Search

BackgroundPerceptions of cigar products' harmfulness and addictiveness in youth are associated with subsequent cigar product initiation, but their association on the age of initiation of cigar product use is unknown.MethodsThe association of perceptions of harmfulness and addictiveness at youth's first wave of PATH participation (waves 1 or 2 in years 2013–2015) on the age of initiation of (i) ever. (ii) past 30-day, and (iii) fairly regular use of any cigar products (cigarillos, filtered cigars, or traditional cigars) during the followed-up in PATH waves 2–4 (2014–2017) was estimated using weighted interval-censored Cox proportional hazards models. Also, the association of the interaction between perceptions of harmfulness and addictiveness and the age of initiation of any cigar use are reported. Hazard ratios (HR) and 95% confidence intervals (CI) are reported.ResultsAmong youth who had ever heard of cigar products, youth who perceived cigars to be “low-medium harmfulness and low-medium addictiveness” had 60% (HR: 1.60, 95%CI: 1.36–1.89) higher hazard risk to initiate ever cigar product use at an earlier age, and had 46% (HR:1.46, 95%CI: 1.14–1.86) higher hazard risk to initiate past 30-day cigar product use at younger ages than those who perceived cigars to be “high harmfulness and high addictiveness.” Moreover, youth who perceived cigars to be “low-medium harmfulness and high addictiveness” had 33% (HR: 1.33, 95%CI: 1.15–1.53) higher hazard risk to initiate ever cigar product use at younger ages than those who perceived cigars to be “high harmfulness and high addictiveness.” Youth who reported “high harmfulness and low-medium addictiveness” (HR: 0.24, 95% CI: 0.07–0.83) had 76% lower hazard risk to initiate fairly regular use of cigar products at younger ages compared to youth who reported “high harmfulness and high addictiveness.”ConclusionsPrevention and awareness campaigns should reinforce the unique potential for harm and addiction of cigar products to curb cigar product initiation among US youth.

This retrospective study examined the accuracy of the International Classification of Diseases, Clinical Modification (ICD-10-CM) coding for physical child abuse among patients less than 18 years of age who were evaluated due to concern for physical abuse by a multidisciplinary child protection team (MCPT) during 2016–2017 (N=312) in a paediatric level I trauma centre. Sensitivity, specificity, predictive values and diagnostic OR for ICD-10-CM coding were calculated and stratified by admission status, using as a reference standard the abuse determination of the MCPT recorded in a hospital registry. Among inpatients, child physical abuse coding sensitivity was 55.6% (95% CI 41.4% to 69.1%) and specificity was 78.6% (95% CI 59.0% to 91.7%), with diagnostic OR of 4.58 (95% CI 1.64 to 12.70). Among outpatients, sensitivity was 22.2% (95% CI 15.5% to 30.2%) and specificity was 86.3% (95% CI 77.7% to 92.5%), with diagnostic OR of 1.80 (95% CI 0.89 to 3.64). Use of ICD-10-CM coded data sets alone for surveillance may significantly underestimate the occurrence of physical child abuse.

We conducted a randomized trial of portable HEPA air cleaners with pre-filters designed to also reduce NH3 in non-smoking homes of children age 6-12 with asthma in Yakima Valley (Washington, USA). Participants were recruited through the Yakima Valley Farm Workers Clinic asthma education program. All participants received education on home triggers while intervention families additionally received two HEPA cleaners (child's sleeping area, main living area). Fourteen-day integrated samples of PM2.5 and NH3 were measured at baseline and one-year follow-up. We fit ANCOVA models to compare follow-up concentrations in HEPA versus control homes, adjusting for baseline concentrations. Seventy-one households (36 HEPA, 35 control) completed the study. Most were single-family homes, with electric heat and stove, A/C, dogs/cats, and mean (SD) 5.3 (1.8) occupants. In the sleeping area, baseline geometric mean (GSD) PM2.5 was 10.7 (2.3) µg/m3 (HEPA) versus 11.2 (1.9) µg/m3 (control); in the living area, it was 12.5 (2.3) µg/m3 (HEPA) vs. 13.6 (1.9) µg/m3 (control). Baseline sleeping area NH3 was 62.4 (1.6) µg/m3 (HEPA) vs. 65.2 (1.8) µg/m3 (control). At follow-up, HEPA families had 60% (95% CI, 41%-72%; p < 0.0001) and 42% (19%-58%; p = 0.002) lower sleeping and living area PM2.5 , respectively, consistent with prior studies. NH3 reductions were not observed.

Background: Mycobacterium bovis (bTB) is a potential health hazard to dairy workers. This study uses the One Health wholistic framework for examining bovine tuberculosis (TB) and its relationship to human health. This approach can help bridge surveillance data gaps and contribute to disease control and prevention programs for dairy farm workers, cattle, and the environment. The primary objective of this study was to compare the self-reported history of TB among dairy workers in Bailey County, Texas, with occupational categories of risk and exposure to TB. Methods: A cross-sectional study was conducted among dairy workers. Job positions were used as a proxy for exposure to cattle—high and medium/low. We employed bivariate analyses to examine differences between groups using both the chi-square test and the nonparametric Kruskal–Wallis test. Results: Of the 293 dairy workers invited, 77.0% ( n = 225) participated. No statistically significant associations were found between job categories and reported history of TB exposure. Workers in the high group were younger, Guatemalan males with lower levels of formal education, more likely to be single with no children, and cohabitating with coworkers compared with the medium/low group. Conclusion/Application to Practice: Self-reported TB history among dairy workers is an imprecise measure of being previously diagnosed with TB. Dairy workers at risk for occupationally acquired TB could be tested for TB before employment and tested periodically thereafter, and more expeditiously treated if a positive test is obtained. Future studies should focus on the feasibility of offering on-farm health services, such as TB screening.

ObjectiveTo examine (1) if tobacco retail outlets (TROs) closer to middle and high schools have more tobacco advertisements than TROs farther away and (2) the potential impact of two place-based tobacco control strategies on tobacco advertisements: a simulated ban of TROs (1) within 1000ft of schools and (2) within 500 ft of other TROs.MethodsTROs within half-mile of 53 middle and high schools in the four largest Metropolitan areas in Texas were audited for all tobacco marketing. ArcGIS was used for mapping and grouping TROs by distance from the schools and simulating the ban. Mean differences in the number of tobacco advertisements were examined with t-tests. Percentage reductions in tobacco advertisements were calculated after simulation of both bans, reported by school type and by location, product and flavour.ResultsTROs within 1000 ft of schools had significantly more tobacco advertisements as compared with TROs located within 1000-2000 ft (p=0.03) for all schools combined and middle schools. Simulation of the 1000 ft ban of TROs led to a slightly greater reduction in advertisements (19.4%) as compared with the 500 ft ban of TROs from other TROs (17.9%). The reduction in all advertisement types was greater around middle schools and greatest for e-cigarettes (23.6%).ConclusionStudents can be exposed to a great deal of tobacco advertising in TROs around their schools. The implementation of a 1000 ft ban of TROs, or at minimum a ban on tobacco advertising outside and within these outlets, is one way to prevent or reduce the use of tobacco among adolescents.

Objectives We examined the distribution of reverse transcription polymerase chain reaction (RT-PCR) cycle threshold (CT) values obtained from symptomatic patients being evaluated for coronavirus disease 2019 (COVID-19) to determine the proportion of specimens containing a viral load near the assay limit of detection (LoD) to gain practical insight to the risk of false-negative results. We also examined the relationship between CT value and patient age to determine any age-dependent difference in viral load or test sensitivity. Methods We collected CT values obtained from the cobas severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay corresponding to 1,213 combined nasopharyngeal-oropharyngeal specimens obtained from symptomatic individuals that were reported as positive or presumptive positive for SARS-CoV-2. CT values were stratified by SARS-CoV target and patient age group. Results In total, 93.3% to 98.4% of specimens demonstrated CT values greater than 3× the assay LoD, at which point false-negative results would not be expected. The mean of CT values between age groups was statistically equivalent with the exception of patients in age group 80 to 89 years, which demonstrated slightly lower CTs. Conclusions Based on the distribution of observed CT values, including the small proportion of specimens with values near the assay LoD, there is a low risk of false-negative RT-PCR results in combined nasopharyngeal-oropharyngeal specimens obtained from symptomatic individuals.

OBJECTIVE Variation in diabetes screening in clinical practice is poorly described. We examined the interplay of patient, provider, and clinic factors explaining variation in diabetes screening within an integrated health care system in the U.S. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of primary care patients aged 18–64 years with two or more outpatient visits between 2010 and 2015 and no diagnosis of diabetes according to electronic health record (EHR) data. Hierarchical three-level models were used to evaluate multilevel variation in screening at the patient, provider, and clinic levels across 12 clinics. Diabetes screening was defined by a resulted gold standard screening test. RESULTS Of 56,818 patients, 70% completed diabetes screening with a nearly twofold variation across clinics (51–92%; P < 0.001). Of those meeting American Diabetes Association (ADA) (69%) and U.S. Preventive Services Task Force (USPSTF) (36%) screening criteria, three-quarters were screened with a nearly twofold variation across clinics (ADA 53–92%; USPSTF 49–93%). The yield of ADA and USPSTF screening was similar for diabetes (11% vs. 9%) and prediabetes (38% vs. 36%). Nearly 70% of patients not eligible for guideline-based screening were also tested. The USPSTF guideline missed more cases of diabetes (6% vs. 3%) and prediabetes (26% vs. 19%) than the ADA guideline. After adjustment for patient, provider, and clinic factors and accounting for clustering, twofold variation in screening by provider and clinic remained (median odds ratio 1.97; intraclass correlation 0.13). CONCLUSIONS Screening practices vary widely and are only partially explained by patient, provider, and clinic factors available in the EHR. Clinical decision support and system-level interventions are needed to optimize screening practices.

Introduction: Body image dissatisfaction (BID) has been inversely associated with breastfeeding initiation particularly among women with obesity. However, less is known on BID and the association with maintaining breastfeeding in Mexico, where breastfeeding rate is decreasing across ethnic subgroups. Therefore, we explore this gap of knowledge in diverse ethnic subgroups across levels of maternal weight status. Methods: Data were derived from the Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición [ENSANUT] 2012), and 10,466 women aged 20–49 years were included. Breastfeeding (0), and 37% had obesity (BMI ≥30 kg/m(2)). In the multivariable analysis, for each one-unit increase in the BID score, the adjusted odds of breastfeeding (≥6 months) decreased by 6% (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.89–0.99). After stratifications, only among women with obesity, a greater BID score was associated with lower odds of breastfeeding duration by 24% (OR = 0.76, 95% CI: 0.64–0.89) in indigenous and by 10% (OR = 0.90, 95% CI: 0.82–0.98) in non-indigenous women. Conclusions: Mexican women with a higher BID score reported lower odds of breastfeeding duration (≥6 months). Body image concerns should be integrated into a health promotion curriculum to mitigate their negative effect particularly in certain segments of the populations, such as women with obesity and among indigenous women.

Past evaluations of Safe Routes to School (SRTS) programs have been relatively small in scope and have lacked objective measurements of physical activity. A 2016 Mobility Bond in Austin, Texas, USA, allocated USD 27.5 million for infrastructure changes to facilitate active commuting to schools (ACS). The Safe TRavel Environment Evaluation in Texas Schools (STREETS) study aims to determine the health effects of these infrastructure changes. The purpose of this paper is to describe the STREETS study design, methods, and selected baseline results. The STREETS study is comprised of two designs: (1) a serial cross-sectional design to assess changes in ACS prevalence, and (2) a quasi-experimental, prospective cohort to examine changes in physical activity. Differences between study arms (Austin SRTS and comparison) were assessed for school demographics, ACS, and school programs. At baseline, 14.3% of school trips were made by ACS, with non-significant differences between study arms. Only 26% of schools implemented ACS-related programs. Some significant differences across SRTS and comparison schools were identified for several school- and neighborhood-level characteristics. Substantial changes are needed across area schools and neighborhoods to promote optimum ACS. STREETS study longitudinal findings will be critical for informing optimal future implementations of SRTS programs.

Background Data on pediatric asthma morbidity and effective environmental interventions in U.S. agricultural settings are few. We evaluated the effectiveness of HEPA air cleaners on asthma morbidity among a cohort of rural Latino children. Methods Seventy-five children with poorly controlled asthma and living in non-smoking homes were randomly assigned to asthma education alone or along with HEPA air cleaners placed in their sleeping area and home living room. The Asthma Control Test (ACT) score, asthma symptoms in prior 2 weeks, unplanned clinical utilization, creatinine-adjusted urinary leukotriene E4 (uLTE4 [ng/mg]), and additional secondary outcomes were evaluated at baseline, six, and 12 months. Group differences were assessed using multivariable-adjusted generalized estimating equations. Incident rate ratios of ever experiencing the metrics of poorer asthma health during follow-up (suboptimal asthma management) were estimated using Poisson regression models in secondary analysis. Results Mean child age was 9.2 and 8.6 years in intervention and control groups, respectively, and two-thirds of participants were male. Primary analysis of repeated measures of ACT score did not differ between groups (HEPA group mean change compared to controls 10% [95% CI: − 12-39%]). A suggestion of greater decrease in uLTE4 (ng/mg creatinine) was observed (− 10% [95% CI: − 20 -1%]). Secondary analysis showed children with HEPAs were less likely to have an ACT score meeting a clinically defined cutoff for poorly controlled asthma using repeated measures (IRR: 0.45 [95% CI: 0.21–0.97]). In Poisson models, intervention participants had reduced risk of ever meeting this cutoff (IRR: 0.43 [95% CI: 0.21–0.89]), ever having symptoms in the past 2 weeks (IRR: 0.71 [95% CI: 0.52–0.98]), and lower risk of any unplanned clinical utilization (IRR: 0.35 [95% CI: 0.13–0.94]) compared to control participants. Discussion The HAPI study showed generally improved outcomes among children in the HEPA air cleaner group. However, primary analyses did not meet statistical significance and many outcomes were subjective (self-report) in this unblinded study, so findings must be interpreted cautiously. HEPA air cleaners may provide additional benefit for child asthma health where traditional asthmagens (traffic, tobacco smoke) are not prominent factors, but larger studies with more statistical power and blinded designs are needed. Trial registration ClinicalTrials.gov Identifier: NCT04919915. Date of retrospective registration: May 19, 2021.

Previous research has established an association between internalizing and externalizing problems with e-cigarette use in youth. Secondary analysis of Population Assessment of Tobacco and Health youth waves 1-4(2013-2017). Age of initiation of ever e-cigarette use and age of first report of past 30-day e-cigarette use were prospectively estimated among never e-cigarette users(waves 1-3). Weighted interval-censoring multivariable Cox proportional hazard models were fit to assess differences in each e-cigarette outcome among youth with internalizing and externalizing problems, as well as the interaction between internalizing and externalizing problems, while adjusting for covariates. Weighted interval-censoring survival analyses estimated the age of initiation of ever and age of first report of past 30-day e-cigarette use stratified by internalizing and externalizing problems. Among youth never e-cigarette users, those with high internalizing problems and high externalizing problems had increased risk of initiating ever e-cigarette use at earlier ages compared to youth with none/low internalizing and externalizing problems, respectively. Youth with high internalizing problems and high externalizing problems had increased risk of first reporting past 30-day e-cigarette use at earlier ages compared to youth with none/low internalizing problems, respectively. By age 17, 36.3% of youth with high internalizing problems and 38.5% of youth with high externalizing problems initiated ever e-cigarette use. By age 17, 16.8% of youth with high internalizing and 18.7% of youth with high externalizing problems first reported past 30-day e-cigarette use. Youth with internalizing and externalizing problems should be screened for e-cigarette use and provided with proper resources to prevent onset of e-cigarette use.

Background The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. Objective Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. Methods With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P Results A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P Conclusions In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. Trial Registration ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 International Registered Report Identifier (IRRID) RR2-10.2196/10977

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.

OBJECTIVE: This study assesses the association between exposure to alcohol in movies and alcohol use transitions among Latin American adolescents. METHOD: A school-based longitudinal study involving 33 secondary schools in Argentina and 57 in Mexico was performed. The baseline sample included 1,504 never drinker adolescents in Argentina and 5,264 in Mexico (mean age = 12.5 years), of whom 1,055 and 3,540, respectively, completed a follow-up survey a year and a half later. Exposure to the 500 popular contemporary films was assessed by querying adolescents on 50 randomly selected titles. Films were content-coded for alcohol and exposure estimated from films seen. Logistic regression models estimated adjusted relative risk (aRR) for the following outcomes, net covariates, at follow-up: use of alcohol (having ever drank), current drinking (drinking in the past 30 days), ever binge drinking (≥ 4 drinks [females] or 5 for males). RESULTS: At follow-up, respective adolescent drinking rates for Mexico and Argentina were 31% and 36% for use of alcohol, 18% and 27% for current drinking, and 8% and 19% for ever binge drinking. Greater exposure to alcohol in movies was independently associated with trying alcohol (aRR = 1.30, 95% CI [1.17, 1.43]), current drinking (aRR = 1.22, 95% CI [1.03, 1.44]), and binge drinking (aRR = 1.71, 95% CI [1.30, 2.25]) in Mexican adolescents, whereas in Argentina, movie alcohol exposure was associated only with trying alcohol (aRR = 1.25, 95% CI [1.02, 1.53]). CONCLUSIONS: Exposure to alcohol in movies predicted underage drinking transitions in these Latin American adolescents, replicating prior results for U.S. and European cohorts.

Background Although school garden programs have been shown to improve dietary behaviors, there has not been a cluster-randomized controlled trial (RCT) conducted to examine the effects of school garden programs on obesity or other health outcomes. The goal of this study was to evaluate the effects of a one-year school-based gardening, nutrition, and cooking intervention (called Texas Sprouts) on dietary intake, obesity outcomes, and blood pressure in elementary school children. Methods This study was a school-based cluster RCT with 16 elementary schools that were randomly assigned to either the Texas Sprouts intervention (n = 8 schools) or to control (delayed intervention, n = 8 schools). The intervention was one school year long (9 months) and consisted of: a) Garden Leadership Committee formation; b) a 0.25-acre outdoor teaching garden; c) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school-year; and d) nine monthly parent lessons. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Child outcomes measured were anthropometrics (i.e., BMI parameters, waist circumference, and body fat percentage via bioelectrical impedance), blood pressure, and dietary intake (i.e., vegetable, fruit, and sugar sweetened beverages) via survey. Data were analyzed with complete cases and with imputations at random. Generalized weighted linear mixed models were used to test the intervention effects and to account for clustering effect of sampling by school. Results A total of 3135 children were enrolled in the study (intervention n = 1412, 45%). Average age was 9.2 years, 64% Hispanic, 47% male, and 69% eligible for free and reduced lunch. The intervention compared to control resulted in increased vegetable intake (+ 0.48 vs. + 0.04 frequency/day, p = 0.02). There were no effects of the intervention compared to control on fruit intake, sugar sweetened beverages, any of the obesity measures or blood pressure. Conclusion While this school-based gardening, nutrition, and cooking program did not reduce obesity markers or blood pressure, it did result in increased vegetable intake. It is possible that a longer and more sustained effect of increased vegetable intake is needed to lead to reductions in obesity markers and blood pressure. Clinical trials number NCT02668744.

This study examined the recalled age of initiation of seven different tobacco products (TPs) and explored potential influences of sex, race/ethnicity, and cigarette-smoking status on tobacco use initiation among adults 26&ndash, 34 years old using the PATH study. Methods: Secondary analyses were conducted in the adult restricted PATH wave 1 (2013&ndash, 2014) dataset. Weighted statistics are reported using the balanced repeated replication method and Fay&rsquo, s correction to account for PATH&rsquo, s complex study design. Distributions and histograms of the recalled age of initiation of seven different TPs (cigarettes, cigarillos, traditional cigars, filtered cigars, hookah, smokeless tobacco, and e-cigarettes) are reported, as well as the impact of sex and race/ethnicity using Cox proportional hazard models. The impact of cigarette-smoking status on the recalled age of initiation of each tobacco product other than cigarettes was explored. Results: The highest modes of the recalled age of initiation of cigarette use were at 14&ndash, 15 and 15&ndash, 16 years old. The distributions of the recalled age of initiation of cigarillos, traditional cigars, filtered cigars, hookah, and smokeless tobacco occurred later, with the highest modes at 15&ndash, 16 and 17&ndash, 18 years old. The distribution of the recalled age of initiation of e-cigarettes had a different shape than the other TPs, with the highest mode reported at 27&ndash, 28 years old. Conclusion: Due to the ever-changing tobacco marketplace, understanding when contemporary adults aged 26&ndash, 34 years recall initiating TP use is important and will inform prevention researchers.

Despite the negative health consequence of hookah, hookah risk perceptions are misguided among youth. Secondary data analysis of 12–17-year-old never hookah users at their first wave of PATH participation (2013–2019) was performed. The effect of perceptions of hookah harmfulness and addictiveness on the age of initiation ever, past 30-day, and fairly regular hookah use were estimated using interval-censored Cox proportional hazards models. The distribution of the age of initiation of hookah outcomes by perception levels of harmfulness and addictiveness are reported as cumulative incidence and 95% CI. Youth who perceived hookah to be neither harmful nor addictive were 173% more likely to initiate ever, 166% more likely to first report past 30-day use, and 142% more likely to first report fairly regular hookah use at earlier ages compared to youth who considered hookah to be both harmful and addictive. By age 18, 25.5% of youth who perceived hookah as neither harmful nor addictive were estimated to initiate ever hookah use while 9.3% of youth who perceived hookah as harmful and addictive were estimated to initiate ever hookah use. These findings indicate the need to provide prevention and education campaigns to change perceptions of the harmfulness and addictiveness of hookah to delay the age of initiation of hookah use.

Significance Young adults, especially those who identify as racial/ethnic minorities, are legal targets of the tobacco industry. Cigarillo initiation is a risk among these vulnerable groups. Estimating the age of initiation of cigarillo use among young adults may inform the timing of prevention interventions. Methods Weighted interval-censored survival analyses of the Population Assessment of Tobacco and Health (PATH) young adult (ages 18–24 at their first wave of adult participation) annual datasets were conducted (2013–2017). Young adult never cigarillo users (n = 7,101; represents N = 24,023,488) at their first wave of adult participation (2013–2016) were followed-up through 2014–2017 to estimate the age of initiation of ever, past 30-day and fairly regular cigarillo use outcomes. Differences by sex and by race/ethnicity, accounting for previous use of other tobacco products and marijuana and blunt use, were assessed using weighted interval-censored Cox proportional hazards models. Results Among PATH young adults, by age 21, 5.8% initiated ever cigarillo use, 4.1% initiated past 30-day cigarillo use, and 1.4% initiated fairly regular cigarillo use. By age 26, 15% initiated ever cigarillo use, and 10.4% initiated past 30-day cigarillo use. Males had higher risk of initiating ever (AHR: 1.63, 95% CI: 1.37–1.95) and past 30-day cigarillo use (AHR: 1.65, 95% CI: 1.32–2.06) at earlier ages than females. Non-Hispanic Blacks had higher risk of initiating ever (AHR: 2.81, 95% CI: 2.26–3.50), past 30-day (AHR: 4.88, 95% CI: 2.95–5.09) and fairly regular cigarillo use (AHR: 4.62, 95% CI: 2.70–7.93) at earlier ages than non-Hispanic Whites. Hispanics had higher risk of initiating past 30-day cigarillo use at earlier ages than non-Hispanic Whites (AHR: 1.51, 95% CI: 1.12–2.03). Non-Hispanic Other race (i.e., Asian, multiracial, etc.) had lower risk of initiating ever (AHR: 0.43, 95% CI: 0.28–0.65) and past 30-day cigarillo use (AHR: 0.40, 95% CI: 0.26–0.63) at earlier ages than Non-Hispanic Whites. Conclusion Along with those aged 21 and younger, interventions should target young adults over the age of 21, specifically males, non-Hispanic Black and Hispanic young adults, to stall initiation and progression of cigarillo use behaviors.

Objective: To estimate trends in the prevalence of child stunting in the population of children under 5 years of age covered by public health programmes, between 2009 and 2014 in Misiones, Argentina. Methods: Using Bayesian model-based geostatistics, we evaluated 724 872 anthropometric measurements corresponding to 110 633 children. In order to identify disparities at local scale, we evaluated the hypotheses of a differential reduction of stunting according to the geographical location (at two-level spatial resolution) and to the socioeconomic level in a rural or urban environment. Results: The prevalence of stunting had fallen significantly in the province overall. Sex and age defined gender disparities at individual level, and there were regional disparities with higher prevalence values in the north and northeast regions. In these areas, stunting decreased to a greater degree during the studied period, although the spatial pattern remained smoother. Stunting increased in peripheral urban and dispersed rural areas that are socioeconomically vulnerable. Conclusions: The spatial multi-level geostatistical estimates of child undernutrition provide a precision public health tool to target public policies to those populations with the greatest need, in order to reduce health disparities. Fil: Nuñez, Pablo Alfredo. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Fernández, María Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Turjanski, Pablo Guillermo. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Computación; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria; Argentina Fil: Pérez, Adriana. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Rivero, Maria Romina. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: de Angelo, Carlos Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Salomón, Oscar Daniel. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina Fil: Cueto, Gerardo Ruben. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Background As no globally accepted dengue vaccines or specific antiviral therapies are currently available, controlling breeding sites of Aedes aegypti is a target to prevent dengue outbreaks. The present study aimed to characterize outdoor artificial breeding sites in urban households using an exhaustive classification system. Methods A cross-sectional entomological survey was carried out in Colón city, Entre Ríos, Argentina, using a two-stage stratified sampling design during March and April 2014. The city was stratified given the degree of urbanization of each block, and blocks and households were randomly selected. All outdoor containers with water were inspected, and the presence of immature mosquitoes was recorded. Containers were classified according to physical, functional, and location attributes. Generalized linear mixed models were applied to take into account the aggregated nature of the data (containers in houses and houses in blocks). Results Overall, 207 houses were inspected. Out of 522 containers with water, 25% had immatures of Ae. aegypti (7336). In adjusted models, the abundance of immatures was higher in containers with increasing opening surface and volume, without roof cover, exposed to shadow, out of use or with functions related to gardening activities, household chores, water storage, or construction. At block level, immatures abundance was positively associated with the degree of urbanization. Conclusions We detected high immatures abundance in containers associated with water utilization. This suggests that containers involved in these activities, whether directly (e.g., water storage) or indirectly (e.g., incomplete water drainage in the last use), are susceptible to present a high immature abundance. Although our results indicate the importance of the type of use over the type of container, we encourage the use of both classification criteria for artificial breeding sites of mosquitoes, mainly because these are complementary. Additionally, generalized linear mixed models allowed us to analyse predictor variables at different scales (container/house/block) and consider the lack of independence between observations. An exhaustive analysis of artificial breeding sites that use this analytical methodology can lead to new information that could help designing more appropriate tools for dengue surveillance and control.

BACKGROUND –: Data addressing air quality effects on children with asthma in rural U.S. communities are rare. Our community engaged research partnership previously demonstrated associations between neighborhood NH(3) and ambient PM(2.5) and asthma in the agricultural lower Yakima Valley of Washington. As a next step, the partnership desired an intervention approach to address concerns about pediatric asthma in this largely Latino immigrant, farm worker community. OBJECTIVE –: The Home Air in Agriculture Pediatric Intervention (HAPI) sought to examine the effectiveness of enrichment of an existing asthma education program with portable high-efficiency particulate air (HEPA) cleaners designed to reduce PM(2.5) and NH(3.) We investigated the effect of this enriched approach on these exposures and asthma health measures. DESIGN –: We randomized children with poorly controlled asthma to a control arm (current asthma education program) or an intervention arm (current asthma education program + placement of two indoor air cleaners in the family’s home). Outcomes included (1) 14-day integrated samples of indoor air contaminants (PM(2.5) and NH(3)) at baseline and one-year follow-up and (2) child asthma health metrics at baseline, midpoint (4–6 months) and one-year follow-up. These included the Asthma Control Test, symptoms days, clinical utilization, oral corticosteroid use, pulmonary function, fractional exhaled nitric oxide, and urinary leukotriene E(4) concentration. DISCUSSION –: To our knowledge, this is the first randomized HEPA cleaner intervention designed to assess NH(3) as well as PM(2.5) and to evaluate health outcomes of children with asthma in an agricultural region.

Significance Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is known about the age of initiation of cigar product use among youth. Methods Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12–17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and “fairly regular” use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data. Results For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and “fairly regular” use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use. Conclusion Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.

Glutathione (GSH) is a tripeptide that constitutes one of the main intracellular reducing compounds. The normal content of GSH in the intestine is essential to optimize the intestinal Ca2+ absorption. The use of GSH depleting drugs such as DL-buthionine-S,R-sulfoximine, menadione or vitamin K3, sodium deoxycholate or diets enriched in fructose, which induce several features of the metabolic syndrome, produce inhibition of the intestinal Ca2+ absorption. The GSH depleting drugs switch the redox state towards an oxidant condition provoking oxidative/nitrosative stress and inflammation, which lead to apoptosis and/or autophagy of the enterocytes. Either the transcellular Ca2+ transport or the paracellular Ca2+ route are altered by GSH depleting drugs. The gene and/or protein expression of transporters involved in the transcellular Ca2+ pathway are decreased. The flavonoids quercetin and naringin highly abrogate the inhibition of intestinal Ca2+ absorption, not only by restoration of the GSH levels in the intestine but also by their anti-apoptotic properties. Ursodeoxycholic acid, melatonin and glutamine also block the inhibition of Ca2+ transport caused by GSH depleting drugs. The use of any of these antioxidants to ameliorate the intestinal Ca2+ absorption under oxidant conditions associated with different pathologies in humans requires more investigation with regards to the safety, pharmacokinetics and pharmacodynamics of them. Fil: Moine, Luciana Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Rivoira, Maria Angelica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Díaz de Barboza, Gabriela Edith. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Pérez, Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Tolosa, Nori Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina

PURPOSE: Historically, adolescence has been regarded as the time when most tobacco use initiation occurs. This study examines the initiation of tobacco product use, including cigarettes, e-cigarettes, cigar products, and hookah, among contemporary youth and young adults, to determine whether the developmental timing (youth vs. young adulthood) of initiation has changed. METHODS: Three cohort studies were used to examine the onset of ever use and current (past 30 days) use of each tobacco product among never-using youth (11 to

Objective: This study examined the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories.Methods: Data from 172 (66.4% response rate) patients were considered in this observational longitudinal study. Participants were measured after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment, and the first post-treatment follow-up visit. Psychological, Health System and Information, Physical and Daily Living, Patient Care and Support, Sexual, and Additional care needs were measured with the Supportive Care Needs Survey (SCNS-SF34). Linear mixed models with maximum-likelihood estimation were computed.Results: The course of supportive care needs was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first post-treatment follow-up visit. Health System and Information care needs were the highest needs over time. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in course of supportive care needs of these patients.Conclusions: Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory.

BackgroundOur objective was to assess whether exposure to tobacco in video games is associated with smoking among adolescent gamers from Argentina.MethodsCross-sectional data were analysed from students in public and private middle schools in Argentina. Tobacco content in video games was estimated using previously validated methods and adolescents’ tobacco exposure was assessed by multiplying tobacco content in the top three video games they play by the hours played per day. The primary outcome was current smoking. Multilevel logistic regression models adjusted for clustering within schools, regressing current smoking on tobacco exposure in video games (ie, none, low, high) after controlling for age, sex, parental education, parenting style, parental rules about the use of video games, rebelliousness, sensation seeking and ‘technophilia’.ResultsOf the 3114 students who participated, 92% of boys (1685/1802) and 56% of girls (737/1312) played video games and were included in the analytical sample. The prevalence of smoking was 13.8% among boys and 22.0% among girls; 74.5% of boys played video games more than 1 hour per day compared with 47.7% of girls. High exposure to tobacco content in video games compared with no exposure was independently associated with current smoking among girls (OR 1.78; 95% CI 1.02 to 3.09) but not among boys (OR 0.98; 95% CI 0.64 to 1.51).ConclusionsGreater exposure to tobacco content in video games was associated with higher likelihood of smoking among Argentine girls who play video games, suggesting the need for policies that limit these exposures.

Objective. To assess the validity of a standard measure of smoking susceptibility for predicting cigarette and e-cigarette use in a sample of early adolescents in Argentina and Mexico. Materials and methods. A school-based longitudinal survey was conducted in 2014-16 among secondary students. We analyzed students who were never smokers of regular cigarettes or e-cigarettes at baseline and who completed both surveys. The main independent variable was smoking susceptibility. Multilevel logistic regression models were used, adjusting for sociodemographic and personal variables, social network use of cigarettes and exposure to advertising. Results. In the adjusted analysis, smoking susceptibility independently predicted cigarette initiation (Argentina: AOR 2.28; 95%CI 1.66-3.14; Mexico: AOR 2.07; 95%CI 1.74-2.45) and current smoking (Argentina: AOR 3.61; 95%CI 2.48-5.24; Mexico: AOR 1.69; 95%CI 1.29-2.22); however, it only predicted e-cigarette initiation in Mexico (Mexico: AOR 1.29; 95%CI 1.02-1.63). Conclusion. Smoking susceptibility was a valid measure to predict future cigarette smoking in this sample.

Background: Bile acids (BAs) are among the main components of bile. Lately, they are also considered important signaling molecules, not only by regulating their own synthesis, but also having a role in several metabolic diseases. Objective: In this review we focus on the effect of sodium deoxycholate (NaDOC), ursodeoxycholic (UDCA) and litocholic (LCA) acids and their combination upon the intestinal Ca2+ absorption. To make clear the actions of those BAs on this physiological process, an overview of current information about the mechanisms by which the intestinal Ca2+ occurs is described. Methods: The PubMed database was searched until 2017, using the keywords bile acids, NaDOC, UDCA and LCA and redox state, apoptosis, autophagy and intestinal Ca2+ absorption. Results: The modulation of redox state, apoptosis and autophagy are mechanisms that are involved in the action of BAs on intestinal Ca2+ absorption. Although the mechanisms are still not completely understood, we provide the latest knowledge regarding the effect of BAs on intestinal Ca2+ absorption. Conclusion: The response of the intestine to absorb Ca2+ is affected by BAs, but it is different according to the type and dose of BA. When there is a single administration, NaDOC has an inhibitory effect, UDCA is an stimulator whereas LCA does not have any influence. However, the combination of BAs modifies the response. Either UDCA or LCA protects the intestine against the oxidative injury caused by NaDOC by blocking the oxidative/nitrosative stress, apoptosis and autophagy. Fil: Marchionatti, Ana María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Cátedra de Bioquímica y Biología Molecular; Argentina Fil: Rivoira, Maria Angelica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Cátedra de Bioquímica y Biología Molecular; Argentina Fil: Rodriguez, Valeria Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Cátedra de Bioquímica y Biología Molecular; Argentina Fil: Perez, Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Cátedra de Bioquímica y Biología Molecular; Argentina Fil: Tolosa, Nori Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Cátedra de Bioquímica y Biología Molecular; Argentina

Objective The purpose of this study was to explore the association between obesity (via body mass index [BMI]) and presence of low back pain (LBP) in a representative sample of US adults, aged ≥18 years. Methods This cross-sectional study used data from 32 060 respondents to the 2015 National Health Interview Survey. Body mass index (kg/m2) was calculated using reported height and weight and expressed as normal weight ( Results Findings suggest a statistically significant association between BMI categories and LBP. The adjusted odds ratios (95% confidence interval) of LBP in overweight and obese participants were higher than those in normal weight participants: 1.21 (1.11-1.32) and 1.55 (1.44-1.67), respectively. Both sex and race/ethnicity statistically significantly modified the association between BMI and LBP. Compared with normal weight white men (reference), odds ratios (95% confidence interval) of LBP were higher among obese white men, obese white women, and obese nonwhite women (1.28 [1.10, 1.48], 1.58 [1.36, 1.84], and 1.36 [1.16, 1.60], respectively), and lower in overweight, nonwhite men, and normal weight nonwhite men and women (0.80 [0.68, 0.94], 0.62 [0.51, 0.76], and 0.73 [0.61, 0.87], respectively). Conclusion Overweight and obesity were associated with increased odds of LBP. However, the measures of associations varied in magnitude and direction by race and sex groups.

The goal of this study was to assess the effect of prenatal maternal cigarette smoking on children’s BMI z-score trajectories, and to evaluate whether small-for-gestational-age (SGA) acts as a potential mediator between prenatal maternal cigarette smoking and child’s BMI z-score at 4 years of age. Group-based trajectory modeling (GBTM) methods were employed to describe and classify developmental BMI z-score trajectories (the outcome of interest) in children from 9 months to 4 years of age (n = 5221) in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) study (2001–2005). Further analysis examined whether the identified BMI z-score trajectories varied with the exposure, prenatal maternal cigarette smoking. Mediation analyses were utilized to examine whether being SGA (binary measure) acted as a potential mediator in the relationship between prenatal maternal cigarette smoking and BMI z-score among 4-year-old children. Using GBTM, two BMI z-score trajectory groups were identified: normal BMI z-score (57.8%); and high BMI z-score (42.2%). Children of mothers who smoked cigarettes during pregnancy were 2.1 times (RR 95% CI: 1.1–4.0, P value = 0.023) more at risk of being in the high BMI z-score trajectory group. Prenatal cigarette smoking was positively related to SGA at birth, but SGA was inversely related to BMI z-score at 4 years. The direct effect (0.19, 95% CI: 0.18, 0.19; P value

Introduction There is a lack of research prospectively estimating the age of e-cigarette initiation in U.S. young adults. Methods Secondary analysis of PATH young adults across 2013–2017 (waves 1–4) were conducted. We prospectively estimated age of initiation of: ever, past 30-day, and fairly regular e-cigarette use using weighted interval-censoring survival analyses. Interval-censoring Cox proportional hazard models adjusting for sex, race/ethnicity, and previous use of six other tobacco products (cigarettes, traditional cigars, filtered cigars, cigarillos, hookah, and smokeless tobacco) were fitted for each of the three e-cigarette initiation outcomes. Results Among never e-cigarette users, by age 21, 16.8% reported ever use, 7.2% reported past 30-day use, and 2.3% reported fairly regular e-cigarette use. Males had increased risk of initiating ever, past 30-day, and fairly regular e-cigarette use at earlier ages compared to females. Hispanic young adults had increased risk of initiating ever and past 30-day e-cigarette use at earlier ages compared to Non-Hispanic White young adults. Previous use of other tobacco products before e-cigarette initiation increased the risk of an earlier age of e-cigarette initiation. Conclusion Prevention and education campaigns should focus on young adults in order to alleviate the public health burden of initiating e-cigarette use at earlier ages.

Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7–5.2) and 2.0% (95% CI: 1.2–2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.

Objective This study reports the prospectively estimated age of initiation of susceptibility to, ever, past 30-day, and fairly regular hookah use. Design Secondary data analyses of the first four waves (2013–2017) of the PATH study, a nationally representative longitudinal cohort study of US youth (ages 12–17). Methods Youth who were never hookah users at their first wave of participation were identified (n = 16,678; N = 31,136,834). Four outcomes were analyzed, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) fairly regular hookah use. The age of hookah initiation of each outcome was estimated. Weighted interval censoring survival analyses and Cox regression models were conducted to estimate the age of initiation of each hookah use outcome, and to estimate differences in age of initiation by sex and by race, respectively. Results Around 11% of youth were classified as susceptible to hookah use by 13 years of age, 8% reported initiating ever hookah use by age 17, almost 10% reported initiating past 30-day hookah use by age 19, and 3% reported initiating fairly regular hookah use by age 20. Females and Hispanics were at higher risk of becoming susceptible to and ever hookah use at earlier ages compared to males and Non-Hispanic White youth. Conclusion Education, communication campaigns, and proven culturally targeted tobacco interventions that reach youth at ages before they first become susceptible or start using hookah use are needed to prevent the onset of hookah use among vulnerable youth.

Purpose Mexican breast cancer patients are generally diagnosed in advanced stages of the disease and often experience delays in cancer treatment delivery. Currently, little is known about these patients’ psychological care needs. This study assessed levels and correlates of supportive care needs of Mexican breast cancer patients around the time of cancer diagnosis. Methods One hundred seventy-three newly diagnosed Mexican breast cancer patients participated in the study. Supportive care needs, anxiety, depression, and patients’ sociodemographic and clinical characteristics were assessed. Multiple regression analyses were used to examine factors associated with care needs. Results Up to 44% of patients showed unmet care needs. Health system/information needs were the most prevalent (68%), while physical/daily living needs the least (19%). Level of depressive symptoms was most consistently related to care needs. Patients with higher levels of depressive symptoms had higher psychological (β = 0.38), physical/daily living (β = 0.43), patient care/support (β = 0.17), and additional unmet care needs (β = 0.30), than patients with lower levels of depressive symptoms. Conclusions This study suggests that mainly health system/information needs arise at the time of cancer diagnosis among Mexican breast cancer patients. Patients suffering high levels of depressive symptoms reported the highest levels of unmet needs. Future studies should be conducted to elucidate the care needs throughout the disease trajectory, as such information can inform health care professionals and policy makers and lead to improvements in the organization and provision of health care services for Mexican breast cancer patients. Electronic supplementary material The online version of this article (doi:10.1007/s00520-017-3741-5) contains supplementary material, which is available to authorized users.

Objective:To explore the association between metabolic syndrome and the Unified Parkinson’s Disease Rating Scale (UPDRS) scores and, secondarily, the Symbol Digit Modalities Test (SDMT).Methods:This is a secondary analysis of data from 1,022 of 1,741 participants of the National Institute of Neurological Disorders and Stroke Exploratory Clinical Trials in Parkinson Disease Long-Term Study 1, a randomized, placebo-controlled trial of creatine. Participants were categorized as having or not having metabolic syndrome on the basis of modified criteria from the National Cholesterol Education Program Adult Treatment Panel III. Those who had the same metabolic syndrome status at consecutive annual visits were included. The change in UPDRS and SDMT scores from randomization to 3 years was compared in participants with and without metabolic syndrome.Results:Participants with metabolic syndrome (n = 396) compared to those without (n = 626) were older (mean [SD] 63.9 [8.1] vs 59.9 [9.4] years; p < 0.0001), were more likely to be male (75.3% vs 57.0%; p < 0.0001), and had a higher mean uric acid level (men 5.7 [1.3] vs 5.3 [1.1] mg/dL, women 4.9 [1.3] vs 3.9 [0.9] mg/dL, p < 0.0001). Participants with metabolic syndrome experienced an additional 0.6- (0.2) unit annual increase in total UPDRS (p = 0.02) and 0.5- (0.2) unit increase in motor UPDRS (p = 0.01) scores compared with participants without metabolic syndrome. There was no difference in the change in SDMT scores.Conclusions:Persons with Parkinson disease meeting modified criteria for metabolic syndrome experienced a greater increase in total UPDRS scores over time, mainly as a result of increases in motor scores, compared to those who did not. Further studies are needed to confirm this finding.ClinicalTrials.gov identifier:NCT00449865.

BACKGROUND Monoamine oxidase type B (MAO-B) inhibitors exhibit neuroprotective effects in preclinical models of PD but clinical trials have failed to convincingly demonstrate disease modifying benefits in PD patients. OBJECTIVE To perform a secondary analysis of NET-PD LS1 to determine if longer duration of MAO-B inhibitor exposure was associated with less clinical decline. METHODS The primary outcome measure was the Global Outcome (GO), comprised of 5 measures: change from baseline in the Schwab and England (ADL) scale, the 39-item Parkinson's Disease Questionnaire (PDQ-39), the UPDRS Ambulatory Capacity Scale, the Symbol Digit Modalities Test, and the most recent Modified Rankin Scale. A linear mixed model was used to explore the association between the cumulative duration of MAO-B inhibitor exposure and the GO, adjusting for necessary factors and confounders. Associations between MAO-B inhibitor exposure and each of the five GO components were then studied individually. RESULTS 1616 participants comprised the analytic sample. Mean observation was 4.1 (SD = 1.4) years, and 784 (48.5%) participants received an MAO-B inhibitor. The regression coefficient of cumulative duration of MAO-B inhibitor exposure (in years) on the GO was - 0.0064 (SE = 0.002, p = 0.001). Significant associations between duration of MAO-B inhibitor exposure and less progression were observed for ADL (p

Background Several Zika virus (ZIKV) outbreaks have occurred since October 2015. Because there is no effective treatment for ZIKV infection, developing an effective surveillance and warning system is currently a high priority to prevent ZIKV infection. Despite Aedes mosquitos having been known to spread ZIKV, the calculation approach is diverse, and only applied to local areas. This study used meteorological measurements to monitor ZIKV infection due to the high correlation between climate change and Aedes mosquitos and the convenience to obtain meteorological data from weather monitoring stations. Methods This study applied the Bayesian structured additive regression modeling approach to include spatial interactive terms with meteorological factors and a geospatial function in a zero-inflated Poisson model. The study area contained 32 administrative departments in Colombia from October 2015 to December 2017. Weekly ZIKV infection cases and daily meteorological measurements were collected. Mapping techniques were adopted to visualize spatial findings. A series of model selections determined the best combinations of meteorological factors in the same model. Results When multiple meteorological factors are considered in the same model, both total rainfall and average temperature can best assess the geographic disparities of ZIKV infection. Meanwhile, a 1-in. increase in rainfall is associated with an increase in the logarithm of relative risk (logRR) of ZIKV infection of at most 1.66 (95% credible interval [CI] = 1.09, 2.15) as well as a 1 °F increase in average temperature is significantly associated with at most 0.79 (95% CI = 0.12, 1.22) increase in the logRR of ZIKV. Moreover, after controlling rainfall and average temperature, an independent geospatial function in the model results in two departments with an excessive ZIKV risk which may be explained by unobserved factors other than total rainfall and average temperature. Conclusion Our study found that meteorological factors are significantly associated with ZIKV infection across departments. The study determined both total rainfall and average temperature as the best meteorological factors to identify high risk departments of ZIKV infection. These findings can help governmental agencies monitor at risk areas according to meteorological measurements, and develop preventions in those at risk areas in priority.

Aims To outline the study design, outcome measures, protocol and baseline characteristics of enrolled participants of Texas (TX) Sprouts, a one-year school-based gardening, nutrition, and cooking cluster randomized trial. Methods Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to the delayed intervention over three years (2016–2019). The intervention arm received: formation/training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly during school hours by hired educators throughout one school year; and nine parent lessons taught monthly to families. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Primary outcomes included: dietary intake, dietary-related behaviors, obesity, and metabolic parameters. Child measures included: height, weight, waist circumference, body composition, blood pressure, and dietary psychosocial variables. A subsample of children were measured for glucose, hemoglobin-A1C, and 24-hour dietary recalls. Parent measures included: height and weight, dietary intake, and related dietary psychosocial variables. Results Of the 4239 eligible students, 3137 students consented and provided baseline clinical measures; 3132 students completed child surveys, with 92% of their parents completing parent surveys. The subsamples of blood draws and dietary recalls were 34% and 24%, respectively. Intervention arm baseline descriptives, clinical and dietary data for children and parents are reported. Conclusion The TX Sprouts intervention targeted primarily low-income Hispanic children and their parents; utilized an interactive gardening, nutrition, and cooking program; and measured a battery of dietary behaviors, obesity and metabolic outcomes.

Aging is a complex phenomenon characterized by the progressive loss of tissue and organ function. The oxidative-stress theory of aging postulates that age-associated functional losses are due to the accumulation of ROS-induced damage. Liver function impairment and non-alcoholic fatty liver disease (NAFLD) are common among the elderly. NAFLD can progress to non-alcoholic steatohepatitis (NASH) and evolve to hepatic cirrhosis or hepatic carcinoma. Oxidative stress, lipotoxicity, and inflammation play a key role in the progression of NAFLD. A growing body of evidence supports the therapeutic potential of omega-3 polyunsaturated fatty acids (n-3 PUFA), mainly docosahaexenoic (DHA) and eicosapentaenoic acid (EPA), on metabolic diseases based on their antioxidant and anti-inflammatory properties. Here, we performed a systematic review of clinical trials analyzing the efficacy of n-3 PUFA on both systemic oxidative stress and on NAFLD/NASH features in adults. As a matter of fact, it remains controversial whether n-3 PUFA are effective to counteract oxidative stress. On the other hand, data suggest that n-3 PUFA supplementation may be effective in the early stages of NAFLD, but not in patients with more severe NAFLD or NASH. Future perspectives and relevant aspects that should be considered when planning new randomized controlled trials are also discussed.

This cohort study uses data from the Population Assessment of Tobacco and Health (PATH) study waves 1 to 4 to assess at what age young people aged 12 to 17 years initiate cigarette use., Key Points Question At what age do youth (aged 12-17 years) initiate 4 cigarette use outcomes (susceptibility to use, ever use, past 30-day use, and fairly regular use)? Findings This cohort study examined nationally representative data for 15 776 youth never users and, among them, 11 022 youth who were nonsusceptible to cigarette use, and found that among youth who were nonsusceptible to cigarette use, by age 18 years, 46.2% became susceptible to cigarette use. Among never users of cigarettes, 24.4% initiated ever cigarette use, 16.4% initiated past 30-day cigarette use, and 4.3% initiated fairly regular cigarette use. Meaning Study results suggest that prevention interventions and educating the public about targeting specific ages, particularly before age 17 to 18 years, may reduce cigarette use initiation., Importance Cigarettes are still a commonly used tobacco product among youth despite recent declines in cigarette use. Objective The aim of this study was to prospectively estimate the age of cigarette use initiation among youth (aged 12-17 years) overall, by sex, and by race/ethnicity. Design, Setting, and Participants This cohort study used data from waves 1 through 4 of the nationally representative Population Assessment of Tobacco and Health (PATH) study, conducted from September 12, 2013, to January 3, 2018. Two subpopulations of youth were assessed: (1) those nonsusceptible to cigarette use and (2) never users of cigarettes at their first wave of PATH participation. Weighted interval-censoring survival analyses were used to prospectively estimate the age of initiation of cigarette use outcomes. Weighted interval-censoring Cox proportional hazard models were used to estimate differences in the age of initiation by sex and by race/ethnicity. Statistical analyses were performed from October 7, 2019, to May 1, 2020. Exposures Differences in the age of initiation by sex and race/ethnicity. Main Outcomes and Measures Age of initiation of susceptibility to cigarette use, ever use, past 30-day use, and fairly regular cigarette use overall, by sex, and by race/ethnicity. Results A total of 15 776 youth never users and, among them, 11 022 youth who were nonsusceptible to cigarette use, were included in this study (weighted mean [SE] age, 13.5 [0.01] years; 58.6% [SE, 0.46%] non-Hispanic White; and 51.0% [SE, 0.32%] boys) and 15 776 were never users of cigarettes at their first wave of PATH participation (weighted mean [SE] age, 13.7 [0.01] years; 55.0% [SE, 0.29%] non-Hispanic White; and 51.0% [SE, 0.15%] boys). By age 18 years, among those who were nonsusceptible, 46.2% (95% CI, 44.3%-48.2%) became susceptible to cigarette use. Among never users, 24.4% (95% CI, 22.9%-25.9%) initiated ever cigarette use, 16.4% (95% CI, 15.2%-17.6%) initiated past 30-day cigarette use, and 4.3% (95% CI, 3.9%-4.8%) initiated fairly regular cigarette use. Boys had a higher risk of initiating ever (hazard ratio [HR], 1.21; 95% CI, 1.08-1.36) and past 30-day cigarette use (HR, 1.27; 95% CI, 1.10-1.47) at earlier ages compared with girls. Non-Hispanic White youth had a higher risk of an earlier age of initiation of susceptibility to cigarette use (HR, 0.77; 95% CI, 0.68-0.88), ever use (HR, 0.59; 95% CI, 0.49-0.71), past 30-day use (HR, 0.64; 95% CI, 0.52-0.77), and fairly regular cigarette use (HR, 0.25; 95% CI, 0.14-0.43) compared with non-Hispanic Black youth. Conclusions and Relevance The results of this cohort study suggest that, despite current interventions and existing laws, a large number of youth initiated cigarette use before the legal age to purchase tobacco products.

Objective To assess the independent relation between parental restrictions on mature-rated media (M-RM) and substance use among South American adolescents. Methods Cross-sectional school-based youth survey of 3,172 students (mean age, 12.8 years; 57.6% boys) in 3 large Argentinean cities. The anonymous survey queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Adolescents reported M-RM restriction for internet and video game use, television programming, and movies rated for adults. Multivariate logistic regression models were used to assess the association between parental M-RM restriction and substance use after adjustment for hourly media use, measures of authoritative parenting style, sociodemographic characteristics, and sensation-seeking. Results Substance use rates were 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking, and 8% for illicit drug use (marijuana or cocaine). Half of the respondents reported parental M-RM restriction (internet 52%, TV 43%, adult movies 34%, video game 25%). Parental M-RM restriction was only modestly correlated with authoritative parenting measures. In multivariate analyses M-RM restriction on all 4 venues was strongly protective for all substance use outcomes. Compared with no restriction, odds ratios for substance use for full restrictions were 0.32 (0.18–0.59), 0.53 (0.38–0.07), 0.36 (0.22–0.59), and 0.49 (0.26–0.92) for current smoking, drinking, binge drinking, and illicit drug use, respectively. The most important single M-RM venue was movies. Conclusions Results of this study confirmed the protective association between parental M-RM restriction during adolescence and multiple substance use outcomes, including illicit drugs. M-RM restriction is independent of traditional parenting measures. The preponderance of the evidence supports intervention development.

Severely obese children and adolescents are at high risk of suffering obesity-related comorbidities. This article is to examine the dose-response relationship between weight status and cardiometabolic risk factors among US adolescents.Youths aged 6-19 years participating in the National Health and Nutrition Examination Surveys (NHANES) 1999-2012 were included (N = 20,905). Severe obesity was defined as BMI ≥120% of 95th percentile of gender-specific BMI-for-age or BMI ≥35 kg/m(2). Obesity-related cardiometabolic risk factors included blood pressure (BP), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglycerides, and fasting glucose (FG). Weighted multiple logistic regression was used to assess whether severe obesity significantly changed the odds of having cardiometabolic risk factors.The prevalence of high BP, high TC, low HDL, high triglycerides, high LDL, and high FG among severely obese adolescents was 9.9%, 16.5%, 40.0%, 30.0%, 13.0%, and 26.8%, respectively. Severely obese adolescents had at least twice the odds compared to normal weight adolescents of presenting high BP (OR = 5.3, 95% CI: 3.8-7.3); high TC (OR = 2.3, 95% CI: 1.8-3.0); low HDL (OR = 7.3, 95% CI: 6.1-8.8); high triglycerides (OR = 4.5, 95% CI: 3.4-5.9); high LDL (OR = 2.3, 95% CI: 1.5-3.5); and high FG (OR = 2.7, 95% CI: 1.8-4.0). Significant differences were also found between severely obese status and moderately obese status in the odds of having high BP (OR = 1.8, 95% CI: 1.7-2.2) and low HDL (OR = 1.9, 95% CI: 1.6-2.3).Adolescents classified as severe status exhibit higher odds of having cardiometabolic risk factors compared to those with normal weight and moderately obese weight status.

Key Points Question Is there an association between race and coronavirus disease 2019 (COVID-19) after controlling for age, sex, socioeconomic status, and comorbidities? Findings In this cross-sectional study of 2595 patients, positive COVID-19 tests were associated with Black race, male sex, and age 60 years or older. Black race and poverty were associated with hospitalization, but only poverty was associated with intensive care unit admission. Meaning The results of this study indicate that in the first weeks of the COVID-19 pandemic in Milwaukee, Wisconsin, Black race was associated with a positive COVID-19 test and the subsequent need for hospitalization, but only poverty was associated with intensive care unit admission., This cross-sectional study characterizes the association of race with incidence and outcomes of coronavirus disease 2019 (COVID-19), while controlling for age, sex, socioeconomic status, and comorbidities., Importance Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19). Objective To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities. Design, Setting, and Participants This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds). Exposures Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown). Main Outcomes and Measures Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death. Conclusions and Relevance In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.

Introduction Research on perceptions of environmental factors in relation to transportation and recreation bicycling is limited in the United States. We explored the association between perceived social and built environment factors with total, transportation, and recreation bicycling in a sample of adult bicyclists in Austin, Texas, and Birmingham, Alabama. The objective of this study was to examine the relationship between perceived social and built environment factors and domain-specific bicycling in a sample of adult bicyclists. Methods Adults aged 18 to 65 who rode a bicycle at least once in the past year completed an internet-based survey that was developed for this study to specifically assess correlates of bicycling; the study was conducted from October 2016 through January 2017. Perceived environmental factors assessed were residential density, traffic safety, destination, connectivity, safety from crime, aesthetics, and bicycle infrastructure. Multivariable logistic regression models were used to estimate the association of each perceived environmental factor (tertile 1, lowest; tertile 3, highest) with recreation-only and transportation bicycling. Effect modification of the relation between environmental factors and bicycling outcomes by sex was also examined. Results The final analytic sample size was 801 participants. All environmental factors examined, including residential density, traffic safety, destinations, connectivity, aesthetics, bicycle infrastructure, and safety from crime showed significantly direct associations with transportation bicycling. Traffic safety, destinations, aesthetics, and bicycle infrastructure showed significant direct and inverse associations with recreation-only bicycling. Effect modification by sex was identified with residential density; a significant direct association with recreation-only bicycling was seen among women. Conclusion These findings illustrate that bicycling for transportation is associated with different perceived environmental factors than is recreation-only bicycling, with some significant modification by sex. Comprehensive tools that assess the perceived environment for bikeability in the United States are warranted.

Background: Single-method assessment of physical activity (PA) has limitations. The utility and cross-validation of a composite PA score that includes reported and accelerometer-derived PA data has not been evaluated. Methods: Participants attending the Year 20 exam were randomly assigned to the derivation (two-thirds) or validation (one-third) data set. Principal components analysis was used to create a composite score reflecting Year 20 combined reported and accelerometer PA data. Generalized linear regression models were constructed to estimate the variability explained (R2) by each PA assessment strategy (self-report only, accelerometer only, composite score, or self-report plus accelerometer) with cardiovascular health indicators. This process was repeated in the validation set to determine cross-validation. Results: At Year 20, 3549 participants (45.2 [3.6] y, 56.7% female, and 53.5% black) attended the clinic exam and 2540 agreed to wear the accelerometer. Higher R2 values were obtained when combined assessment strategies were used; however, the approach yielding the highest R2 value varied by cardiovascular health outcome. Findings from the cross-validation also supported internal study validity. Conclusions: Findings support continued refinement of methodological approaches to combine data from multiple sources to create a more robust estimate that reflects the complexities of PA behavior.

Introduction In Mexico the breastfeeding rate is low and the obesity rate is high. Body image concerns, particularly prevalent in obese women, are associated with low breastfeeding rate; however, this association has never been examined in Mexican women. To fill this need, we examined the association between body image dissatisfaction (BID) and breastfeeding across levels of maternal weight status in Mexican women. Methods A cross-sectional study was used, utilizing data from the Mexican National Health and Nutrition Survey (ENSANUT) for 2012. The breastfeeding (Never or breastfed less than 30 days, Still breastfeeding, Ever breastfed) of the last child (age ≤ 3 years), BID (Stunkard Figure Rating Scale), anthropometric (Body Mass Index, BMI), and associated characteristics were collected. Weighted-multinomial logistic regression models were utilized to examine the adjusted association between BID and breastfeeding and the effect modification of maternal weight status. Results Overall, 2422 women aged 20-49 years met the eligibility criteria. Of these, 247 (10.8%) had never breastfed or breastfed less than 30 days, 826 (32%) were still breastfeeding, and 1349 (57.2%) had breastfed. A total of 38.2% were overweight (25 ≤ BMI

Background Zika virus (ZIKV) infection is a pandemic and a public health emergency. It is transmitted by mosquitoes, primarily the Aedes genus. In light of no treatment currently, it is crucial to develop effective vector control programs to prevent the spread of ZIKV infection earlier when observing possible risk factors, such as weather conditions enhancing mosquito breeding and surviving. Methods This study collected daily meteorological measurements and weekly ZIKV infectious cases among 32 departments of Colombia from January 2015–December 2016. This study applied the distributed lag nonlinear model to estimate the association between the number of ZIKA virus infection and meteorological measurements, controlling for spatial and temporal variations. We examined at most three meteorological factors with 20 lags in weeks in the model. Results Average humidity, total rainfall, and maximum temperature were more predictable of ZIKV infection outbreaks than other meteorological factors. Our models can detect significantly lagged effects of average humidity, total rainfall, and maximum temperature on outbreaks up to 15, 14, and 20 weeks, respectively. The spatial analysis identified 12 departments with a significant threat of ZIKV, and eight of those high-risk departments were located between the Equator and 6°N. The outbreak prediction also performed well in identified high-risk departments. Conclusion Our results demonstrate that meteorological factors could be used for predicting ZIKV epidemics. Building an early warning surveillance system is important for preventing ZIKV infection, particularly in endemic areas. Electronic supplementary material The online version of this article (10.1186/s12879-018-3085-x) contains supplementary material, which is available to authorized users.

Introduction A unique population of Nigerian children, aged 1–5 years, never receive any of the recommended childhood vaccines. However, the characteristics of this population has not been previously described. Given Nigeria’s historically poor childhood immunization coverage and high child mortality rates, it was imperative we investigate the prevalence and correlates of never-vacccination among Nigerian children. Methods We conducted secondary analysis of the 2013 Nigeria Demographic Health Survey data of Nigerian children, aged 12–59 months (n = 20,586). Weighted multivariate logistic regressions were used to examine the relationship between socio-demographic factors and never-vaccination of Nigerian children. Further regression analysis was conducted after stratifying by Northern and Southern regions. Results About twenty one percent of study sample, had never been vaccinated. Over eighty percent of the never-vaccinated children in our study resided in the Northern geopolitical zones of Nigeria. Child never-vaccination was found to be significantly associated with key socio-demographic characteristics. Children born into poor households, with mothers who are unemployed and uneducation, were more likely to be never-vaccinated. Unique predictors of child never-vaccination specific to Northern Nigeria were identified. Islam (aOR: 1.56, 95% CI: 1.11–2.17) and lack of access to Television or Radio (aOR: 1.49, 95% CI: 1.22–1.81) promoted never-vaccination, while increasing maternal age and rural residence (aOR: 0.63, 95% CI: 0.42–0.95) were associated with lower odds of never-vaccination. Conclusion Socio-demographic factors are predictors of child never-vaccination in Nigeria. Further investigations are needed to better understand the underlying contexts that conribute to child never-vaccination in populations identified in this study. More so, it is important to examine the mechanism through which predictors that are region-speific, culminate in child never-vaccination.