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Lower socioeconomic status (SES) and elevated psychosocial stress are known contributors to adverse pregnancy outcomes; however, biological mechanisms linking these factors to adverse pregnancy outcomes are not well-characterized. Oxidative stress may be an important, yet understudied mechanistic pathway. We used a pooled study design to examine biological, behavioral, and social factors as predictors of prenatal oxidative stress biomarkers.Leveraging four pregnancy cohorts from the Environmental influences on Child Health Outcomes (ECHO) Program spanning multiple geographic regions across the United States (U.S.) (N = 2082), we measured biomarkers of oxidative stress in urine samples at up to three time points during pregnancy, including 8-isoprostane-prostaglandin FNumerous biological, behavioral, and social factors were associated with elevated levels of 8-isoPGFOxidative stress biomarkers are elevated among pregnant people with higher socioeconomic disadvantage and may represent one pathway linking biological, behavioral, and social factors to adverse pregnancy and child health outcomes, which should be explored in future work.

Background Epidemiological studies on the associations of legacy per- and polyfluoroalkyl substances (PFASs) and glucose homeostasis remain discordant. Understanding of PFAS alternatives is limited, and few studies have reported joint associations of PFASs and PFAS alternatives. Objectives To investigate associations of novel PFAS alternatives (chlorinated perfluoroalkyl ether sulfonic acids, Cl-PFESAs and perfluorobutanoic acid, PFBA) and two legacy PFASs (Perfluorooctanoic acid, PFOA and perfluorooctane sulfonate, PFOS) with glucose-homeostasis markers and explore joint associations of 13 legacy and alternative PFASs with the selected outcomes. Methods We used cross-sectional data of 1,038 adults from the Isomers of C8 Health Project in China. Associations of PFASs and PFAS alternatives with glucose-homeostasis were explored in single-pollutant models using generalized linear models with natural cubic splines for PFASs. Bayesian Kernel Machine Regression (BKMR) models were applied to assess joint associations of exposures and outcomes. Sex-specific analyses were also conducted to evaluate effect modification. Results After adjusting for confounders, both legacy (PFOA, PFOS) and alternative (Cl-PFESAs and PFBA) PFASs were positively associated with glucose-homeostasis markers in single-pollutant models. For example, in the total study population, estimated changes with 95% confidence intervals (CI) of fasting glucose at the 95th percentile of 6:2Cl-PFESA and PFOS against the thresholds were 0.90 (95% CI: 0.59, 1.21) and 0.44 (95% CI: 0.26, 0.62). Positive joint associations were found in BKMR models with 6:2Cl-PFESA contributing most. Sex-specific associations existed in both single- and multi-pollutant models. Conclusions Legacy and alternative PFASs were positively associated with glucose-homeostasis markers. 6:2Cl-PFESA was the primary contributor. Sex-specific associations were also identified. These results indicate that joint associations and effect modification should be considered in risk assessment. However, further studies are recommended to strengthen our findings and to elucidate the mechanisms of action of legacy and alternative PFASs.

Background. Infants whose mothers experience greater psychosocial stress and environmental chemical exposures during pregnancy may face greater rates of preterm birth, lower birth weight, and impaired neurodevelopment. Methods. ECHO.CA.IL is composed of two cohorts, Chemicals in Our Bodies (CIOB, n = 822 pregnant women and n = 286 infants) and Illinois Kids Development Study (IKIDS, n = 565 mother-infant pairs), which recruit pregnant women from San Francisco, CA and Urbana-Champaign, IL, respectively. We examined associations between demographic characteristics and gestational age, birth weight z-scores, and cognition at 7.5 months across these two cohorts using linear models. We also examined differences in biomarkers of exposure to per- and polyfluoroalkyl substances (PFAS), measured in second-trimester serum, and psychosocial stressors by cohort and participant demographics. Results. To date, these cohorts have recruited over 1300 pregnant women combined. IKIDS has mothers who are majority white (80%), whereas CIOB mothers are racially and ethnically diverse (38% white, 34% Hispanic, 17% Asian/Pacific Islander). Compared to CIOB, median levels of PFOS, a specific PFAS congener, are higher in IKIDS (2.45 ng/mL versus 1.94 ng/mL), while psychosocial stressors are higher among CIOB. Across both cohorts, women who were non-white and single had lower birth weight z-scores relative to white women and married women, respectively. Demographic characteristics are not associated with cognitive outcomes at 7.5 months. Conclusions. This profile of the ECHO.CA.IL cohort found that mothers and their infants who vary in terms of socioeconomic status, race/ethnicity, and geographic location are similar in many of our measures of exposures and cognitive outcomes. Similar to past work, we found that non-white and single women had lower birth weight infants than white and married women. We also found differences in levels of PFOS and psychosocial stressors based on geographic location.

Purpose Perfluoroalkyl substances (PFASs) are a class of manmade chemicals commonly used in consumer product manufacturing. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are two of the most highly studied PFASs. Both are present in the blood of the most Americans. PFASs are associated with intermediate cardiovascular disease (CVD) outcomes, but their relationship with obesity, a risk factor for intermediate and advanced CVD, remains largely unconfirmed. In this context, we aimed to explore the relationship between PFASs and both overweight/obesity and abdominal obesity among children. Methods We examine associations between PFOA and PFOS levels, and Body Mass Index (BMI) and waist circumference (WC) in a representative sample (N = 2473) of US children, aged 12–18 years from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey 1999–2012. Overweight/obesity is defined as age-, sex-specific BMI z-score ≥ 85th percentile; abdominal obesity is defined as age-, sex-specific waist circumference ≥90th percentile. Results Associations between PFASs and anthropometric outcomes show a dose-response relationship overall. For overweight/obese BMI z-score, findings indicate OR = 1.42 and 95% CI: 0.85–2.38 for quartile 2 of PFOA exposure; OR = 2.22 (95% CI: 1.20–4.13) for quartile 3 of PFOA exposure; and OR = 2.73 (95% CI:1.10–6.74) for quartile 4 of PFOA exposure. Discussion Findings indicate an association between elevated PFOA and overweight/obesity among children after multivariable adjustment.

CONTEXT: Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. OBJECTIVE: Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. DESIGN: Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. MAIN OUTCOME MEASURES: Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. RESULTS: Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. CONCLUSION: Visualization of vulnerability could help local public health agencies prepare for future extreme heat events. Language: en

Motivated by compelling, but scant, literature on high rates of breast cancer mortality among the United States Amish, a survey was conducted to examine mammography-seeking practices among Amish women. Inclusion criteria included age 40-70 years and membership of the Arthur, Illinois Amish community. Data were collected from this unique, socially isolated group through a mail questionnaire focusing on health history, mammography practices, and beliefs surrounding breast health. Sample mammography adherence and "ever mammogram" rates were compared with both the general population of the United States (U.S.) and other Amish communities in the U.S. Logistic regression on the "ever mammogram" variable showed that Amish women with knowledge of screening guidelines experienced an adjusted odds ratio (OR) of 5.26 [confidence interval (CI) 1.79, 15.45] for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer experienced an OR of 4.27 (CI 1.39, 13.11) for mammography and those who believed physical injury caused breast cancer had an OR of 3.86 (CI 1.24, 12.04) compared to women who do not hold these beliefs. Future research is needed to confirm and extend these results.

While exposure to places with higher greenness shows health benefits, evidence is scarce on its lipidemic effects. We assessed the associations between residential greenness and blood lipids and effect mediations by air pollution, physical activity, and adiposity in China. Our study included 15,477 adults from the population-based 33 Communities Chinese Health Study, conducted between April and December 2009, in Northeastern China. We measured total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Residential greenness was estimated using two satellite-derived vegetation indices - the Normalized Difference Vegetation Index (NDVI) and the Soil Adjusted Vegetation Index (SAVI). We used both nitrogen dioxide (NO2) and particles ≤2.5 μm in aerodynamic diameter (PM2.5) as proxies of outdoor air pollution. Associations were assessed using linear mixed effects regression models and logistic mixed effects regression models, and mediation analyses were also performed. Living in higher greenness areas was consistently associated with lower TC, TG, and LDL-C levels and higher HDL-C levels (e.g., change in TC, TG, LDL-C, and HDL-C per 0.1-unit increase in NDVI500-m was -1.52%, -3.05%, -1.91%, and 0.52%, respectively). Similar results were obtained for the corresponding dyslipidemias. These associations were generally stronger in women and older adults. While educational levels showed effect modifications, the effect pattern was inconsistent. Both outdoor air pollution and body mass index mediated 9.1-62.3% and 5.6-40.1% of the associations for greenness and blood lipids, respectively, however, physical activity did not. Our results suggest beneficial associations between residing in places with higher greenness and blood lipid levels, especially in women and the elder individuals. The associations were partly mediated by lower air pollution and adiposity.

Studies have reported an association between serum perfluoroalkyl substances (PFASs) and asthma. However, few studies have examined the possible associations between PFASs and the 16-kDa club cell secretory protein (Clara) (CC16) level, a prominent biomarker of asthma, among adolescents.We recruited a total of 231 asthmatic children and 225 non-asthmatic controls in the Genetic and Biomarkers study for Childhood Asthma (GBCA) in northern Taiwan from 2009 to 2010. Structured questionnaires were administered by face-to-face interview. Urine CC16 was determined by an enzyme-link immunoassay kit. Multiple general linear models were employed to examine the associations between PFASs and urinary CC16 levels.Asthmatic participants had significantly higher serum PFAS concentrations overall than the healthy controls. After adjusting for confounding factors, urinary CC16 was significantly, negatively associated with PFASs, especially PFOS, PFOA, PFDA and PFNA, and especially among males, as follows: PFOS (β = -0.003, 95% confidence interval [CI]: -0.004, -0.002), PFOA (β = -0.045, 95% CI: -0.086, -0.004), and PFHxA (β = -0.310, 95% CI: -0.455, -0.165) among asthmatic boys, and PFDA (β = -0.126, 95%CI: -0.241, -0.012) and PFNA (β = -0.329, 95% CI: -0.526, -0.132) among non-asthmatic boys. Among girls, PFDA (β = -0.088, 95% CI: -0.172, -0.004), was the only PFAS significantly associated with CC16. Significant interaction effects (p0.15) on CC16 levels were found between asthma and PFOS, PFOA, PFBS and PFHxA in all participants.Our overall results showed that serum PFASs were significantly, inversely associated with CC16 levels. Associations were stronger among males.

Previous studies have demonstrated associations of perfluoroalkyl substances (PFASs), a group of highly persistent chemicals ubiquitous in wildlife and humans, with hypertension, but the relationships are mixed. Furthermore, academic literature on the relationship between isomers of PFASs and blood pressure (BP) and hypertension in populations from a higher pollution area is scant. We studied 1612 Chinese adults, ages 22-96years old, from Shenyang, China, utilizing high performance liquid chromatography-mass spectrometry to analyze isomers of perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and other PFASs in blood serum. We used a mercury sphygmomanometer to measure BP. Hypertension was defined as a mean systolic BP (SBP) of at least 140mmHg, and/or diastolic BP (DBP) of at least 90mmHg, and/or use of antihypertensive medications. The results showed that increased serum concentrations of all (both branched and linear) isomers of PFASs were associated with higher prevalence of hypertension. Adjusted odds ratios for hypertension per ln-unit (ng/mL) increase in PFASs ranged from 1.10 (95%CI: 1.04, 1.17) for perfluorobutanoic acid (PFBA) to 1.26 (95%CI: 1.12, 1.42) for 3+4+5m PFOS, and the estimated increases in mean SBP and DBP ranged from 0.80mmHg (95%CI: 0.25, 1.34) for PFBA to 4.51mmHg (95%CI: 3.52, 5.51) for 3+4+5m PFOS, and from 0.51mmHg (95%CI: 0.01, 1.01) for perfluorodecanesulfonate (PFDS) to 2.48 (1.80, 3.16) for perfluorononanoic acid (PFNA), respectively. Compared with linear PFASs isomers, we identified more and stronger associations among branched PFASs isomers and blood pressure. Furthermore, females exhibited consistently stronger effects than males. In conclusion, this study is the first of its kind to show that not only PFASs positively associated with elevated blood pressure, but also that branched PFAS isomers are more frequently associated with blood pressure than linear PFAS isomers.

Excessive alcohol consumption, the fourth leading preventable cause of death in the United States, resulted in approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) annually during 2006-2010 and cost an estimated $223.5 billion in 2006. To estimate state-specific average annual rates of alcohol-attributable deaths (AAD) and YPLL caused by excessive alcohol use, 11 states analyzed 2006-2010 data (the most recent data available) using the CDC Alcohol-Related Disease Impact (ARDI) application. The age-adjusted median AAD rate was 28.5 per 100,000 population (range = 50.9 per 100,000 in New Mexico to 22.4 per 100,000 in Utah). The median YPLL rate was 823 per 100,000 (range = 1,534 YPLL per 100,000 for New Mexico to 634 per 100,000 in Utah). The majority of AAD (median = 70%) and YPLL (median = 82%) were among working-age (20-64 years) adults. Routine monitoring of alcohol-attributable health outcomes, including deaths and YPLL, in states could support the planning and implementation of evidence-based prevention strategies recommended by the Community Preventive Services Task Force to reduce excessive drinking and related harms. Such strategies include increasing the price of alcohol, limiting alcohol outlet density, and holding alcohol retailers liable for harms related to the sale of alcoholic beverages to minors and intoxicated patrons (dram shop liability).

Hyperuricemia in children is associated with increased risk of high blood pressure, metabolic syndrome, and future cardiovascular disease. Serum perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) levels have been shown to be positively associated with hyperuricemia in adults, but the association in children remains unexplored. We therefore examined the association between serum PFOA and PFOS levels and hyperuricemia in a representative sample of US children. A cross-sectional study was performed on 1,772 participants ≤18 years of age from the National Health and Nutrition Examination Survey 1999–2000 and 2003–2008. The main outcome of interest was hyperuricemia, defined as serum uric acid levels ≥6 mg/dL. We found that serum levels of PFOA and PFOS were positively associated with hyperuricemia, independent of age, sex, race/ethnicity, body mass index, annual household income, physical activity, serum total cholesterol, and serum cotinine levels. Compared with subjects in quartile 1 (referent), subjects in quartile 4 had multivariable-adjusted odds ratios for hyperuricemia of 1.62 (95% confidence interval: 1.10, 2.37) for PFOA and 1.65 (95% confidence interval: 1.10, 2.49) for PFOS. Our findings indicate that serum perfluoroalkyl chemical levels are significantly associated with hyperuricemia in children even at the lower “background” exposure levels of the US general population.

Previous studies have demonstrated associations between serum levels of perfluoroalkyl substances (PFASs) and asthma or asthma related-biomarkers. However, no studies have reported a possible relationship between PFASs exposure and lung function among children. The objective of the present study is to test the association between PFASs exposure and lung function in children from a high exposure area by using a cross-sectional case-control study, which included 132 asthmatic children and 168 non-asthmatic controls recruited from 2009 to 2010 in the Genetic and Biomarkers study for Childhood Asthma. Structured questionnaires were administered face-to-face. Lung function was measured by spirometry. Linear regression models were used to examine the influence of PFASs on lung function. The results showed that asthmatics in our study had significantly higher serum PFAS concentrations than healthy controls. Logistic regression models showed a positive association between PFASs and asthma, with adjusted odds ratios (ORs) ranging from 0.99 (95% confidence interval [CI]: 0.80-1.21) to 2.76 (95% CI: 1.82-4.17). Linear regression modeling showed serum PFASs levels were significantly negatively associated with three pulmonary function measurements (forced vital capacity: FVC; forced expiratory volume in 1s: FEV1; forced expiratory flow 25-75%: FEF25-75) among children with asthma, the adjusted coefficients between lung function and PFASs exposure ranged from -0.055 (95%CI: -0.100 to -0.010) for FVC and perfluorooctane sulfonate (PFOS) to -0.223 (95%CI: -0.400 to -0.045) for FEF25-75 and perfluorooctanoic acid (PFOA). PFASs were not, however, significantly associated with pulmonary function among children without asthma. In conclusion, this study suggests that serum PFASs are associated with decreased lung function among children with asthma.

Objective: Our objective was to examine racial/ethnic disparities in injury-related risk behaviors and deaths among teens in Missouri, with a focus on Hispanic people—the fastest-growing racial/ethnic group in the state. Methods: We used data from the 2013 Missouri Youth Risk Behavior Survey, which included 1616 students in grades 9 through 12 from 32 public and charter high schools. The overall response rate was 69%. We compared the prevalence of 10 injury-related risk behaviors among racial/ethnic groups and used multivariate logistic regression models to control for respondent age and sex. Using data from the 2000-2014 Missouri death records, we also compared injury-related death rates among racial/ethnic groups of teens aged 15 to 19 years. Results: Hispanic students had a significantly higher prevalence than non-Hispanic white students for 9 of 10 risk behaviors and a significantly higher prevalence than non-Hispanic black students for 6 of the 10 risk behaviors included in the study. However, Hispanic teens aged 15 to 19 years had a significantly lower death rate from suicide, homicide, and unintentional injury combined (39.8 per 100000 population, 95% confidence interval [CI], 32.2-48.5) when compared with their non-Hispanic white (54.3 per 100000 population, 95% CI, 52.3-54.6) or non-Hispanic black (94.1 per 100000 population, 95% CI, 87.9-100.3) counterparts. Conclusion: Injury-related risk behaviors were more prevalent among Hispanic students than non-Hispanic white or non-Hispanic black students. Further efforts are needed to understand risk behaviors among Hispanic teens to guide intervention efforts.

Journal is deposited in PubMed Central for public release after 2017-10-15 STUDY OBJECTIVES Existing studies on sleep quality and associated obesity are inconsistent, and few studies have prospectively evaluated the association between sleep quality and abdominal obesity among Chinese individuals. To fill this void, the current study aimed to assess the association between sleep quality and abdominal obesity in a rural Chinese population. METHODS A representative sample of 9,404 adults aged 20-93 years in northeastern China was selected between 2012 and 2013 by a multistage cluster and random sampling method. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), where a score of 6 or higher indicated sleep disorder. Abdominal obesity was measured by waist circumference (WC), with abdominal obesity defined as WC > 90 cm for men and WC > 80 cm for women. RESULTS Male participants with abdominal obesity had higher global PSQI scores in addition to higher subscores in almost all of the elements compared to normal values. The odds ratios of abdominal obesity among participants with sleep disorders were 1.64 (95% confidence interval [CI]: 1.39-1.95) and 1.14 (95% CI: 0.98-1.32) for males and females compared to the reference group. The risk in all sleep elements was significantly increased, with odds ratios ranging from 1.28 (95% CI: 1.08-1.51) to 5.81 (95% CI: 3.54-9.53) for males. The risk only in four elements was significantly increased, from 1.28 (95% CI: 1.12-1.47) to 2.27 (95% CI: 1.36-3.80) for females. CONCLUSIONS Poor sleep quality was associated with abdominal obesity in Chinese. Furthermore, effects in males were larger than those in females.

There is growing evidence that exposure to food marketing influences dietary preferences among youth. Few studies exploring this association, however, have focused on the retail food store environment where families negotiate the influence of food and beverage marketing on purchasing practices. Consequently, we sought to examine: (i) the extent to which foods marketed on the internet and television to youth are also available and marketed in retail food stores, and (ii) whether differences exist in the marketing practices across store types and by neighborhood racial composition. In 2008, a cross-sectional survey of 118 food stores was conducted in four Midwestern cities in the United States. Results showed that 82% of stores assessed carried items commonly marketed to youth via television or the internet. The items most likely to have some type of marketing technique were noncarbonated drinks (97.7%), fruit and cereal bars (76.9%), and soda (62.2%). Grocery stores were significantly more likely than convenience stores to have marketing for breads and pastries (34.6% vs. 17.9%), breakfast cereals (52.0% vs. 22.9%), cookies and crackers (54.2% vs. 25.3%), dairy (70.8% vs. 42.7%), and ice cream (23.8% vs. 9.8%). Stores located in black neighborhoods were significantly more likely to have marketing, in comparison to white neighborhoods, for breads and pastries (35.7% vs. 17.1%), breakfast cereals (44.4% vs. 25.0%), and cookies and crackers (48.1% vs. 26.3%). Our results highlight the importance of examining food marketing techniques in the retail food store environment, where visual cues from television and the internet may be reinforced.

The hottest year on record for the contiguous United States was 2012. July 2012 ranked as Wisconsin's fourth warmest July, which has profound implications for heat-related mortality.We conducted a case series of 27 heat-related fatalities in Wisconsin during summer 2012. Data from death certificates supplemented by coroner reports were analyzed to characterize factors that increase vulnerability to heat-related fatality.The 2012 heat-related fatalities occurred in both urban and rural counties. All cases had 1 or more known risk factors: 100% lacked functioning residential air conditioning; 70% were over age 65; 75% had a cardiovascular disease; and 52% had a mental health condition. Of the 14 cases with a mental health condition, half were known to be taking psychotropic medication. None of the decedents had been in air conditioning immediately prior to death, and 8 (36%) had been using fans.Air conditioning is known to be a strong protective factor in preventing heat-related deaths whereas fans have not been shown to be significantly protective across all exposure situations. Prevention efforts should stress reducing social isolation by encouraging checks by friends, neighbors, or police. Prevention messages should also warn patients on psychotropic medications that the medication could increase their risk of heat-related illness or fatality.

Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertension, cardiovascular disease (CVD), and mortality. Self-rated health (SRH) has been shown to be a predictor of CVD and mortality. However, study of the association between insufficient sleep and SRH is limited. We examined participants >18 years of age (n=377, 160) from a representative, cross-sectional survey (2008 BRFSS). Self-reported insufficient sleep in the previous 30 days was categorized into six groups. The outcome was poor SRH. We calculated odds ratios ((OR) (95% confidence interval (CI)) of increasing categories of insufficient rest/sleep, taking zero days of insufficient sleep as the referent category. We found a positive association between increasing categories of insufficient sleep and poor SRH, independent of relevant covariates. In the multivariable-adjusted model, compared to 0 days insufficient sleep, the OR (95% CI) of poor SRH was 1.03 (0.97–1.10) for 1–6 days, 1.45 (1.34–1.57) for 7–13 days, 2.12 (1.97–2.27) for 14–20 days, 2.32 (2.09–2.58) for 21–29 days, and and 2.71 (2.53–2.90) for 30 days of insufficient sleep in the prior 30 days (P-trend