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Background: Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts. Methods: Cross-sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2-stage cluster sample design to produce a statewide population-based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9-12. Results: Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences. Conclusions: Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence.

Caries is the most common chronic disease among children. In Pennsylvania, a comprehensive oral health Basic Screening Survey and assessment of the association between caries and community water fluoridation (CWF) among children have not been conducted. From 2021 through 2022, the first Basic Screening Survey was conducted among third-grade students in Pennsylvania. Oral health and demographic data were collected. CWF data were provided by the Pennsylvania Department of Environmental Protection. The relative risk of developing caries in association with CWF was assessed using the GENMOD procedure in SAS, Version 9.4 (SAS Institute) in this cross-sectional study. Caries prevalence was 59.7% among 4,120 screened students. Participation in the free or reduced lunch program and CWF were each significantly associated with risk of developing caries after adjustment for age, sex, and race and ethnicity. The risk of developing caries was 33% higher among students who participated in the free or reduced lunch program than those who did not participate (relative risk, 1.33; 95% CI, 1.24 to 1.42). Students with the highest CWF coverage had a nearly 16% lower risk of developing caries than those without CWF coverage (relative risk, 0.84; 95% CI, 0.75 to 0.94). CWF was significantly associated with a reduced risk of developing caries. Efforts are needed to increase CWF coverage, along with promotion of oral health education and healthy dietary habits among Pennsylvania children. Increasing CWF coverage will reduce caries burden among Pennsylvania children. Although Pennsylvania has no state laws to regulate CWF, these findings are persuasive for local municipalities to consider expanding CWF coverage. [ABSTRACT FROM AUTHOR]

Objectives: To characterize demographics, birth parameters, and social determinants of health among mother-infant dyads affected by neonatal abstinence syndrome (NAS) in Pennsylvania. Methods: We linked 2018–2019 NAS surveillance data to birth record data using probabilistic methods and then geospatially linked to local social determinants of health data based on residential address. We generated descriptive statistics and used multivariable mixed-effects logistic regression to model the association between maternal characteristics, birth parameters, social determinants of health, and NAS. Results: In adjusted models maternal age > 24, non-Hispanic white race/ethnicity, low educational attainment, Medicaid as payor at delivery, inadequate or no prenatal care, smoking during pregnancy, and low median household income were associated with NAS. We found no significant associations between NAS and county-level measures of clinician supply, number of substance use treatment facilities, or urban/rural designation. Conclusions for Practice: This study characterizes mother-infant dyads affected by NAS using linked non-administrative, population data for Pennsylvania. Results demonstrate a social gradient in NAS and inequity in prenatal care receipt among mothers of infants with NAS. Findings may inform implementation of state-based public health interventions. Significance: This article is the first to characterize Pennsylvania mother-infant dyads affected by NAS that is not reliant on administrative data. Findings demonstrating a social gradient in NAS and inequity in receipt of care will inform state-based public health practice to better support pregnant people using opioids. Additionally, Pennsylvania was among the first states to initiate NAS surveillance. While data are from 2018 to 2019, they represent the first datasets available, and the methods and limitations described in the article may be instructive to other jurisdictions. [ABSTRACT FROM AUTHOR]

Objectives. To (1) determine the prevalence of elevated blood lead levels (EBLLs; ≥ 5 µg/dL) among newly arrived refugee children, (2) understand the demographic characteristics of refugee children with EBLLs, and (3) assess health care providers' compliance with Centers for Disease Control and Prevention (CDC) recommendations for retesting. Methods. We matched refugee demographic data (2015–2019) from the CDC's Electronic Disease Notification (EDN) system with lead-testing laboratory report data from the Pennsylvania National Electronic Disease Surveillance System using Match*Pro software. Results. Of 3833 refugee children 16 years or younger in the EDN system, matching identified 3142 children with blood lead level data. Among children with blood lead level data, 578 (18.4%) had EBLLs. Among children with EBLLs, 341 (59.0%) were male. Of the 1370 children aged 6 years or younger with blood level test results, 335 (24.5%) had initial EBLLs, and only 78 (5.7%) were retested within 3 to 6 months. Of the 335 children 6 years or younger with an initial EBLL, only 44 (13.1%) were retested within 3 to 6 months. Conclusions. Following up on refugee children with EBLLs is necessary to ensure that they do not have continued lead exposure. (Am J Public Health. 2022;112(S7):S706–S714. https://doi.org/10.2105/AJPH.2022.306856) [ABSTRACT FROM AUTHOR]

Background: Despite declining lead exposure among U.S. children, childhood blood lead level (BLL) undertesting and elevation remains a public health issue. This study explores the impacts of maternal, infant, and neighborhood characteristics on the receipt of lead testing and having elevated BLLs (EBLLs) among children under age two. Methods: Pennsylvania infants born in 2015 and 2016 were followed to 24 months. Birth certificate data were linked to 2015 through 2018 blood lead surveillance data and neighborhood data on household income, poverty, and the burden of houses built before 1970. Generalized linear mixed models were used to examine the individual and neighborhood characteristics independently and/or interactively affecting the likelihood of lead testing and of having EBLLs. Results: A total of 48.6% of children were tested for BLLs, and 2.6% of them had confirmed EBLLs. The likelihood of lead testing and of having EBLLs among non-Hispanic black children was respectively 7% and 18% higher than white children. Children born to mothers with the lowest educational attainment (

Infants and children are particularly vulnerable to in utero and early-life exposures. Thus, a mother's exposures before and during pregnancy could have important consequences for her child's health, including cancer development. We examined whether birth certificate–derived maternal anthropometric characteristics were associated with increased risk of subsequent childhood cancer development, accounting for established maternal and infant risk factors. Pennsylvania birth and cancer registry files were linked by the state Department of Health, yielding a virtual cohort of births and childhood cancers from 2003 through 2016. The analysis included 1,827,875 infants (13,785,309 person-years at risk), with 2,352 children diagnosed with any cancer and 747 with leukemia before age 14 years. Children born to mothers with a body mass index (weight (kg)/height (m)2) of ≥40 had a 57% (95% confidence interval: 12, 120) higher leukemia risk. Newborn size of ≥30% higher than expected was associated with 2.2-fold and 1.8-fold hazard ratios for total childhood cancer and leukemia, respectively, relative to those with expected size. Being <30% below expected size also increased the overall cancer risk (P for curvilinearity < 0.0001). Newborn size did not mediate the association between maternal obesity and childhood cancer. The results suggest a significant role of early-life exposure to maternal obesity- and fetal growth–related factors in childhood cancer development. [ABSTRACT FROM AUTHOR]

Mortality due to opioid misuse and overdose has increased substantially in the United States over the past two decades. The study objective was to describe the causes of death among persons with opioid-related hospitalizations and examine survival by Hepatitis C virus (HCV) or HIV. Opioid-related hospitalization records in Pennsylvania from 2000 to 2010 were linked to death registry files to assess cause of death, and survival from first hospital discharge date to death date, or December 31, 2010. Accelerated failure time models were used to compare survival between persons with and without HCV or HIV diagnoses. Among the 136,416 individuals with an opioid-related hospitalization, 13.0% died over a median of 56 months of follow-up; the most common causes of death were circulatory diseases (26.4%) and drug overdose (23.5%). There were 27,122 (19.9%) and 3662 (2.7%) persons who had an HCV and HIV diagnosis, respectively. Among patients aged ≥20 years, those with HCV had shorter survival time compared to those without HCV, with discrepancies more pronounced at older ages. Patients with HIV also had shorter survival time (time ratio: 0.29 [95% CI: 0.26, 0.34]) compared to without HIV. These findings show that in a cohort of patients with opioid-related hospitalizations, those with HCV or HIV diagnoses have shorter survival. This has public health implications, providing further evidence that medical providers should educate patients who use opioids about the risks of HCV and HIV infection and focus prevention and treatment to decrease mortality among patients hospitalized for opioid use. [ABSTRACT FROM AUTHOR]

Per- and polyfluoroalkyl substances (PFASs) are widely used in industrial and consumer products and have been linked to various adverse health effects. Communities near two former military bases in Pennsylvania were exposed to PFAS through contaminated drinking water for several decades. The Pennsylvania Department of Health (DOH) conducted biomonitoring of 235 randomly selected community members living in four public water system (PWS) service areas to evaluate a toolkit developed by the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR). DOH also collected data on participants' demographics, exposure history and self-reported health conditions. Serum PFAS levels were compared with the national averages for 2013-2014 and their relationships with demographic and exposure characteristics were analyzed. Of the 11 PFASs analyzed for, only perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) were consistently detected in the serum samples. The average levels of PFOA, PFOS, PFHxS and PFNA among the study participants were 3.13, 10.24, 6.64 and 0.74 μg per liter (μg/L), respectively. Overall, 75, 81, 94 and 59 percent of the study participants had levels exceeding the national average for PFOA (1.94 μg/L), PFOS (4.99 μg/L), PFHxS (1.35 μg/L) and PFNA (0.66 μg/L), respectively. Results indicated associations between serum levels of some PFAS compounds and sex, age, employment in the study area, PWS area, quantity of daily tap water consumption, and length of residence in the study area. [ABSTRACT FROM AUTHOR]

Background: Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts., Methods: Cross-sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2-stage cluster sample design to produce a statewide population-based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9-12., Results: Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences., Conclusions: Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

Objectives: To evaluate the characteristics driving higher diabetes-related hospitalization charges., Methods: Hospital discharge data on 216,858 hospitalizations from 2001 to 2011 with primary discharge diagnosis of diabetes were linked to the Pennsylvania death registry. Multiple linear regression analysis was used to evaluate the association between inpatient hospitalization charges and complications, sociodemographic status, comorbidities, readmission, length of stay, admission type, region, procedures, payer type, and hospitalization misadventures., Results: Diabetes-related adjusted hospitalization charges were higher for those with long-term complications [renal manifestations (75%), peripheral circulatory disorders (38%), neurological manifestations (30%), ophthalmic manifestations (16%)], acute complications [ketoacidosis (48%), hyperosmolarity (41%), coma (40%)], amputations (91%) or other medical procedure(s) (70%), emergency/urgent admissions (7%), comorbidity (3% per modified Charlson Comorbidity Index score item), medical misadventure (20%), different regions [Philadelphia (135%), and Pittsburgh (8%)], and for minorities [non-Hispanic black (12%), Hispanic (21%), and non-Hispanic other (14%)]. Readmission adjusted charges were not different from the initial admission charges., Conclusions: To reduce diabetes-related hospitalizations and curb hospitalization charges, public health and healthcare policy makers should be cognizant of high-impact drivers: diabetes-related complications, unnecessary procedures, race/ethnicity, and region. Inpatient are should focus on preventing unnecessary readmissions and misadventures. These findings are timely as the Affordable Care Act reduces Medicare payments to hospitals with high readmission rates, and as states consider Medicaid expansion.

Background: Multiple chronic conditions (MCCs) are significant public health problems receiving much attention, and rightly so, because of the substantial morbidity, mortality, and cost burden., Objectives: To report the prevalence of selected frequent MCCs with shared risk factors that are leading causes of death; and to quantify the association between diabetes and its comorbidity and shared risk factors., Methods: This is a cross-sectional study of 9172 participants in Pennsylvania's 2009 Behavioral Risk Factor Surveillance System (BRFSS). Centers for Disease Control and Prevention's Web Enabled Analysis Tool (WEAT) and SAS Proc Survey were used for all analyses, to account for BRFSS's multistage complex survey design and sample weights., Results: SAS estimated prevalence among ≥35-year-olds were as follows: diabetes (11.9%), heart disease (9.5%), stroke (3.3%), diabetes and heart disease (2.9%), diabetes and stroke (1.0%), heart disease and stroke (1.1%), and diabetes, heart disease, and stroke (0.4%). Adults ≥35 years old with the following characteristics were more likely to have diabetes when self-reporting: obese (adjusted odds ratio [ORAdj] = 4.63, 95% confidence interval [95% CI] = 3.41-6.30); low income (<$15 000 ORAdj = 2.85, 95% CI = 1.90-4.27; $15 000-$24 999 ORAdj = 2.07, 95% CI = 1.50-2.86; $25 000-$34 999 ORAdj = 2.06, 95% CI = 1.47-2.88; $35 000-$49 999 ORAdj = 1.51, 95% CI = 1.08-2.12); elderly ≥65 years old (ORAdj = 2.84, 95% CI = 1.76-4.56); non-Hispanic black (ORAdj = 2.54, 95% CI = 1.08-6.00); overweight (ORAdj = 1.99, 95% CI = 1.47-2.68); heart disease (ORAdj = 1.94, 95% CI = 1.47-2.56); 45 to 64 years old (ORAdj = 1.88 95%, CI = 1.21-2.93); hypertension (ORAdj = 1.78, 95% CI = 1.39-2.29); stroke (ORAdj = 1.62, 95% CI = 1.05-2.50); high cholesterol (ORAdj = 1.49, 95% CI = 1.18-1.88); physically inactive (ORAdj = 1.33 95% CI = 1.06-1.67); and men (ORAdj = 1.32, 95% CI = 1.04-1.67)., Conclusion: Adults with comorbidity and risk factors were 1.3 to 4.6 times more likely to have diabetes, with obesity consistently the strongest risk factor. WEAT's limitations are the predefined categories, inability to restrict to specific age groups and to estimate the prevalence of >2 MCCs. WEAT has considerable potential to advance evidence-based primary care practice and community health programs, such as state-wide programs that target obesity and physical inactivity. The robust capability of SAS to calculate MCC prevalence and adjusted associations with risk factors provides the fundamentals for developing and evaluating primary care services and community health programs.