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BACKGROUND Maternal pre-pregnancy body mass index (BMI) is strongly associated with infant birthweight and the risk differs in pregnancies complicated by gestational diabetes (GDM). OBJECTIVES To examine the risk of large for gestational age (LGA) (≥97th percentile) singleton births at early term, full term and late term in relation to maternal pre-pregnancy BMI status mediated through GDM. METHODS We analysed data from the 2018 U.S. National Vital Statistics Natality File restricted to singleton term births (N = 3,229,783). In counterfactual models for causal inference, we estimated the total effect (TE), natural direct effect (NDE) and natural indirect effect (NIE) for the association of pre-pregnancy BMI with subcategories of LGA births at early, full and late term mediated through GDM, using log-binomial regression and adjusting for race/ethnicity, age, education, parity and infant sex. Proportion mediated was calculated on the risk difference scale and potential unmeasured confounders were assessed using the E-value. RESULTS Overall, 6.4% of women had GDM, and there were 3.6% LGA singleton term births. The highest prevalence of GDM was among pre-gestational overweight/obesity that also had the highest rates of LGA births at term. The TE estimates for the risk of LGA births were the strongest across women with higher pre-pregnancy BMI compared to women with normal pre-pregnancy BMI. The NDE estimates were higher than the NIE estimates for overweight/obese BMI status. The proportion mediated, which answers the causal question to what extent the total effect of the association between pre-pregnancy BMI and LGA births is accounted for through GDM, was the highest (up to 16%) for early term births. CONCLUSIONS Term singleton births make up the largest proportion in a cohort of newborns. While the percentage mediated through GDM was relatively small, health risks arising from pre-pregnancy overweight, and obesity can be substantial to both mothers and their offspring.

This study aims to determine whether newly introduced biomarkers Visinin-like protein-1 (VILIP-1), chitinase-3-like protein 1 (YKL-40), synaptosomal-associated protein 25 (SNAP-25), and neurogranin (NG) in cerebrospinal fluid are useful in evaluating the asymptomatic and early symptomatic stages of Alzheimer's disease (AD). It further aims to shed new insight into the differences between stable subjects and those who progress to AD by associating cerebrospinal fluid (CSF) biomarkers and specific magnetic resonance imaging (MRI) regions with disease progression, more deeply exploring how such biomarkers relate to AD pathology.We examined baseline and longitudinal changes over a 7-year span and the longitudinal interactions between CSF and MRI biomarkers for subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI). We stratified all CSF (140) and MRI (525) cohort participants into five diagnostic groups (including converters) further dichotomized by CSF amyloid beta (Aβ) status. Linear mixed models were used to compare within-person rates of change across diagnostic groups and to evaluate the association of CSF biomarkers as predictors of magnetic resonance imaging (MRI) biomarkers. CSF biomarkers and disease-prone MRI regions are assessed for CSF proteins levels and brain structural changes.VILIP-1 and SNAP-25 displayed within-person increments in early symptomatic, amyloid-positive groups. CSF amyloid-positive (Aβ+) subjects showed elevated baseline levels of total tau (tTau), phospho-tau181 (pTau), VILIP-1, and NG. YKL-40, SNAP-25, and NG are positively intercorrelated. Aβ+ subjects showed negative MRI biomarker changes. YKL-40, tTau, pTau, and VILIP-1 are longitudinally associated with MRI biomarkers atrophy.Converters (CNc, MCIc) highlight the evolution of biomarkers during the disease progression. Results show that underlying amyloid pathology is associated with accelerated cognitive impairment. CSF levels of Aβ42, pTau, tTau, VILIP-1, and SNAP-25 show utility to discriminate between mild cognitive impairment (MCI) converter and control subjects (CN). Higher levels of YKL-40 in the Aβ+ group were longitudinally associated with declines in temporal pole and entorhinal thickness. Increased levels of tTau, pTau, and VILIP-1 in the Aβ+ groups were longitudinally associated with declines in hippocampal volume. These CSF biomarkers should be used in assessing the characterization of the AD progression.

Background and objectives Substance use in community college students has been explored in only a handful of studies. Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behavior. Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research. The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services. Methods We conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use). Results Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences. Discussion and conclusions Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population. Scientific significance The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students. (Am J Addict 2020;29:97-104).

Purpose Our aim is to determine if propoxyphene withdrawal from the US market was associated with opioid continuation, continued chronic opioid use, and secondary propoxyphene-related adverse events (emergency department visits, opioid-related events, and acetaminophen toxicity). Methods Medical service use and pharmacy data from 19/11/08 to 19/11/11 were collected from the national Veterans Healthcare Administration healthcare databases. A quasi-experimental pre–post retrospective cohort design utilizing a historical comparison group provided the study framework. Logistic regression controlling for baseline covariates was used to estimate the effect of propoxyphene withdrawal. Results There were 24 328 subjects (policy affected n = 10 747; comparison n = 13 581) meeting inclusion criteria. In the policy-affected cohort, 10.6% of users ceased using opioids, and 26.6% stopped chronic opioid use compared with 3.8% and 13.5% in the historical comparison cohort, respectively. Those in the policy-affected cohort were 2.7 (95%CI: 2.5–2.8) and 3.2 (95%CI: 2.9–3.6) times more likely than those in the historical comparison cohort to discontinue chronic opioid and any opioid use, respectively. Changes in adverse events and Emergency Department (ED) visits were not different between policy-affected and historical comparison cohorts (p > 0.05). Conclusions The withdrawal of propoxyphene-containing products resulted in rapid and virtually complete elimination in propoxyphene prescribing in the veterans population; however, nearly 90% of regular users of propoxyphene switched to an alternate opioid, and three quarters continued to use opioids chronically. Copyright © 2015 John Wiley & Sons, Ltd.

Study Objective To examine the effect of the drug interaction between clopidogrel and proton pump inhibitors (PPIs) on the risk of an adverse cardiovascular event. Design Population-based, retrospective cohort study. Data Source IMS LifeLink Health Plan administrative claims database. Patients A total of 10,101 patients aged 18 years or older with a diagnosis of acute coronary syndrome (ACS) made during a hospitalization or emergency department visit between 2001 and 2008 and who had their first clopidogrel prescription within 90 days after their ACS diagnosis were included in the study. Patients were stratified according to concurrent use (clopidogrel plus PPI group) or no use (clopidogrel alone group) of the following PPIs: esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole. Measurements and Main Results Data were collected on baseline patient demographic and clinical characteristics. Patients were followed from their first clopidogrel prescription until they experienced an adverse cardiovascular event, defined as inpatient hospitalization or emergency department visits for myocardial infarction, percutaneous coronary intervention, or intermediate coronary syndrome; were disenrolled; discontinued clopidogrel; or reached the end of the study period. Using a propensity scoring method, the clopidogrel plus PPI group was matched in a 1:1 ratio with the clopidogrel alone group. Exposure to overlapping clopidogrel-PPI prescriptions was modeled as a time-dependent covariate. The Cox hazards regression model was used to estimate the risk of an adverse cardiovascular event in the clopidogrel plus PPI group versus the clopidogrel alone group. Propensity score matching resulted in 2674 patient pairs. In the propensity score–matched sample, the mean age was 61.30 years, with a mean follow-up of 268 days, and 70.04% were male. Concurrent use of clopidogrel with a PPI was associated with a significantly increased risk of a cardiovascular adverse event (hazard ratio 1.438, 95% confidence interval 1.237–1.671) compared with clopidogrel alone. Conclusion Concurrent use of clopidogrel plus a PPI was associated with a significant increase in risk of an adverse cardiovascular event in patients with ACS. Large randomized studies are needed to confirm this finding. Until then, clinicians should prescribe the concurrent use of these two drugs cautiously.

Weight concern is a common and significant barrier to abstinence for many smokers. This quasi-experimental pilot study used multivariate logistic regression to examine the effects of offering a weight management treatment program on tobacco dependence treatment outcomes. Age, gender, ethnicity, educational level, nicotine dependence level, body mass index, and concern about weight gain were entered as factors/covariates to account for differences between groups. Offering a weight management program increased attendance at the first scheduled contact (88.1% vs. 71.6%; OR = 2.93; p = .029) and increased 6-month abstinence (21.4% vs. 10.1%; OR = 2.42; p = .052). With factors and covariates included in the multivariate models to account for group differences, those offered weight management were five times more likely to attend their first session (OR = 5.10; 95% CI 1.53–16.98; p = .008) and three times more likely to be abstinent 6 months after tobacco treatment (OR = 2.98; 95% CI = 1.09–8.17; p = .033). Proactively informing weight-concerned, overweight/obese smokers about the availability of a weight management program as an incentive for completing treatment for tobacco dependence may improve tobacco treatment outcomes. (Am J Addict 2010;00:1–8)

Objective: To provide the specific weight loss outcomes for African-American, Hispanic, and white men and women in the lifestyle and metformin treatment arms of the Diabetes Prevention Program (DPP) by race-gender group to facilitate researchers translating similar interventions to minority populations, as well as provide realistic weight loss expectations for clinicians. Methods and Procedures: Secondary analyses of weight loss of 2,921 overweight participants (22% black; 17% Hispanic; 61% white; and 68% women) with impaired glucose tolerance randomized in the DPP to intensive lifestyle modification, metformin or placebo. Data over a 30-month period are examined for comparability across treatment arms by race and gender. Results: Within lifestyle treatment, all race-gender groups lost comparable amounts of weight with the exception of black women who exhibited significantly smaller weight losses (P < 0.01). For example, at 12 months, weight losses for white men (−8.4%), white women (−8.1%), Hispanic men (−7.8%), Hispanic women (−7.1%), and black men (−7.1%) were similar and significantly higher than black women (−4.5%). In contrast, within metformin treatment, all race-gender groups including black women lost similar amounts of weight. Race-gender specific mean weight loss data are provided by treatment arm for each follow-up period. Discussion: Diminished weight losses were apparent among black women in comparison with other race-gender groups in a lifestyle intervention but not metformin, underscoring the critical nature of examining sociocultural and environmental contributors to successful lifestyle intervention for black women.

Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback. Methods and Procedures: Statewide telephone surveys of parents of overweight (BMI ≥ 85th percentile) Arkansas public school children before (n = 1,551; 15% African American) and after (n = 2,508; 15% African American) policy implementation were examined for correspondence between parental perception of child's weight and objective classification. Results: Most (60%) parents of overweight children underestimated weight at baseline. Parents of younger children were significantly more likely to underestimate (65%) than parents of adolescents (51%). Overweight parents were not more likely to underestimate, nor was inaccuracy associated with parental education or socioeconomic status. African-American parents were twice as likely to underestimate as whites. One year after BMI screening and feedback was implemented, the accuracy of classification of overweight children improved (53% underestimation). African-American parents had significantly greater improvements than white parents (P < 0.0001). Discussion: Parental recognition of childhood overweight may be improved with BMI screening and feedback, and African-American parents may specifically benefit. Nonetheless, underestimation of overweight is common and may have implications for public health interventions.

Objective: To characterize sugar-sweetened beverage intake of college students. Research Methods and Procedures: Undergraduates in an urban southern community campus were surveyed anonymously about sugared beverage consumption (soda, fruit drinks, energy drinks, sports drinks, sweet ice tea) in the past month. Results: Two hundred sixty-five undergraduates responded (66% women, 46% minority, 100% of volunteers solicited). Most students (95%) reported sugared beverage intake in the past month, and 65% reported daily intake. Men were more likely than women to report daily intake (74% vs. 61%, p = 0.035). Soda was the most common sugar-sweetened beverage. Black undergraduates reported higher sugared beverage intake than whites (p = 0.02), with 91% of blacks reporting sugar-sweetened fruit drink intake in the past month and 50% reporting daily consumption. Mean estimated caloric intake from combined types of sugar-sweetened beverages was significantly higher among black students than whites, 796 ± 941 vs. 397 ± 396 kcal/d (p = 0.0003); the primary source of sugar-sweetened beverage calories among blacks was sugared fruit drinks (556 ± 918 kcal/d). Younger undergraduates reported significantly higher intake than older students (p = 0.025). Discussion: Self-reported sugar-sweetened beverage consumption among undergraduates is substantial and likely contributes considerable non-nutritive calories, which may contribute to weight gain. Black undergraduates may be particularly vulnerable due to higher sugared beverage intake. Obesity prevention interventions targeting reductions in sugar-sweetened beverages in this population merit consideration.

African-American women with type 2 diabetes experience limited weight loss in behavioral weight control programs. Some research suggests that overly ambitious weight loss expectations may negatively affect weight losses achieved but it is unknown whether they affect weight loss among African-American women. The current study examined personal weight loss goals and expected satisfaction with a reasonable weight loss among African-American women with type 2 diabetes starting a behavioral obesity treatment. We also explored associations among these factors and weight loss treatment outcomes. Self-identified African-American women (N = 84) in a 24-session group program were assessed at baseline and 6-month follow-up. At baseline, women indicated weight loss goals of 14.1 ± 6.6 kg (14% of initial weight). They also reported relatively high expected satisfaction with a reasonable weight loss (7-10%). On average, participants lost 3.0 ± 3.9 kg (3% of initial weight) and attended 73 ± 21% of group sessions. Neither weight loss goals nor expected satisfaction with a reasonable weight loss was correlated with either actual weight loss outcome or attendance. Having higher personal weight loss goals was associated with lower expectations of satisfaction with a reasonable weight loss. This suggests that African-American women with type 2 diabetes enter treatment hoping to lose far more weight than they are likely to achieve. It is important to understand the psychosocial sequelae of failing to reach these goals on subsequent weight maintenance and future weight loss attempts within this population.