represent these regions, but fail to account for private schools and school of choice programs. We offer a new approach to estimate childhood vaccination coverage rates at a community level by integrating school level data with population commuting information. The resulting mobility-adjusted vaccine coverage estimates resolve the spatial mismatch problem and are more aligned with the geographic scale at which public health policies are implemented. We illustrate the utility of our approach using a case study on diphtheria, tetanus, and pertussis (DTP) vaccination coverage for kindergarten students in California. The modeled community-level DTP coverage estimates yield a statewide coverage of 92.37%, which is highly similar to the 92.44% coverage rate calculated from the original school-level data.

Diabetes, obesity, and recommended fruit and vegetable consumption in relation to food environment sub-types: a cross-sectional analysis of Behavioral Risk Factor Surveillance System, United States Census, and food establishment data.

BACKGROUND: Social and spatial factors are an important part of individual and community health. The objectives were to identify food establishment sub-types and evaluate prevalence of diabetes, obesity, and recommended fruit and vegetable consumption in relation to these sub-types in the Washington DC metropolitan area. METHODS: A cross-sectional study design was used. A measure of retail food environment was calculated as the ratio of number of sources of unhealthier food options (fast food, convenience stores, and pharmacies) to healthier food options (grocery stores and specialty food stores). Two categories were created: ≤ 1.0 (healthier options) and > 1.0 (unhealthier options). k-means clustering was used to identify clusters based on proportions of grocery stores, restaurants, specialty food, fast food, convenience stores, and pharmacies. Prevalence data for county-level diabetes, obesity, and consumption of five or more fruits or vegetables per day (FV5) was obtained from the Behavioral Risk Factor Surveillance System. Multiple imputation was used to predict block-group level health outcomes with US Census demographic and economic variables as the inputs. RESULTS: The healthier options category clustered into three sub-types: 1) specialty food, 2) grocery stores, and 3) restaurants. The unhealthier options category clustered into two sub-types: 1) convenience stores, and 2) restaurants and fast food. Within the healthier options category, diabetes prevalence in the sub-types with high restaurants (5.9 %, p = 0.002) and high specialty food (6.1 %, p = 0.002) was lower than the grocery stores sub-type (7.1 %). The high restaurants sub-type compared to the high grocery stores sub-type had significantly lower obesity prevalence (28.6 % vs. 31.2 %, p < 0.001) and higher FV5 prevalence (25.2 % vs. 23.1 %, p < 0.001). Within the larger unhealthier options category, there were no significant differences in diabetes, obesity, or higher FV5 prevalence across the two sub-types. However, restaurants (including fast food) sub-type was significantly associated with lower diabetes and obesity, and higher FV prevalence compared to grocery store sub-type. CONCLUSIONS: These results suggest that there are sub-types within larger categories of food environments that are differentially associated with adverse health outcomes. These observations support the specific food establishment composition of an area may be an important component of the food establishment-health relationship.

Survey of health status, nutrition and geography of food selection of chronic liver disease patients.

BACKGROUND: Obesity, a complex disease determined both by genetic and environmental factors, is strongly associated with NAFLD, and has been demonstrated to have a negative impact on HCV and other chronic liver diseases (CLD). RATIONALE: This study assessed the association between type and location of food sources and chronic liver disease (CLD) using Geographic Information Systems (GIS). RESULTS: CLD patients completed surveys [267 subjects, 56.5% female, age 55.8 ± 12.0, type of CLD: 36.5% hepatitis C (HCV), 19.9% hepatitis B (HBV), 19.9% non-alcoholic fatty liver disease (NAFLD); primary food source (PFS): 80.8% grocery store, secondary: 26.2% bulk food store, tertiary: 20.5% restaurants; fresh food (FF): 83%, pre-packaged (PP) 8.7%, already prepared (AP) 8.3%]. FF consumers had significantly fewer UEH servings/month (p = 0.030) and lived further away from convenience stores (1.69 vs. 0.95 km, p = 0.0001). Stepwise regression reveals the lowest FF consumers were NAFLD patients, subjects with UEH or restaurants and ethnic food stores as their PFS (R = 0.557, p = 0.0001). Eating already-packaged foods and utilizing restaurants or ethnic food stores as the PFS positively correlated with NAFLD (R = 0.546, p = 0.0001). CONCLUSIONS: Environmental food source measures, including type and density, should be included when examining areas hyper-saturated with a variety of food options. In hyper-saturated food environments, NAFLD patients consume more prepared food and less FF. CLD patients with UEH also eat significantly more prepared food and frequent restaurants and ethnic food stores as their PFS.

Reduced-risk pest management programs for eastern U.S. peach orchards: effects on arthropod predators, parasitoids, and select pests.

We developed new integrated pest management programs for eastern U.S. peaches with minimal use of organophosphates. From 2002-2005, we assessed the ecological impacts of these reduced-risk programs versus grower standard conventional programs that still relied primarily on the use of organophosphorous and carbamate insecticides. Using a split-plot design replicated at four commercial Pennsylvania peach orchards, we quantified pesticide rates, environmental impact, and arthropod community response. We used Environmental Impact Quotient (EIQ) analysis based on the growers' pesticide records from each orchard to calculate seasonal cumulative EIQ field ratings for all years. Ecological effects of the reduced-risk and conventional program were also measured as the abundance and diversity of nontarget arthropod predators, parasitoids, and selected pest taxa. Pesticide inputs and EIQ values were substantially lower in reduced-risk programs compared with conventional spray programs. Arthropod arrays differed significantly between pest management programs: most beneficial predator and parasitoid taxa were positively associated with the reduced-risk program and negatively associated with the standard grower program. Regardless of the pest management program, we observed significant differences in species arrays in the peach tree canopy compared with the ground cover of the orchards, but the arthropod community did not differ among the field sites or based on distance from the edge of the orchard. We conclude that reduced-risk programs not only provide control comparable with that of conventional programs, but they also reduce negative environmental effects while conserving key arthropod biological control agents within eastern U.S. peach orchards.

Geographic distribution and socio-economic determinants of women's nutritional status in Mali households.

OBJECTIVE: Mali is one of the poorest countries in Africa, with 72% of its population surviving on less than $US 1.00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women's anthropometric status and use of adequately iodized salt among households in Mali. DESIGN: Demographic and Health Survey data, multistage-stratified cluster sampling methodology. SETTING: Rural and urban areas of Mali. SUBJECTS: Non-pregnant women (n 6015) between the ages of 19 and 44 years. RESULTS: Nineteen per cent of the women were overweight or obese while 11% were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women's BMI or households' use of adequately iodized salt. CONCLUSIONS: The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.

Neighborhood location and nutritional resources as a risk factor for congenital heart disease in the fetus.

BACKGROUND: Congenital heart disease (CHD) is the most common birth defect, influenced by maternal health, environmental conditions, and genetics. Maternal health and nutrition, particularly maternal diabetes, is a modifiable risk factor for development of CHD in the fetus. However, the importance of food access during pregnancy on the development of CHD remains unknown. The objective of this study was to investigate the association between maternal neighborhood characteristics, particularly food access, and occurrence of prenatally diagnosed CHD. METHODS: A retrospective case series studied maternal-fetal dyads with prenatally diagnosed CHD between 2019 and 2021 in Washington, DC. Moran's I of maternal addresses evaluated geographic clustering of disease. Negative binomial regression assessed association between census tract demographics and population-adjusted CHD rate. RESULTS: A total of 307 dyads were analyzed. Global Moran's I showed significant CHD clustering (p-value = .004). However, degree of clustering was not clinically meaningful. After adjusting for neighborhood socioeconomic status, residing in food deserts was not a predictor for CHD. However, neighborhoods with a higher percentage of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits were associated with higher rates of conotruncal heart defects (Incident Rate Ratio [IRR] = 1.04, CI = 1.01-1.08) and aggregate CHD (IRR = 1.03, CI = 1.01-1.05). CONCLUSIONS: Neighborhood location and food access were not associated with CHD. However, increased enrollment in SNAP was associated with higher rates of CHD. The association between CHD and SNAP benefits warrants further exploration. Understanding food access and maternal nutrition may illuminate disparities in the burden of CHD.

Differentiating Black and Hispanic: outcome differences of segregated communities and police shootings in the USA, 2015-2020.

BACKGROUND: Police shootings are unevenly spatially distributed, with substantive spikes throughout the USA. While minorities are disproportionately the victims of police force, social or structural factors associated with this distribution are not well understood. The objective of this work was to evaluate police shootings in relation to victim race or ethnicity and residential segregation and racial diversity. METHODS: Validated crowdsourced data from the Washington Post's Fatal Force (2015-2020) were linked with census tract-level data from the American Community Survey. Residential minority dissimilarity, interaction, and a racial and ethnic diversity metric were calculated in order to assess the potentially variant importance of evenness in distribution, exposure likelihood, and general representation. Logistic and multinomial regression was used to model associations between segregation and diversity, adjusted for other ecological characteristics. Analyses were stratified by victim race or ethnicity (Black, Asian, or Hispanic). RESULTS: Across all races combined, the odds of a police shooting in a particular census tract were associated with non-Hispanic Black dissimilarity (OR = 0.98, 95% CI 0.97, 0.99) and racial and ethnic diversity (1.046, 95% CI 1.044, 1.060). Areas with higher racial diversity had a higher likelihood of having a police shooting event with Black victims (OR = 1.092, 95% CI 1.064, 1.120) or Asian victims (OR = 1.188, 1.051, 1.343) than less diverse areas. Higher non-Hispanic Black interaction was associated with a lower likelihood of having a police shooting event with Black victims (OR = 0.914, 95% CI 0.833, 0.946) than lower interaction areas. Higher Hispanic dissimilarity was associated with a lower likelihood of having a police shooting event with a Hispanic victim (OR = 0.398, 95% CI 0.324, 0.489) than lower dissimilarity areas. CONCLUSIONS: The variant effects of residential segregation are only seen when victims are analyzed separately by race. There appears to be a protective effect for Hispanic populations in Hispanic communities, while the reverse is true of Black individuals. We urge law enforcement responsible for locations with segregated communities to monitor individual interactions that police have with residents as well as the patterns of frequency and context of those interactions.

All-cause mortality and residential racial and ethnic segregation and composition as experienced differently by individual-level race, ethnicity, and gender: Mortality disparities in american communities data.

PURPOSE: Use a large nationally representative population to evaluate whether differences in mortality in relation to residential racial and ethnic segregation and diversity varied by gender, and race or Hispanic ethnicity in the United States. METHODS: The Mortality Disparities in American Communities (MDAC) was used to evaluate mortality risk in relation to segregation. MDAC is a nationally representative record linkage of the 2008 American Community Survey data with mortality outcomes derived from the National Death Index through 2015. Gender-stratified mortality risk for White, Black, and Hispanic groups in relation to quartiles of residential segregation, composition, and diversity were modeled using parametric survival regression with an exponential distribution, adjusted for individual-level socioeconomic characteristics. RESULTS: The study population included >3,950,000 individuals and >273,000 all-cause mortality outcomes. Statistically significant differences in associations were observed with Black segregation vs. Hispanic segregation across Black or Hispanic groups; some differences in stratification by gender for Hispanic and Non-Hispanic Black groups, but gender-stratified associations were more similar in non-Hispanic Whites. CONCLUSIONS: Future multidisciplinary and ethnographic research is needed to identify the specific structural mechanisms by which these associations differ to support means by which to more effectively target public health interventions.

Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010-2015.

PURPOSE: To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations. METHODS: We utilized Georgia state cancer registry data (2010-2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted. RESULTS: Average income of the Census tract and racial residential segregation of the diagnosing hospital's neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy. CONCLUSION: Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments.

Wild bees respond differently to sampling traps with vanes of different colors and light reflectivity in a livestock pasture ecosystem.

Wild bees are important pollinators and monitoring their abundance and diversity is necessary to develop conservation protocols. It is imperative to understand differences in sampling efficiency among different trap types to help guide monitoring efforts. This study used a new vane trap design to collect bees in a livestock pasture ecosystem and examined the impact of six different vane colors on wild bee sampling. We recorded 2230 bees comprising 49 species and five families. The most abundant species were Augochlorella aurata (25.8%), Lasioglossum disparile (18.3%), Lasioglossum imitatum (10.85%), Agapostemon texanus (10.8%), Melissodes vernoniae (9.9%) and Halictus ligatus (4.7%). Traps with bright blue vanes captured the greatest number and diversity of bees as compared to traps with bright yellow, dark blue, dark yellow, and purple vanes. Red vanes had the lowest captures rates of individuals and species. Different colors were associated with different bee species arrays and only nine species were found in all vane color types. Vanes with higher light reflectance properties (within 400-600 nm range) attracted the greatest number of bees. These results show that different light wavelengths and reflectivity of vane traps influence bee capture rates, and such findings can help optimize bee sampling methods in different ecosystems.

Descriptive Epidemiology of Homicides With Victim and Suspect Race or Hispanic Ethnicity Discordance in the United States: Analysis of National Violent Death Reporting System (NVDRS) 2005-2015.

Cross-racial violence is a high-profile issue in the United States; however, there is little empirical research on the epidemiology of cross-racial homicides. The objective of this work was to use national-level data to evaluate the characteristics of homicides in which the victim and suspect are of the same or different race or Hispanic ethnicity. Victims and suspects from National Violent Death Reporting System data (2005-2015) were classified into seven-categories on the basis of race/ethnicity (six non-Hispanic races or Hispanic ethnicity), and 51,454 homicide events were classified as concordant (same race or ethnicity), discordant (different race or ethnicity), or unknown (missing race or ethnicity or no suspect information). While discordancy was observed to be similar across all race and ethnicity groups, it was less likely with relatives, romantic partners, and relatives of romantic partners; less likely to occur at home; less likely to occur in intimate partner violence-related homicides; less likely when the homicide was preceded by an argument over money or property; less likely when the homicide was associated with a family problem; more likely among rival gangs and strangers than other known person relationships; and more likely with drug-involved homicides. There were differences for victims of non-Hispanic Black race. Notably, discordance was more likely for justifiable self-defense and more likely with victim having used a weapon. These results suggest that discordant homicides may follow patterns of peer groups and close relationships in society regardless of victim race/ethnicity, that is, individuals may form closer relationships with individuals of the same race/ethnicity.

Color of Pan Trap Influences Sampling of Bees in Livestock Pasture Ecosystem.

The decline in insect pollinators has increased the importance of accurately monitoring pollinator diversity and abundance over time. Sampling techniques include the use of passive insect traps such as pan traps, yet there is still discussion over their utility and effectiveness in different ecosystems. The objective was to examine four different colors of pan traps (blue, green, yellow, and purple) for their utility in sampling bees in native forages rotationally grazed by sheep and to compare the relative abundance, richness, similarity, and community assemblage patterns among the four trap colors. Most bees were from the Halictidae family (89%). The most abundant species were Lasioglossum imitatum (42.2%), Augochlorella aurata (8.3%), L. subviridatum (6.8), Agapostemon texanus (6.4), and L. birkmani (4.1%). Blue color traps exhibited the highest rates of bee capture and species accumulation. Purple and yellow colored traps were moderately effective in capturing bees, while the green color pan traps were least effective. Similarly, observed and extrapolated species richness was highest in blue trap, followed by purple, yellow, and green. Notably, the blue trap captured the highest number of unique species, followed by purple, yellow and green traps. Considering the total number of insects collected (including bees and other insects), yellow and green traps captured a significantly higher number of insects than other colored traps. The light reflectance from blue, purple, green and yellow pan traps had peaks at ~450, 400, 550, and 600 nm, respectively. Since different insects respond to different light intensities, wavelengths, and reflectivity, these results could be used to guide future trapping protocols targeting certain insect groups in livestock pasture and similar ecosystems.

Not just another nasal polyp: Chondro-osseous respiratory epithelial adenomatoid hamartomas of the sinonasal tract.

OBJECTIVES: Chondro-osseous respiratory epithelial adenomatoid hamartomas (COREAH) are extremely rare benign lesions in the sinonasal cavity. We aim to (a) report two cases of COREAH and (b) perform a literature review with a summary on previously published cases of COREAH till August 2019. METHODS: A literature review identified 16 cases, but only 12 cases from publications from 2005 to 2019 were included in analysis. In addition, we report two cases of COREAH from our tertiary academic medical center. RESULTS: COREAH is found in patients from 3 to 83 years old. It originates from various sites in the nasal cavity and sinuses but the most common location is the lateral nasal wall. Calcification on imaging is a common finding. CONCLUSION: COREAH is an uncommon entity that is important to recognize and distinguish from other sinister nasal masses. It is a slow growing benign lesion which lacks aggressive features on imaging. Future studies are needed to evaluate the possibility of an underlying genetic predisposition. LEVEL OF EVIDENCE: 4.

Sociodemographic determinants of growth among Malian adolescent females.

In Africa, research concerning the social determinants of poor nutritional status has typically focused on children under 5 years of age and has used defined categorical boundaries based on international reference standards. In this article, stunting and wasting of 1,157 Malian adolescent girls is measured through both categorical and continuous data. The focus on adolescent girls is significant because there is relatively little literature examining this group, and because adolescence marks the time when girls gain greater workload responsibilities, autonomy of food choices, and, as a result of the adolescent growth spurt, require the greatest amount of caloric intake respective to their weight since infancy. To differentiate stunting and wasting causes, a number of socioeconomic, geographic, and demographic factors are explored. The findings suggest that continuous data provides a basis for modeling stunting and wasting superior to utilizing international reference categories. Estimations show that decreasing age, the presence of servants, a greater number of wives in a compound, and residence in a large urban area correlate with improved nutritional status while wealthier families appear to correlate with greater stunting and wasting, and no correlation exists with estimated energy expenditure. Future studies should incorporate continuous data, and the need exists for greater analysis of social determinants of growth indicators among adolescent females. Further, these findings have significant implications in the development of nutrition intervention programs aimed at the vulnerable population in Mali, leading us to conclude that factors beyond socioeconomic indicators such as household structure and location should be more fully examined.