Early childhood diarrhea and cardiometabolic risk factors in adulthood: the Institute of Nutrition of Central America and Panama Nutritional Supplementation Longitudinal Study

BackgroundNutritional deficits in early life have been associated with a higher prevalence of the metabolic syndrome (MetS) in adulthood. Early childhood diarrhea contributes to undernutrition and may potentially increase the risk for adult noncommunicable diseases. Our objective was to examine associations between early childhood diarrhea burden and later development of MetS.MethodsWe studied individuals who participated in the Institute of Nutrition of Central America and Panama Nutritional Supplementation Longitudinal Study (1969–1977) and were followed up in 2002–2004. We used logistic regression to determine associations of diarrhea burden at ages 0 to 6, 6 to 12, and 12 to 24 months with odds of MetS and elevations in its components as adults.ResultsAmong 389 adults age 25 to 42 years at follow-up, the prevalence of MetS was 29%. Adjusting for several confounders including adult body mass index (BMI), each absolute 1% increase in diarrhea burden at age 0 to 6 months (but not at other time periods) was associated with increased odds of MetS (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.06). This was attributable primarily to associations with elevated blood pressure (OR, 1.03; 95% CI, 1.00–1.06) and waist circumference (OR, 1.03; 95% CI, 1.00–1.06).ConclusionsChildhood diarrhea burden at 0 to 6 months is associated with MetS in adulthood after controlling for childhood growth parameters and adult BMI.     

Association of Enjoyable Childhood Mealtimes with Adult Eating Behaviors and Subjective Diet-related Quality of Life

ObjectiveThis study examined whether the experience of enjoyable mealtimes at home during childhood was related to eating behaviors and subjective diet-related quality of life in adulthood.MethodsThe study used data (n = 2,936) obtained from a research program about Shokuiku (food and nutrition education) conducted by the Cabinet Office in Japan in November and December 2009. The study employed logistic regression adjusted for all predictor variables.ResultsEnjoyable eating experiences in childhood were positively associated with a balanced diet (meals with 3 dishes; odds ratio [OR]: 1.78, 95% confidence interval [CI]: 1.45-2.19), eating vegetable dishes (OR: 1.71, 95% CI: 1.37–2.12), and subjective diet-related quality of life scores (OR: 3.84, 95% CI: 3.14-4.70) in adulthood.Conclusions and ImplicationsThis study suggests that enjoyable eating experiences at home during childhood appear to promote healthy eating habits and the development of a positive diet-related quality of life in the future.     

Proton-pump inhibitor use and hip fractures in men: a population-based case-control study

PurposeTo estimate the association between proton-pump inhibitor (PPI) use and hip fracture.MethodsWe conducted a case-control study of 6774 pairs of men aged 45 years or older, matched on age, race, and medical center. Cases sustained incident hip fractures in 1997–2006. Fracture date was index date for each case-control pair. PPI exposure was identified from electronic pharmacy records, 1991–2006. PPI use was measured as (1) ever versus never; (2) adherence; (3) duration; and (4) recentness. Omeprazole and pantoprazole were analyzed separately using conditional logistic regression, adjusted for comorbidities. Nonusers were the referent group.ResultsEight hundred ninety-six (13.2%) cases and 713 (10.5%) controls used omeprazole before index date (matched odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27). Greatest adherence (medication possession ratio > 80%) (OR, 1.33; 95% CI, 1.09–1.62), highest tertile of duration (OR, 1.23; 95% CI, 1.02–1.48), and recent use (OR, 1.22; 95% CI, 1.02–1.47) were associated with hip fracture. Six hundred ninety-four (10.2%) cases and 576 (8.5%) controls had used pantoprazole (OR, 1.10; 95% CI, 0.97–1.24). Longest duration (OR, 1.25; 95% CI, 1.02–1.53) and most recent use (OR, 1.38; 95% CI, 1.12–1.71) were associated with hip fracture. Our study suggests that PPI use and hip fractures are associated, with risk increasing with longer duration and more recent use.     

Sociodemographic,clinical, and psychological factors associated with attrition in a prospective study of cardiovascular prevention: the Heart Strategies Concentrating on Risk Evaluation study

PurposeTo identify factors associated with attrition in a longitudinal study of cardiovascular prevention.MethodsDemographic, clinical, and psychosocial variables potentially associated with attrition were investigated in 1841 subjects enrolled in the southwestern Pennsylvania Heart Strategies Concentrating on Risk Evaluation study. Attrition was defined as study withdrawal, loss to follow-up, or missing 50% or more of study visits.ResultsOver 4 years of follow-up, 291 subjects (15.8%) met criteria for attrition. In multivariable regression models, factors that were independently associated with attrition were black race (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.55–3.16; P < .001), younger age (OR per 5-year increment, 0.88; 95% CI, 0.79–0.99; P < .05), male gender (OR, 1.79; 95% CI, 1.27–2.54; P < .05), no health insurance (OR, 2.04; 95% CI, 1.20–3.47; P < .05), obesity (OR, 1.80; 95% CI, 1.07–3.02; P < .05), CES-D depression score 16 or higher (OR, 2.02; 95% CI, 1.29–3.19; P < .05), and higher ongoing life events questionnaire score (OR, 1.09; 95% CI, 1.04–1.13; P < .001). Having a spouse/partner participating in the study was associated with lower odds of attrition (OR, 0.60; 95% CI, 0.37–0.97; P < .05). A synergistic interaction was identified between black race and depression.ConclusionsAttrition over 4 years was influenced by sociodemographic, clinical, and psychological factors that can be readily identified at study entry. Recruitment and retention strategies targeting these factors may improve participant follow-up in longitudinal cardiovascular prevention studies.     

Family Meals and Diet Quality Among Children and Adolescents in North Carolina

ObjectiveTo examine the relationship between diet quality and frequency of family meals throughout childhood and adolescence.MethodsCross-sectional study of children ages birth through 17 years (n = 1,992) using data from the 2010 North Carolina Child Health and Monitoring Program. Multiple logistic regression was used to estimate the associations between family meals and fruit intake, vegetable intake, and sugar-sweetened beverage intake among younger children, older children, and adolescents.ResultsIn adjusted analyses, participating in ≥ 5 family meals/wk was associated with less sugar-sweetened beverage intake among younger (OR 2.04; CI 1.06–3.93) and older children (OR 2.12; 95% CI 1.27–3.55), greater vegetable intake among older children (OR 1.87; 95% CI 1.08–3.24) and adolescents (OR 1.81; 95% CI 1.14–2.88), and greater fruit intake among adolescents (OR 2.11; 95% CI 1.40–3.19).Conclusions and ImplicationsStrategies to encourage families to establish regular family meals early in life and continue them throughout childhood and adolescence is warranted.     

Childhood sexual abuse and risk for initiating injection drug use: A prospective cohort study

ObjectiveThis study examined whether childhood sexual abuse predicts initiation of injection drug use in a prospective cohort of youth.MethodFrom October 2005 to November 2010, data were collected from the At Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Inclusion criteria were age 14–26 years, no lifetime drug injection, and non-injection drug use in the month preceding enrollment. Participants were interviewed at baseline and semiannually thereafter. Cox regression was employed to identify risk factors for initiating injection.ResultsAmong 395 injection-naïve youth, 81 (20.5%) reported childhood sexual abuse. During a median follow-up of 15.9 months (total follow-up 606.6 person-years), 45 (11.4%) youth initiated injection drug use, resulting in an incidence density of 7.4 per 100 person-years. In univariate analyses, childhood sexual abuse was associated with increased risk of initiating injection (unadjusted hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.29–4.38; p = 0.006), an effect that persisted in multivariate analysis despite adjustment for gender, age, aboriginal ancestry and recent non-injection drug use (adjusted HR, 2.71; 95% CI, 1.42–5.20; p = 0.003).ConclusionChildhood sexual abuse places drug users at risk for initiating injection. Addiction treatment programs should incorporate services for survivors of childhood maltreatment.     

The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States

ObjectiveTo investigate the prospective associations between oral health and progression of physical frailty in older adults.DesignProspective analysis.Setting and ParticipantsData are from the British Regional Heart Study (BRHS) comprising 2137 men aged 71 to 92 years from 24 British towns and the Health, Aging, and Body Composition (HABC) Study of 3075 men and women aged 70 to 79 years.MethodsOral health markers included denture use, tooth count, periodontal disease, self-rated oral health, dry mouth, and perceived difficulty eating. Physical frailty progression after ∼8 years follow-up was determined based on 2 scoring tools: the Fried frailty phenotype (for physical frailty) and the Gill index (for severe frailty). Logistic regression models were conducted to examine the associations between oral health markers and progression to frailty and severe frailty, adjusted for sociodemographic, behavioral, and health-related factors.ResultsAfter full adjustment, progression to frailty was associated with dentition [per each additional tooth, odds ratio (OR) 0.97; 95% CI: 0.95–1.00], <21 teeth with (OR 1.74; 95% CI: 1.02–2.96) or without denture use (OR 2.45; 95% CI 1.15–5.21), and symptoms of dry mouth (OR ≥1.8; 95% CI ≥ 1.06–3.10) in the BRHS cohort. In the HABC Study, progression to frailty was associated with dry mouth (OR 2.62; 95% CI 1.05–6.55), self-reported difficulty eating (OR 2.12; 95% CI 1.28–3.50) and ≥2 cumulative oral health problems (OR 2.29; 95% CI 1.17–4.50). Progression to severe frailty was associated with edentulism (OR 4.44; 95% CI 1.39–14.15) and <21 teeth without dentures after full adjustment.Conclusions and ImplicationsThese findings indicate that oral health problems, particularly tooth loss and dry mouth, in older adults are associated with progression to frailty in later life. Additional research is needed to determine if interventions aimed at maintaining (or improving) oral health can contribute to reducing the risk, and worsening, of physical frailty in older adults.     

A prospective study of childhood social hardships and age at menarche

PurposeTo determine the role of type, timing, and cumulative childhood hardships on age at menarche in a prospective cohort study.MethodsA longitudinal analysis was undertaken of 4524 female participants of the National Child Development Study cohort (1958–2003). Six types of childhood hardships were identified with a factor analysis methodology. Paternal absence/low involvement in childhood was an a priori hardship. Retrospective reports of abuse in childhood also were explored in relation to age at menarche. Generalized logit regression analyses explored the impact of type, timing, and cumulative hardships on age at menarche (≤11, 12–13, ≥14 years).ResultsCumulative childhood hardships were associated with a graded increase in risk for later menarche with adjusted odds ratio [AOR] of 1.37 (95% confidence interval [95% CI], 1.10–1.70), 1.50 (95% CI, 1.18–1.91), and 1.58 (95% CI, 1.29–1.92) among those with two, three, and four or more adversities, respectively. More than two hardships in early life had the strongest association with late menarche (AOR, 2.32; 95% CI, 1.12–4.80). Sexual abuse was most strongly associated with early menarche (AOR, 2.60; 95% CI, 1.40–4.81).ConclusionsCumulative childhood hardships increased risk for later age at menarche. Child abuse was associated with both early and late menarche, although associations varied by type of abuse.     

Associations of allostatic load with sleep apnea,insomnia, short sleep duration,and other sleep disturbances: findings from the National Health and Nutrition Examination Survey 2005 to 2008

PurposeTo examine whether allostatic load (AL), a measure of cumulative physiologic dysregulation across biological systems, was associated with sleep apnea, insomnia, and other sleep disturbances.MethodsData from the National Health and Nutrition Examination Survey 2005–2008 were used. AL was measured using nine biomarkers representing cardiovascular, inflammatory, and metabolic system functioning. A total of 3330 US adults aged 18 years and older were included in this study.ResultsThe prevalence of high AL (AL score ≥3) was the highest among African Americans (26.3%), followed by Hispanic Americans (20.3%), whites (17.7%), and other racial/ethnic group (13.8%). After adjustment for sociodemographic and lifestyle factors, high AL was significantly associated with sleep apnea (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.40–2.63), snoring (OR, 2.20; 95% CI, 1.79–2.69), snorting/stop breathing (OR, 2.16; 95% CI, 1.46–3.21), prolonged sleep latency (OR, 1.42; 95% CI, 1.08–1.88), short sleep duration (<6 hours) (OR, 1.35; 95% CI, 1.00–1.82), and diagnosed sleep disorder (OR, 2.26; 95% CI, 1.66–3.08). There was no clear evidence that observed associations varied by sociodemographic characteristics.ConclusionsThis study suggests significant associations of high AL with sleep apnea, sleep apnea symptoms, insomnia component, short sleep duration, and diagnosed sleep disorder among US adults.     

Lower respiratory tract infection in the first year of life is associated with worse lung function in adult life: prospective results from the Barry Caerphilly Growth study

PurposeWe examined the association between childhood respiratory infections and adult lung function and how this association varies depending on the age at infection.MethodsThe Barry Caerphilly Growth study collected information on childhood upper and lower respiratory tract infections (URTI, LRTI) from birth to 5 years on 14 occasions. Subjects were traced prospectively and had lung function measured at age 25 years.ResultsA total of 581 subjects had acceptable data for both forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC). Childhood LRTIs (0–5 years) but not URTIs were negatively associated with all lung function measures except FVC and showed a dose–response effect. In the first year of life, a two-fold increase in the number of LRTIs experienced was associated with a reduction in FEV₁ (78 mL; 95% confidence interval [95% CI], 3–153), FEV₁/FVC (1.23%; 95% CI 0.25–2.22), forced expiratory flow 25%–75% (0.25 l/sec; 95% CI 0.08–0.41), and peak expiratory flow (0.30 l/sec; 95% CI 0.11–0.49) after adjustment for confounders. Few associations were found after the first year of life. There was evidence that age at infection effect modifies the association between LRTIs and FEV₁, forced expiratory flow 25%–75%, and peak expiratory flow.ConclusionsLRTIs are associated with an obstructive lung function deficit. Furthermore, the first year of life may be a sensitive period for experiencing LRTIs.     

Men who have sex with men who do not access sexual health clinics nor disclose sexual orientation are unlikely to receive the HPV vaccine in the UK

BackgroundMen who have sex with men (MSM) are recommended the Human Papillomavirus (HPV) vaccination due to their higher risk of genital warts and anal cancer.PurposeTo examine HPV vaccine acceptability amongst MSM in the UK.MethodsUsing advertisements via Facebook, MSM were recruited to an online survey measuring motivations for HPV vaccination. Logistic regression was performed to identify predictors of HPV vaccine acceptability.ResultsOut of 1508 MSM (median age = 22, range: 14–63 years) only 19% knew about HPV. Overall, 55% of MSM were willing to ask for the HPV vaccine and 89% would accept it if offered by a healthcare professional (HCP). Access to sexual health clinics (SHCs) [OR = 1.82, 95% CI 1.29–2.89], the disclosure of sexual orientation to a HCP [OR = 2.02, CI 1.39–3.14] and HIV-positive status [OR = 1.96, CI 1.09–3.53] positively predicted HPV vaccine acceptability. After receiving information about HPV, perceptions of HPV risk [OR = 1.31, CI 1.05–1.63], HPV infection severity [OR = 1.89, CI 1.16–3.01), HPV vaccination benefits [OR = 1.61, CI 1.14–3.01], HPV vaccine effectiveness [OR = 1.54, CI 1.14–2.08], and the lack of perceived barriers to HPV vaccination [OR = 4.46, CI 2.95–6.73] were also associated with acceptability.ConclusionsAlthough nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. In order to achieve optimal uptake, vaccine promotion campaigns should focus on MSM who do not access SHCs and those unwilling to disclose their sexual orientation.     

Willingness to accept a future influenza A(H7N9) vaccine in Beijing,China

BackgroundThe present study aimed to estimate residents’ willingness to accept a future H7N9 vaccine and its determinants in the general adult population in Beijing, China.MethodsWe conducted a multi-stage sampling, cross-sectional survey using self-administered anonymous questionnaires from May to June, in 2014. The main outcome variable was residents’ willingness to accept a future H7N9 vaccine. Logistic regression was used to identify the predictors of vaccination willingness.ResultsOf the 7264 eligible participants, 14.5% of Beijing residents reported that they had not heard of H7N9. Among those who had heard of H7N9, 59.5% of the general adult population would be willing to accept a future H7N9 vaccine, and approximately half of them reported ‘I am afraid of being infected by H7N9’ and ‘H7N9 vaccine can prevent infections’, and 28.1% reported ‘my daily life is affected by H7N9’. The variables that were significantly associated with a higher likelihood of reporting willingness were being younger adults (aged 18–29 years: OR = 1.52, 95% CI: 1.17–1.97; aged 30–39 years: OR = 1.39, 95% CI: 1.08–1.78), being farmers (OR = 1.61; 95% CI: 1.32–1.96), being unemployed people (OR = 1.36; 95% CI: 1.04–1.78), living in suburban areas (OR = 2.18; 95% CI: 1.89–2.51), having ≥2 children in the family (OR = 1.41; 95% CI: 1.03–1.92), perceived risk in China (OR = 1.30; 95% CI: 1.15–1.48), perceived susceptibility to disease (OR = 3.13; 95% CI: 2.73–3.58), perceived negative effect on daily life (OR = 1.32; 95% CI: 1.13–1.55), perceived effectiveness of vaccination (OR = 2.34; 95% CI: 2.07–2.64), and recent uptake of influenza vaccine (OR = 2.26; 95% CI: 1.92–2.66).ConclusionsA great number of Beijing residents had doubts about the vaccine’s effectiveness and were not concerned about disease risk, which were the factors affecting willingness to be vaccinated. Targeted education programs on disease risk as well as vaccine’s effectiveness are needed to improve the willingness of vaccination for potential H7N9 pandemic preparedness.     

Ten-Year Changes in Healthy Eating Attitudes in the SUN Cohort

Objective: The objective of this study was to assess the within-subject longitudinal changes in self-perceived healthy eating attitudes after 10 years of follow-up and to identify predictors of long-term changes in a middle-aged adult cohort.

Methods: Four thousand five hundred seventy-two participants completed a validated food frequency questionnaire (FFQ) at baseline and after 10 years of follow-up. The FFQ was expanded with a brief 10-item questionnaire about eating attitudes with 2 possible answers: yes or no. A baseline score and a 10-year score were calculated with these 10 items (range from 0 to 10). Participants were categorized into 3 groups according to this score. Linear and logistic regressions were used to examine changes at follow-up and associations between baseline characteristics and improvement in the score.

Results: After 10 years of follow-up, a statistically significant favorable change (p < 0.001) was achieved in all questions about eating attitudes, particularly in these items: “Do you try to eat less sweets and pastries?” (12%), “Do you try to eat less meat?” (11.1%), and “Do you try to reduce your fat intake?” (10%). Being female (odds ratio [OR] = 1.19, 95% confidence interval [CI], 1.02–1.39), being 35–50 or ≥ 50 years old (OR = 1.24, 95% CI, 1.07–1.44 and OR = 1.74, 95% CI, 1.38–2.18, respectively), a high level of physical activity (OR for third vs first tertile = 1.20, 95% CI, 1.02–1.41), and a higher Mediterranean diet score (OR for second and third tertiles = 1.18, 95% CI, 1.01–1.37 and OR = 1.26, 95% CI, 1.04–1.52, respectively) were associated with a higher probability of improving the eating attitudes score, while a low body mass index (BMI; OR = 0.71, 95% CI, 0.51–1.00) and snacking between meals (OR = 0.84, 95% CI, 0.73–0.97) were associated with a lower probability of improving their score.

Conclusions: The eating attitudes of the participants in the Seguimiento Universidad de Navarra (SUN) cohort became more favorable after 10 years of follow-up. Certain sociodemographic or clinical variables may predict a positive change.     

Effects of South African men's having witnessed abuse of their mothers during childhood on their levels of violence in adulthood

OBJECTIVES: We sought to assess the effects of witnessing violence against their mothers in childhood on men's use of violence in a range of settings in adulthood. METHODS: We conducted a cross-sectional questionnaire survey of 1368 randomly selected male municipal workers in Cape Town, South Africa. RESULTS: Almost a quarter (23.5%; 95% confidence interval [CI]=21.2, 25.7) of the men reported witnessing abuse of their mother, and having witnessed such events was associated with men's later involvement in physical conflicts in their community (odds ratio [OR]=1.72; 95% CI=1.29, 2.30) and at their place of work (OR = 1.83; 95% CI = 1.30, 2.58), use of physical violence against their partners (OR = 2.61; 95% CI = 1.94, 3.54), and arrest for possession of illegal firearms (OR=2.86; 95% CI=1.29, 6.32). CONCLUSIONS: Our results show strong links between "publicly" violent behavior among men and childhood experiences of "private" violence against their mothers. Prevention of domestic violence is essential both in its own right and as part of efforts to reduce broader violence and crime in society.     

The Role of Family History of Cancer on Cervical Cancer Screening Behavior in a Population-based Survey of Women in the Southeastern United States

BackgroundOur objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities.MethodsSelf-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus and cervical cancer (n = 918). Random-digit dial, computer-assisted telephone interviews were used to contact eligible respondents (adult [ages 18–70] women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12.FindingsAlthough FHC+ was not predictive (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.55–2.51), private health insurance (OR, 2.35; 95% confidence interval [CI], 1.15–4.81) and younger age (18–30 years: OR, 7.76; 95% CI, 1.91, 3.16) were associated with recent Pap test behavior. FHC and cervical cancer screening associations were not detected in the sample.ConclusionsFindings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.     

Factors Associated With Social Isolation in Older Adults: A Systematic Review and Meta-Analysis

ObjectiveSocial isolation is a global health issue that affects older adults throughout their lives. This study aimed to identify the factors associated with social isolation in older adults.DesignSystematic review and meta-analysis.Setting and ParticipantsAdults aged 60 years and older.MethodsWe searched for observational studies without language restrictions in 11 databases from inception to August 2022. Pooled odds ratio (OR) and 95% CI were calculated using the R software (version 4.2.1). The modified Newcastle-Ottawa Scale was used to evaluate the risk of bias.ResultsEighteen factors were grouped into 5 themes. The following 13 factors were statistically significant: (1) demographics theme: aged 80 years and older (OR: 2.41; 95% CI: 1.20–4.85), less than or equal to a high school degree (OR: 1.68; 95% CI: 1.44–1.97), smoking (OR: 1.43; 95% CI: 1.18–1.73), and male (OR: 1.38; 95% CI: 1.01–1.89); (2) environment theme: low social support (OR: 7.77; 95% CI: 3.45–17.50) and no homeownership (OR: 1.38; 95% CI: 1.25–1.51); (3) role theme: no social participation (OR: 3.18; 95% CI: 1.30–7.80) and no spouse (OR: 2.61; 95% CI: 1.37–4.99); (4) physical health: hearing loss (OR: 2.78; 95% CI: 1.54–5.01), activities of daily living impairment (OR: 2.38; 95% CI: 1.57–3.61), and poor health status (OR: 1.52; 95% CI: 1.32–1.74); and (5) mental health: cognitive decline (OR: 1.85; 95% CI: 1.40–2.45) and depression (OR: 1.72; 95% CI: 1.21–2.44).Conclusions and ImplicationsSocial isolation in older adults is associated with various factors. Hence, focused intervention should be adopted for older adults. In addition, further longitudinal studies are required to confirm a direct link between multiple factors and social isolation.     

Adverse Childhood Experiences and Use of Cigarettes and Smokeless Tobacco Products

Adverse childhood experiences (ACEs) have been linked to increased use of tobacco products later in life. However, studies to date have ignored smokeless tobacco products. To address this, data from the 2011 Behavioral Risk Factor Surveillance System, which interviewed adults 18 years and over (N = 102,716) were analyzed. Logistic regression models were fit to estimate odds ratios of ever smoking, current smoking and current smokeless tobacco use in relation to ACEs. Results showed that less than 4 % of respondents currently used smokeless tobacco products, while 44.95 and 18.57 % reported ever and current smoking, respectively. Physical abuse (OR 1.40; 95 % CI 1.14, 1.72), emotional abuse (OR 1.41; 95 % CI 1.19, 1.67), sexual abuse (OR 0.70; 95 % CI 0.51, 0.95), living with a drug user (OR 1.50; 95 % CI 1.17, 1.93), living with someone who was jailed (OR 1.50; 95 % CI 1.11, 2.02) and having parents who were separated or divorced (OR 1.31; 95 % CI 1.09, 1.57) were associated with smokeless tobacco use in unadjusted models. After accounting for confounders, physical abuse (OR 1.43; 95 % CI 1.16, 1.78), emotional abuse (OR 1.32; 95 % CI 1.10, 1.57), living with a problem drinker (OR 1.30; 95 % CI 1.08, 1.58), living with a drug user (OR 1.31; 95 % CI 1.00, 1.72) and living with adults who treated each other violently (OR 1.30; 95 % CI 1.05, 1.62) were associated with smokeless tobacco use. Living with someone who was mentally ill (OR 0.70; 95 % CI 0.53, 0.92) was associated with smokeless tobacco use after accounting for confounders and all ACEs. Results indicated that some childhood adversities are associated with use of smokeless tobacco products. Special attention is needed to prevent tobacco use of different types among those experiencing ACEs.     

Comparison of Different Case-Crossover Variants in Handling Exposure-Time Trend or Persistent-User Bias: Using Dipeptidyl Peptidase-4 Inhibitors and the Risk of Heart Failure as an Example

ObjectivesInappropriate use of the case-crossover design, which is efficient for examining associations between brief exposure and abrupt outcomes, in evaluating the effects of medications in the presence of exposure-time trends or persistent drug use may generate spurious associations. We compared different approaches to adjusting for these sources of bias by examining the risk of heart failure hospitalization (HFH) associated with dipeptidyl peptidase-4 (DPP-4) inhibitors. Overall, existing evidence does not suggest a higher risk of HFH associated with DPP-4 inhibitors; however, case-crossover analyses of these medications may be susceptible to bias.MethodsWe conducted case-crossover; age, sex, risk-set (ASR) matched case-time-control; disease risk score (DRS)-matched case-time-control; and case-case-time-control analyses to assess the association between DPP-4 inhibitors and HFH among patients with diabetes mellitus (DM) in a population-based Taiwanese database. We also examined metformin and sulfonylureas, both with assumed null associations.ResultsAmong 362 022 DM patients, 4105 (case-crossover), 4103 (ASR-matched case-time-control), 3957 (DRS-matched case-time-control), and 2812 (case-case-time-control) HFH cases were identified. The OR for DPP-4 inhibitors and HFH was elevated in the case-crossover analysis (1.52; 95% confidence interval [95% CI] 0.95–2.42). The ASR-matched case-time control, DRS-matched case-time-control, and case-case-time control analyses yielded near-null associations (0.90 [95% CI 0.45–1.83], 0.96 [95% CI 0.46–2.02], and 0.92 [95% CI 0.39–2.21], respectively). Null effects were observed for metformin across designs and for sulfonylureas in the case-case-time control analysis.ConclusionsOur case-crossover analysis suggested DPP-4 inhibitors may be associated with HFH; however, each method for adjusting for exposure-time and persistent user bias attenuated the findings. The case-case-time-control analysis had the least precision.     

The Impact of First-Person Abortion Stories on Community-Level Abortion Stigma: A Randomized Trial

ObjectiveWe aimed to assess the impact of first-person abortion stories on community-level abortion stigma.MethodsBetween November 2018 and March 2019, we recruited participants and analyzed data from a nationally representative, probability-based online panel of U.S. adults, randomized to watch three first-person abortion video stories (intervention, n = 460) or three nature videos (control, n = 426). We measured community-level abortion stigma using the Community Abortion Attitudes Scale, Reproductive Experiences and Events Scale, and Community Level Abortion Stigma Scale at baseline, immediately after video exposure, and 3 months later. We dichotomized stigma change scores as decreased stigma compared with no change or increased stigma. Bivariate and logistic regression analysis accounted for complex survey methodology and sample weighting.ResultsSample demographics reflected U.S. Census benchmarks (51% female, 68% White, 47% aged 18–44 years). Most participants (83.1%) completed the 3-month follow-up. Viewing the intervention videos was not associated with decreased stigma measured by Community Abortion Attitudes Scale or Community Level Abortion Stigma Scale immediately (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.59–1.09; OR, 1.28; 95% CI, 0.93–1.75) or at the 3-month follow-up (OR, 0.86; 95% CI, 0.62–1.19; OR, 0.98; 95% CI, 0.70–1.37). Intervention exposure was associated with decreased stigma as measured by Reproductive Experiences and Events Scale immediately (OR, 1.74; 95% CI, 1.23–2.46); however, this association was not observed at the 3-month follow-up (OR, 0.98; 95% CI, 0.70–1.37).ConclusionsExposure to first-person video stories may not decrease community-level abortion stigma among U.S. adults.