Veteran suicide and associated community characteristics in Oregon.

Developing a public health approach to suicide prevention among United States (US) military veterans requires additional data and guidance on where, when, for whom, and what prevention resources should be deployed. This study examines veteran suicide mortality across one US state (Oregon) to identify county-level "hotspots" for veteran suicide, identify community characteristics associated with increased suicide among veterans, and examine excess spatial risk after accounting for space, time, and community characteristics. We linked Oregon mortality data with VA databases to identify veterans who had resided in Oregon and died by suicide between January 1, 2009 and December 31, 2018 (n = 1727). Community characteristic data were gathered at the county level from publicly available datasets on social determinants of health known to be associated with poor health outcomes, including suicide risk. We estimated spatial generalized linear mixed models for the full 10-year period and for each 5-year period using integrated nested Laplace approximation with county as the higher hierarchy. Smoothed standardized mortality ratios were used to identify counties with higher risk of veteran suicide. We found a small clustering of counties in the southwestern corner of Oregon that held the highest risk for veteran suicide across the ten years studied. In multivariable models, higher prevalence of unmarried persons was the only community measure significantly associated with increased veteran suicide risk. However, social contextual factors as a group, along with geographic space, explained most risk for suicide among veterans at the population level.

Spatial Analysis of the Alcohol, Intimate Partner Violence, and HIV Syndemic Among Women in South Africa.

The co-occurrence of and synergistic interactions between substance abuse, violence, and HIV, known as the "SAVA syndemic," is thought to be a driver of women's elevated risk for HIV in sub-Saharan Africa. This study uses data from the 2016 South African Demographic and Health Survey (DHS) and the 2016 South African Census to examine geospatial associations between alcohol use, intimate partner violence (IPV), unprotected sex, and HIV status among a population-based sample of 8528 South African women (age 15-49). Results support the geographic clustering of alcohol use, unprotected sex, and IPV, but not HIV, and geospatial clustering of HIV alone. This study highlights the need for geographically-tailored interventions to address syndemics through integrated interventions, such as those simultaneously focused on alcohol, IPV, and sexual risk reduction, and points to the need for more targeted research to link these factors to HIV from a place-based risk perspective.

Sleep duration is related to increased mortality risk through white blood cell counts in a large national sample.

OBJECTIVES: Sleep, like many biological processes, is linked with immunity and inflammation such that "abnormal" sleep is associated with changes in circulating immune cells. These sleep patterns are also associated with increased mortality risk, and it may be that altered immune cell counts are one biological pathway through which sleep affects mortality. We used NHANES survey data to examine the associations between sleep duration, total white blood cell (WBC) count, and mortality from biological causes. METHODS: Several waves of public NHANES data (2005-2011; n = 11 353, ages 18+) were analyzed using bivariate statistics and causal mediation models including corrections for complex survey design. RESULTS: Deceased individuals were characterized by higher WBC but lower monocyte counts relative to surviving individuals. Significant associations between sleep duration, total WBC count, monocytes and mortality were found, as were marginally significant relationships between sleep and these cell counts. Significant mediated effects of sleep on mortality were found. Including covariates known to affect mortality, such as BMI, age, and self-reported health resulted in a nonsignificant mediated effect of sleep on mortality for monocytes, while mediated effects for total WBC count remained. CONCLUSIONS: This large, cross-sectional analysis suggests that sleep duration is associated with changes in mortality risk through-in part-effects on leukocyte count. These findings support an immunological/inflammatory pathway linking sleep and mortality. Further research in populations with quantitatively different sleep patterns can determine whether this sleep-immune-mortality pathway is restricted to Western, industrial samples or is characteristic of humans in general.

Machine learning algorithms for predicting undernutrition among under-five children in Ethiopia.

OBJECTIVE: Child undernutrition is a global public health problem with serious implications. In this study, we estimate predictive algorithms for the determinants of childhood stunting by using various machine learning (ML) algorithms. DESIGN: This study draws on data from the Ethiopian Demographic and Health Survey of 2016. Five ML algorithms including eXtreme gradient boosting, k-nearest neighbours (k-NN), random forest, neural network and the generalised linear models were considered to predict the socio-demographic risk factors for undernutrition in Ethiopia. SETTING: Households in Ethiopia. PARTICIPANTS: A total of 9471 children below 5 years of age participated in this study. RESULTS: The descriptive results show substantial regional variations in child stunting, wasting and underweight in Ethiopia. Also, among the five ML algorithms, xgbTree algorithm shows a better prediction ability than the generalised linear mixed algorithm. The best predicting algorithm (xgbTree) shows diverse important predictors of undernutrition across the three outcomes which include time to water source, anaemia history, child age greater than 30 months, small birth size and maternal underweight, among others. CONCLUSIONS: The xgbTree algorithm was a reasonably superior ML algorithm for predicting childhood undernutrition in Ethiopia compared to other ML algorithms considered in this study. The findings support improvement in access to water supply, food security and fertility regulation, among others, in the quest to considerably improve childhood nutrition in Ethiopia.

Levels and determinants of HIV testing uptake among Ghanaian men.

The uptake of HIV testing has always been found to be lower among men compared with women in many developing countries. The aim of this study was to ascertain the level and determinants of HIV testing uptake among men aged 15 to 59 in Ghana. This article was based on data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. A bivariate statistical method was used to calculate the levels of uptake while three logit models were fitted to estimate the determinants of HIV uptake among the respondents. The total levels of the uptake of HIV testing among the respondents were 9.1%, 14.7% and 22.7% for 2003, 2008 and 2014, respectively; 15% overall. These were significantly determined by age, educational attainment, religious affiliation, wealth and work status, region of residence and media exposure. HIV testing uptake is very low among men in Ghana, albeit it has seen consistent improvements over the past years. Specially tailored HIV education and prevention programmes should be targeted at men in areas of low uptake, based on their different characteristics, in order to increase uptake.

How Does the Context of Reception Matter? The Role of Residential Enclaves in Maternal Smoking During Pregnancy Among Mexican-Origin Mothers.

This study investigated whether and how different patterns of group exposure within residential contexts (i.e., living in a Mexican immigrant enclave, a Mexican ethnic enclave, a pan-Hispanic enclave, or a non-Hispanic white neighborhood) are associated with smoking during pregnancy among Mexican-origin mothers. Using a hierarchical linear modeling approach, we found that Mexican-origin mothers' residential contexts are important for understanding their smoking during pregnancy. Residence in an ethnic enclave is associated with decreased odds of smoking during pregnancy, while residence in a non-Hispanic white neighborhood is associated with increased odds of smoking during pregnancy, above and beyond the mothers' individual characteristics. The magnitude of the associations between residence in an ethnic enclave and smoking during pregnancy is similar across the different types of ethnic enclaves examined. The important roles of inter- and intra-group exposures suggests that in order to help Mexican-origin women, policy makers should more carefully design place-based programs and interventions that target geographic areas and the specific types of residential contexts in which women are at greater risk.

Decomposing Kenyan socio-economic inequalities in skilled birth attendance and measles immunization.

INTRODUCTION: Skilled birth attendance (SBA) and measles immunization reflect two aspects of a health system. In Kenya, their national coverage gaps are substantial but could be largely improved if the total population had the same coverage as the wealthiest quintile. A decomposition analysis allows identifying the factors that influence these wealth-related inequalities in order to develop appropriate policy responses. The main objective of the study was to decompose wealth-related inequalities in SBA and measles immunization into their contributing factors. METHODS: Data from the Kenyan Demographic and Health Survey 2008/09 were used. The study investigated the effects of socio-economic determinants on [1] coverage and [2] wealth-related inequalities of SBA utilization and measles immunization. Techniques used were multivariate logistic regression and decomposition of the concentration index (C). RESULTS: SBA utilization and measles immunization coverage differed according to household wealth, parent's education, skilled antenatal care visits, birth order and father's occupation. SBA utilization further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent's education (28%), antenatal care (9%), and province (6%). The overall C for measles immunization was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent's education (28%). Rural residence (-19%) reduced this inequality. CONCLUSION: Both health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups.

Infant mortality and intra-household competition in the Northern Islands of Orkney, Scotland, 1855-2001.

This study applies principles from the theory of household life cycles to the study of early childhood mortality in the population of the Northern Orkney Islands, Scotland. The primary hypothesis is that unfavorable household economic conditions resulting from changes in household demographic composition increase the risk of death for children under the age of 5 years because of limited resources and intra-household competition. We apply Cox proportional hazards models to nearly 5,000 linked birth and death records from the Northern Orkney Islands, Scotland, from the period 1855 to 2001. The dependent variable is the child's risk of death before age 5. Findings suggest that children in households with unfavorable age compositions face higher risk of death. This elevated risk of death continues once heterogeneity among children, islands, and households is controlled. Results also show differential risk of death for male children, children of higher birth orders, and twin births. The analyses present evidence for intra-household competition in this historic setting. The most convincing evidence of competition is found in the effects of household consumer/producer ratios and twinning on child mortality risks.

Spatiotemporal Variations and Determinants of Under-Five Stunting in Ethiopia.

BACKGROUND: Stunting has been a major concern in sub-Saharan Africa. However, little evidence exists on the spatiotemporal variations in under-five stunting within a national context. OBJECTIVE: This paper examines the spatiotemporal variations in under-five stunting and determinants using data from the Ethiopia Demographic and Health Surveys (2000-2016). METHODS: Spatial autocorrelation and multilevel logistic regression models were used to conduct the analyses. RESULTS: The stunting prevalence has decreased from 51% to 37%, while the prevalence of severe stunting has decreased by more than half (from 28% to 12%). Wide regional variations in stunting have been consistently observed over the years, which exhibited a higher level of stunting in Tigray (48%), Afar (42%), and Amhara (42%). The results show considerable local and regional variations in under-five stunting levels with diverse patterns of improvements in regional stunting levels over time. Stunting levels were associated with child-level factors such as the sex of a child, birth size, age of a child, birth order, preceding birth interval, and place of birth. Maternal educational attainment, nutritional status, household wealth, toilet facility type, and place of residence were linked to under-five stunting. The regional-level infant mortality rate was associated with under-five stunting. CONCLUSIONS: Specially tailored policies and interventions should be devised to address persistent spatial inequalities in stunting by focusing on higher risk populations.

Lower testosterone levels are associated with higher risk of death in men.

Background and Objectives: Testosterone plays an important role in regulating male development, reproduction and health. Declining levels across the lifespan may reflect, or even contribute to, chronic disease and mortality in men. Methodology: Relationships between testosterone levels and male mortality were analyzed using data from multiple samples of the cross-sectional National Health and Nutrition Examination Survey (n = 10 225). Target outcomes included known deaths from heart disease, malignant neoplasms, chronic lower respiratory diseases, cerebrovascular diseases, Alzheimer's disease, diabetes mellitus, influenza and pneumonia, kidney diseases, and accidents or unintentional injuries. Results: Results of discrete-time hazard models revealed that lower levels of testosterone were related to higher mortality for the majority of disease categories in either an age-dependent or age-independent fashion. Analysis of all-cause mortality-which included deaths from any known disease-also revealed greater general risk for those with lower testosterone levels. For most disease categories, the hazard associated with low testosterone was especially evident at older ages when mortality from that particular ailment was already elevated. Notably, testosterone levels were not related to mortality risk for deaths unrelated to chronic disease (i.e. accidents and injuries). Conclusions and Implications: While the causal direction of relationships between testosterone and mortality risk remains unclear, these results may reflect the decline in testosterone that accompanies many disease states. Accordingly, the relationship between testosterone and male mortality may be indirect; ill individuals are expected to have both lower testosterone and higher mortality risk.

Life histories, blood revenge, and reproductive success among the Waorani of Ecuador.

The Waorani may have the highest rate of homicide of any society known to anthropology. We interviewed 121 Waorani elders of both sexes to obtain genealogical information and recollections of raids in which they and their relatives participated. We also obtained complete raiding histories of 95 warriors. An analysis of the raiding histories, marital trajectories, and reproductive histories of these men reveals that more aggressive warriors have lower indices of reproductive success than their milder brethren. This result contrasts the findings of Chagnon [Chagnon N (1988) Science 239:985-992] for the Yanomamo. We suggest that the spacing of revenge raids may be involved in the explanation of why the consequences of aggressiveness differ between these 2 warlike lowland South American peoples.

Drug overdose mortality by race/ethnicity across US-born and immigrant populations.

BACKGROUND: The present study examined racial/ethnic differences in US drug overdose mortality among US-born and foreign-born men and women. METHODS: In this cross-sectional analysis of 2010-2019 data from the National Center for Health Statistics, Bayesian hierarchical models predicted drug overdose mortality based on the interaction of race/ethnicity, nativity, and sex, adjusting for age, for 518,553 drug overdose deaths among individuals ages 15-74 identified as Non-Hispanic (NH) White, NH Black, Hispanic, or NH Asian/Pacific Islander (PI). Rate ratios with 95% Highest Posterior Density Intervals (HPDIs) were examined by race/ethnicity and nativity. RESULTS: In the US-born population, 2017-2019 estimated overdose mortality rates were higher for NH Black than NH White men (ratio 1.48 [95% HPDI 1.28-1.72]), similar between NH Black and NH White women (ratio 1.03 [95% HPDI 0.89-1.20]), similar between Hispanic and NH White men (ratio 0.96 [95% HPDI 0.82-1.10]), and lower for NH Asian/PI than NH White men and women. In the foreign-born population, both for men and women, estimated overdose mortality rates were lower in every racial/ethnic group relative to the NH White group. For men and women of all racial/ethnic groups examined, estimated overdose mortality rates were higher in US-born than foreign-born subpopulations, yet the extent of this nativity differential was least pronounced in the NH White group. CONCLUSIONS: In the US-born population, NH Black men experienced the highest recent rates of overdose mortality; in the foreign-born population, the highest rates of overdose mortality were observed among NH White men and women.

Parental investment and socioeconomic status influences on children's height in Honduras: An analysis of national data.

OBJECTIVES: This research analyzes variation in children's height-for-age z-scores from a nationally representative sample of children from Honduras in 2006. This work draws on theoretical perspectives from parental investment theory to describe the mediating effects that parental investment may have on children's health and nutrition, even in low socioeconomic status households. METHODS: This research uses the 2006 Demographic and Health Survey for the country of Honduras. The dependent variable is the child's height-for-age z-score (HFAZ). Variation in the HFAZ is analyzed using multiple regression and multilevel regression models to incorporate individual, family and higher-level predictors. RESULTS: The findings suggest that children who are more invested in by their parents had better outcomes (HFAZ) than children whose parents did not invest as much. Of the three measures of parental investment used in this study, child wantedness and adequate prenatal care represented significant effects on children's HFAZ, and breastfeeding duration exhibited an interactive effect with household socioeconomic status. CONCLUSIONS: Results suggest that families that can invest more in their children through breastfeeding and sufficient prenatal care can mediate the negative effects of poor socioeconomic status on their children's health. This suggests that these measures of investment used here may be effective at mediating the negative effects of low socioeconomic status for this particular child health outcome.

White-handed gibbons (Hylobates lar) alter ranging patterns in response to habitat type.

Small apes are often characterized as inhabiting small home ranges and being dependent on evergreen forest due to their dietary specialization on ripe fruits. Yet few primate studies, particularly those with gibbons, have considered intraspecific variations in ranging behaviors in response to local ecological conditions. This study examines Endangered white-handed gibbon (Hylobates lar) ranging patterns in a heterogeneous landscape. We conducted 13 months of behavioral observations on four white-handed gibbon groups living in Huai Kha Khaeng Wildlife Sanctuary in western Thailand, and combine these data with group location and transect-based productivity data. We compare home range area, site fidelity, and microhabitat preferences. Home range (HR) area varied considerably among the four groups (17-61 hectares). Site fidelity was higher in one of the groups with more evergreen forest in the HR (0.72 ± 0.1) than one of the groups with very little evergreen forest in the habitat (0.47 ± 0.07). While groups with more evergreen forest in the HR preferred evergreen forest areas, groups with very little evergreen forest within the HR demonstrated less preference for evergreen forest areas. We conclude that gibbons at this site exhibit a considerable degree of behavioral variation in response to local ecological conditions. These findings suggest that while gibbons exhibit significant ecological flexibility, this flexibility may be limited by habitat type and key food resources.

Meaning to multiply: Electrophysiological evidence that children and adults treat multiplication facts differently.

Multiplication tables are typically memorized verbally, with fluent retrieval leading to better performance in advanced math. Arithmetic development is characterized by strategy shifts from procedural operations to direct fact retrieval, which would not necessitate access to the facts' conceptual meaning. This study tested this hypothesis using a combination of event related brain potentials (ERP) and behavioral measures with 3rd-5th grade children and young adults. Participants verified the solutions to simple multiplication problems (2 × 3 = 6 or = 7) and the semantic fit of word-picture pairs, separately. Children showed an N400 effect to multiplication solutions with larger (more negative) amplitude for incorrect than correct solutions, reflecting meaning-level processing. A similar ERP response was observed in the word-picture verification task, with larger negative amplitude for word-picture pairs that were semantically mismatched compared to matched. In contrast, adults showed a P300 response for correct solutions, suggesting that they treated these solutions as potential targets in over-rehearsed mathematical expressions. This P300 response was specific to math fact processing, as the word-picture verification task elicited a classic N400 in adults. These ERP findings reveal an overlooked developmental transition that occurs after fifth grade, and speak to theories of arithmetic that have been based primarily on adult data.

Fur Color and Nutritional Status Predict Hair Cortisol Concentrations of Dogs in Nicaragua.

This study examined the relationships between hair cortisol concentrations (HCC) and sex, age, nutritional status (as determined by body condition scores, or BCS), and body mass (geometric mean calculated from morphometric measurements), as well as the potential influence of hair pigmentation (light, dark, or agouti/mixed) on HCC in dogs of the Bosawas Biosphere Reserve, Nicaragua. The dogs examined in this study live in a marginal environment where disease, malnutrition, and mortality rates are high. For fur color, HCC was significantly higher in light fur than in than dark and mixed fur (p < 0.001). In addition, BCS scores were found to have a negative effect on HCC (p < 0.001). Measures of sex and body size exhibited inconclusive effects on HCC, and when compared to adult dogs, juvenile dogs did not exhibit significantly different HCC. Repeated measures of dogs over time reveal a moderate intra-class correlation, suggesting that there are unmeasured sources of individual-level heterogeneity. These findings imply a need to account for fur color in studies of HCC in dogs, and the study suggests an overlooked relationship between cortisol and body condition scores in undernourished dogs in diverse settings.

Early-career trajectories of young workers in the U.S. in the context of the 2008-09 recession: The effect of labor market entry timing.

OBJECTIVE: The goal of this study was to analyze differences in the employment and wage trajectories of college-educated young workers in the United States, as distinguished by the timing of their entry into the labor market relative to the onset of the 2008-09 recession. METHODS AND FINDINGS: Using annual American Community Survey microdata, we analyzed the first six years of employment and wage outcomes for cohorts of young workers on traditional-student pathways entering the market (1) in 2006, shortly before recession onset; (2) in 2009, during the recession; and (3) in 2012, three years after the recession officially ended. We found evidence for negative effects on outcomes and outcome trajectories differentiated by the recession's proximity to workers' labor market entry, including lower wages for the cohort entering in 2009. However, recession effects tended to be smaller for workers at the high end of the education gradient or with no direct exposure to the recession and were outweighed by gendered labor outcome disparities. We also observed a possibly enduring, recession-induced rise in the number of idle young males and the proportion of male and female high school graduates enrolled in college and not working. CONCLUSIONS: Cohort differences in labor outcomes show that the disadvantages of entering the labor market during an economic downturn appear lasting. However, the subordinate role of timing effects in sorting young workers' employment and wage rates, when compared to the stark stratification of employment and wage outcomes by education or sex, is a useful reminder that these latter social structures remain key determinants of labor outcomes.

Interdisciplinary Approach to Spatiotemporal Population Dynamics: The North Orkney Population History Project.

The North Orkney Population History Project is a multidisciplinary data collection, digitization, and analysis effort that aims to reconstruct longitudinal demographic, environmental, and economic change. We describe the motivation, methodological approach, data sources, and some initial findings of the project. Detailed contextual information about a single community allows for the joint analysis of the changing population and changing landscape. The combination of diverse data sources and disciplinary approaches has resulted in findings that would not have been possible if each source had been considered in isolation. The approach adopted by the project offers a way to examine the interaction of a population with its landscape over a period of change.

An examination of disparities in cancer incidence in Texas using Bayesian random coefficient models.

Disparities in cancer risk exist between ethnic groups in the United States. These disparities often result from differential access to healthcare, differences in socioeconomic status and differential exposure to carcinogens. This study uses cancer incidence data from the population based Texas Cancer Registry to investigate the disparities in digestive and respiratory cancers from 2000 to 2008. A Bayesian hierarchical regression approach is used. All models are fit using the INLA method of Bayesian model estimation. Specifically, a spatially varying coefficient model of the disparity between Hispanic and Non-Hispanic incidence is used. Results suggest that a spatio-temporal heterogeneity model best accounts for the observed Hispanic disparity in cancer risk. Overall, there is a significant disadvantage for the Hispanic population of Texas with respect to both of these cancers, and this disparity varies significantly over space. The greatest disparities between Hispanics and Non-Hispanics in digestive and respiratory cancers occur in eastern Texas, with patterns emerging as early as 2000 and continuing until 2008.