Search

As SARS-CoV-2 and influenza viruses co-circulate, co-infections with these viruses generate an increasing concern to public health. To evaluate the prevalence and clinical impacts of SARS-CoV-2 and influenza A virus co-infections during the 2021-2022 influenza season, SARS-CoV-2-positive samples from 462 individuals were collected from October 2021 to January 2022. Of these individuals, 152 tested positive for influenza, and the monthly co-infection rate ranged from 7.1% to 48%. Compared to the Delta variant, individuals infected with Omicron were less likely to be co-infected and hospitalized, and individuals who received influenza vaccines were less likely to become co-infected. Three individuals had two samples collected on different dates, and all three developed a co-infection after their initial SARS-CoV-2 infection. This study demonstrates high prevalence of co-infections in central Missouri during the 2021-2022 influenza season, differences in co-infection prevalence between the Delta and the Omicron waves, and the importance of influenza vaccinations against co-infections.

As of 2022, only 51% of active eligible state employees in Missouri have been screened for colorectal cancer and 67% for breast cancer, despite having state-sponsored health insurance. In fall 2020, the Missouri Department of Health and Senior Services Comprehensive Cancer Program partnered with the Missouri Cancer Consortium to create a strategy to improve cancer screening rates among state employees. The project was designed to include 3 phases: 1) a colorectal cancer education phase, 2) an expanded education phase that included additional cancers, and 3) a proposed intervention phase that will include screening events. In the first phase, in 2020, colorectal cancer educational materials were sent to all state employees. In the second phase, in 2022, educational resources were expanded to include additional cancers and screening tools. In both initiatives, educational materials and information on current screening recommendations were distributed to approximately 40,000 state employees. A database of screening rates was developed to monitor screening rates and challenge state employees to complete screenings. Evidence-informed interventions were implemented with a focus on health equity. We used a regional approach to identify geographic areas with the greatest need. These efforts will support the next phase of the project, which involves planning breast and colorectal cancer screening events. Policy changes will be encouraged to remove systems-level barriers that discourage employees from being screened for cancer. Recommended tools and strategies can be adopted by similar organizations with complex, multitier employee structures.

Increasing detection of reinfections and waning neutralizing antibody (Nab) titers as early as 23 days following initial infection raise concerns for herd immunity and the durability of vaccine efficacy. This article is protected by copyright. All rights reserved.

Background Pregnancy has been reported to be a risk factor for severe COVID-19. We evaluated the impact of pregnancy on severe COVID-19 and mortality in an electronic medical record (EMR) database that enabled exclusion of labor and delivery (L&D) encounters. Methods In this retrospective cohort study, EMRs from 82 healthcare facilities in the Cerner COVID-19 Datamart were analyzed. The study comprised 38 106 individuals aged 18–45 years old with COVID-19 who had emergency department, urgent care, or inpatient encounters from December 2019 to September 2020. Subgroups were balanced through propensity score weights for age, race, smoking status, and number of comorbidities. The primary outcome was COVID-19–related mortality; secondary outcomes were markers of severe COVID-19: intubations, mechanical ventilation, use of vasopressors, diagnosis of sepsis, and diagnosis of acute respiratory distress syndrome. Results In comparing pregnant and nonpregnant women, no statistical differences were found for markers of severe COVID-19, after adjusting for age, smoking, race, and comorbidities. The adjusted odds of an inpatient encounter were higher for pregnant vs nonpregnant women (adjusted odds ratio [aOR], 13.2; 95% confidence interval [CI], 11.6–15.3; P < .001), but notably lower after excluding L&D encounters (aOR, 2.3; 95% CI, 1.89–2.88; P < .001). In comparison to women without L&D encounters, hospitalization was significantly more likely for men. Conclusions We did not find an increased risk of severe COVID-19 or mortality in pregnancy. Hospitalization does not necessarily indicate severe COVID-19 in pregnancy, as half of pregnant patients with COVID-19 were admitted for L&D encounters in this study.

Children are particularly vulnerable to many classes of the volatile organic compounds (VOCs) detected in indoor environments. The negative health impacts associated with chronic and acute exposures of the VOCs might lead to health issues such as genetic damage, cancer, and disorder of nervous systems. In this study, 40 VOCs including aldehydes and ketones, aliphatic hydrocarbons, esters, aromatic hydrocarbons, cyclic terpenes, alcohols, and glycol ethers were identified and qualified in different locations at the University of Missouri (MU) Child Development Laboratory (CDL) in Columbia, Missouri. Our results suggested that the concentrations of the VOCs varied significantly among classrooms, hallways, and playground. The VOCs emitted from personal care and cleaning products had the highest indoor levels (2-ethylhexanol-1, 3-carene, homomenthyl salicylate with mean concentration of 5.15 µg/m3 , 1.57 µg/m3 , and 1.47 µg/m3 , respectively). A cancer risk assessment was conducted, and none of the 95th percentile dose estimates exceeded the age-specific no significant risk levels (NSRL) in all classrooms. Dimensionless toxicity index scores were calculated for all VOCs using a novel web-based framework called Toxicological Prioritization Index (ToxPi), which integrates multiple sources of toxicity data. According to the method, homomenthyl salicylate, benzothiazole, 2-ethylhexyl salicylate, hexadecane, and tridecane exhibited diverse toxicity profiles and ranked as the five most toxic indoor VOCs. The findings of this study provide critical information for policy makers and early education professionals to mitigate the potentially negative health impacts of indoor VOCs in the childcare facilities.

The National Comprehensive Cancer Network (NCCN) distress thermometer (DT) was developed as a brief screening tool for detecting distress in cancer patients. Conceptually, distress was considered a more acceptable and inclusive term than other psychological terms such as depression or anxiety. It is used extensively in the United States and other English-speaking countries. We aim to describe the translation and validation methods of the DT and describe the recommended cutoff scores used to identify cancer patients experiencing clinically significant distress.Nine bibliographic databases were searched using keywords to identify original research studies for non-English speaking countries' cancer patients. Full articles were independently assessed for inclusion and data extraction by two authors.The review of 4442 articles yielded 39 articles that validated the DT. We identified 20 languages in 25 countries. In all but one country, investigators were able to agree upon a word or phrase that meant distress in their native language that was subsequently validated against standardized instruments. Asian, Middle Eastern and European counties recommended cutoff score of 4 or 5 to identify clinically significant distress; however, European Union countries had a range of 2 to 7.Use of the translated DT with non-English speaking cancer patients provides a simple and quick tool to identify high distress. Similar to NCCN, the cutoff score of 4 or 5 was suggested by 78% of the studies; however, more studies of different types of cancer and within and among more countries will strengthen a recommended global DT cutoff score.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a higher infection rate in pregnant women than age-matched adults. With increased infectivity and transmissibility, the Delta variant is predominant worldwide. Methods In this study, we describe intrauterine fetal demise in unvaccinated women with mild symptoms of SARS-CoV-2 Delta variant infection. Results Histology and elevated proinflammatory responses of the placenta suggest that fetal demise was associated with placental malperfusion due to Delta variant infection. Conclusions This study suggests that the Delta variant can cause severe morbidity and mortality to fetuses. Vaccination should continue to be advocated and will likely continue to reduce SARS-CoV-2 infection risks for pregnant women and their fetuses.

Introduction Primary care provider (PCP) competency in dermatology is inadequate despite the high volume of patients with skin conditions. Better education and access to dermatology expertise is vital to improve patient care. We present a comprehensive case-based evaluation of Dermatology Extension for Community Healthcare Outcomes (ECHO) sessions, an innovative videoconferencing educational model, by determining the diagnostic and treatment accuracy of dermatological conditions by PCPs over a 2-year period. Methods This is a retrospective cross-sectional study evaluating the use and impact of Dermatology ECHO over a 2-year period. Outcomes assessed include patient demographics, PCPs’ diagnostic accuracy, and expert treatment impact. Results were analysed using summary statistics and Pearson’s chi-square test to describe the adult and paediatric populations. Results One hundred and sixty-seven adult cases and 56 paediatric cases were presented in 2016–2017. Among the 223 cases, 137 adult and 44 paediatric cases were complete and eligible for analysis. The mean lesion duration was 3.3 years in adults and 2.9 years in children prior to presentation. Upon case presentation, almost half (43.8%) of the adult cases were incorrectly diagnosed by their PCP with 18.8% receiving a partially correct diagnosis. PCPs had greater diagnostic accuracy in children (45% correct diagnosis, 27.5% partially correct, 27.5% incorrect). Expert treatment recommendations benefited 83.6% of adult cases and 72.5% of paediatric cases. Discussion This study highlights the need for better dermatology access and teaching opportunities among PCPs in Missouri. Dermatology ECHO provides a platform for didactic learning and case presentations to improve dermatology competency among PCPs.

Objective Our objective was to determine whether 15 min yogic breathing exercises practiced 5 times a week can lower blood pressure in uncontrolled hypertensive patients. Design Take a deep Breath study was a 3-arm randomized controlled blood pressure trial, 2016–2017 with in-class instruction, home DVD/YouTube instruction, and a control arm. Blood pressure measurements with a 1-month follow-up. Methods A list of uncontrolled hypertensive patients (n = 5507) generated from Family Medicine Department’s Electronic Medical Record registry was given to their respective providers to recommend. After chart review of the 1682 recommended patients, the number reduced to 984 of which 610 were contacted and 22% of 610 (n = 133) were enrolled. Eligible participants were randomly assigned to in-class instruction (n = 44), DVD/YouTube group (n = 57), or control (n = 32). The outcome measured was at least 5 mm Hg systolic blood pressure reduction. Results Participants were predominately white (89%), approximately half male (52%) with a mean age of 61 years (sd = 12 years). Of the 133 participants who were allocated to a study arm, 30 never participated in any aspect of the study, 20 partially completed and 83 completed the study. Compared to those who completed the study, no differences were noted in demographics or initial blood pressure for those who partially completed. From chart review 6% of participants made a change to their blood pressure medications during the study. Intervention participants were significantly more likely to have ≥5 mm Hg decrease in systolic blood pressure (OR = 4.49, 95% CI: 1.18–17.0) compared to controls in the multivariable logistics model. DVD/YouTube instruction did just as well as in-class instruction group. Conclusions In this RCT, statistically significant systolic blood pressure reduction was noted in the intervention groups. Yogic breathing exercises may provide an additional non- pharmacologic tool to treat uncontrolled blood pressure.

Cadmium is a toxic, bioaccumulating, non-essential, and highly persistent metal, making up 0.1 parts per million (ppm) of the Earth’s crust, with ubiquitous exposure to the population [1]. No signi...

Inpatient coronavirus disease 2019 (COVID‐19) cases present enormous costs to patients and health systems in the United States. Many hospitalized patients may continue testing COVID‐19 positive even after the resolution of symptoms. Thus, a pressing concern for clinicians is the safety of discharging these asymptomatic patients if they have any remaining infectivity. This case report explores the viral viability in a patient with persistent COVID‐19 over the course of a 2‐month hospitalization. Positive nasopharyngeal swab samples were collected and isolated in the laboratory and analyzed by quantitative reverse‐transcription polymerase chain reactions (qRT‐PCR), and serology was tested for neutralizing antibodies throughout the hospitalization period. The patient experienced waning symptoms by hospital day 40 and had no viable virus growth by hospital day 41, suggesting no risk of infectivity, despite positive RT‐PCR results which prolonged his hospital stay. Notably, this case showed infectivity for at least 24 days after disease onset, which is longer than the discontinuation of transmission‐based precautions recommended by the Center for Disease Control and Prevention. Thus, our findings suggest that the timeline for discontinuing transmission‐based precautions may need to be extended for patients with severe and prolonged COVID‐19 disease. Additional large‐scale studies are needed to draw definitive conclusions on the appropriate clinical management for these patients. ​, Highlights A patient with severe COVID‐19 disease demonstrated infectivity at least 24 days after disease onset, which is longer than the current discontinuation of transmission‐based precautions guidelines in the United States.The patient had no viable virus growth by hospital day 41, suggesting no risk of infectivity despite a positive RT‐PCR test result.Our findings suggest that the timeline for discontinuation of transmission‐based precautions may require an extension for patients with severe and prolonged COVID‐19 illness.

Since the first report of SARS-CoV-2 in December 2019, genetic variants have continued to emerge, complicating strategies for mitigating the disease burden of COVID-19. Positive SARS-CoV-2 nasopharyngeal swabs (n=8,735) were collected from Missouri, USA, from March-October 2020, and viral genomes (n=178) were sequenced. Hospitalization status and length of stay were extracted from medical charts of 1,335 patients and integrated with emerging genetic variants and viral shedding analyses for assessment of clinical impacts. Multiple introductions of SARS-CoV-2 into Missouri, primarily from Australia, Europe, and domestic states, were observed. Four local lineages rapidly emerged and spread across urban and rural regions in Missouri. While the majority of Missouri viruses harbored Spike-D614G mutations, a large number of unreported mutations were identified among Missouri viruses, including seven in the RNA-dependent RNA polymerase complex and Spike protein that were positively selected. A 15.6-fold increase in viral RNA levels in swab samples occurred from March to May and remained elevated. Accounting for other comorbidities, individuals test-positive for COVID-19 with high viral loads were less likely to be hospitalized (odds ratio=0.39, 95% confidence interval [CI]=0.20, 0.77) and had shorter hospital stays (hazard ratio=0.34, p=0.003) than those with low viral loads. Overall, the first eight months of the pandemic in Missouri saw multiple locally acquired mutants emerge and dominate in urban and rural locations. Although we were unable to find associations between specific variants and greater disease severity, Missouri COVID-positive individuals that presented with increased viral shedding had less severe disease by several measures.

The rise of hydraulic fracturing and unconventional oil and gas (UOG) exploration in the United States has increased public concerns for water contamination induced from hydraulic fracturing fluids and associated wastewater spills. Herein, we collected surface and groundwater samples across Garfield County, Colorado, a drilling-dense region, and measured endocrine bioactivities, geochemical tracers of UOG wastewater, UOG-related organic contaminants in surface water, and evaluated UOG drilling production (weighted well scores, nearby well count, reported spills) surrounding sites. Elevated antagonist activities for the estrogen, androgen, progesterone, and glucocorticoid receptors were detected in surface water and associated with nearby shale gas well counts and density. The elevated endocrine activities were observed in surface water associated with medium and high UOG production (weighted UOG well score-based groups). These bioactivities were generally not associated with reported spills nearby, and often did not exhibit geochemical profiles associated with UOG wastewater from this region. Our results suggest the potential for releases of low-saline hydraulic fracturing fluids or chemicals used in other aspects of UOG production, similar to the chemistry of the local water, and dissimilar from defined spills of post-injection wastewater. Notably, water collected from certain medium and high UOG production sites exhibited bioactivities well above the levels known to impact the health of aquatic organisms, suggesting that further research to assess potential endocrine activities of UOG operations is warranted.

Objectives We compared HPV vaccine initiation and completion of heterosexual with lesbian and bisexual (LB) women. Methods We aggregated National Health and Nutrition Examination Survey data from 2009 to 2016 for 3,017 women aged 18 to 34 y in the United States. HPV vaccine initiation was defined as reported receipt of ≥1 dose of the vaccine and completion as receipt of the three recommended doses. Weighted percentages and multivariable logistic regression models were used to examine differences in HPV vaccine initiation and completion between heterosexual and LB women. Results Approximately 12% of respondents self-identified as LB women. Overall, a higher percentage of respondents (26%) had initiated the HPV vaccine than completed the three vaccine doses (17%). In the bivariate analysis, LB women had higher initiation ([35% of LB women versus 25% heterosexual]; p = .0012) and completion rates ([24% of LB women versus 17% heterosexual]; p = .0052) than heterosexual women. After adjusting for covariates, compared to heterosexual women, LB women were 60% (aOR = 1.60, 95% CI: 1.16-2.19) more likely to initiate and 63% (aOR = 1.63, 95% CI: 1.12-2.37) more likely to complete the HPV vaccine. Conclusions Although LB women had higher likelihood of HPV vaccine initiation and completion compared with heterosexual women, their HPV vaccine uptake was well below the Healthy People 2020 target (80%). Understanding differences in the drivers of vaccine uptake in the LB population may inform strategies that would further increase HPV vaccine uptake toward achieving the 80% completion target.

Rapid spread of coronavirus disease 2019 (COVID-19) forced an abrupt shift in the traditional US health care delivery model to meet the needs of patients, staff, and communities. Through federal policy changes on telehealth, patient care shifted from in-person to telephone or video visits, and health care providers reached out to patients most at risk for exacerbation of chronic disease symptoms. ECHO (Extension for Community Healthcare Outcomes), a videoconferencing peer learning application, engaged health care providers across Missouri in the treatment and management of complex COVID-19-positive patients. Re-envisioning health care in the digital age includes robust utilization of telehealth to enhance care for all.

Unconventional oil and gas (UOG) extraction (fracking) has increased in the United States, as well as interest in the associated risks and benefits. This study’s purpose was to qualitatively examine residents’ perceptions about UOG development in their community. Fifteen interviewees involving residents of Garfield County, Colorado, a drilling-dense region, were transcribed and analyzed. The study found six themes: (1) health concerns, both human and animal, (2) power struggles between government and industry/between industry and residents, and (3) perception and some acceptance of increased risk. Less common themes were (4) reliance on science to accurately determine risk, (5) frustration with potential threat and loss of power, and (6) traffic and safety concerns. Community perceptions of UOG development are complex, and understanding the position of community members can support the need for additional public health research and impact assessments regarding community exposures from UOG drilling operation exposures.

This study evaluated how breast cancer diagnoses were shared with patients. Current members of the Dr. Susan Love Research Foundation’s Army of Women cohort were sent one email with a link to a survey assessing how their breast cancer diagnosis was communicated, a description of their support system during treatment, basic demographic information, and breast cancer diagnosis details. Participants (n = 2896) were more likely to be given their diagnosis over the telephone in more recent years (OR 1.07, 95% CI 1.06–1.08). Up until about 10 years ago (1967–2006), breast cancer diagnoses were communicated in person more often than by telephone. Since 2006, more than half of participants learned about their diagnosis over the telephone. From 2015 to 2017, almost 60% of participants learned about their diagnosis over the telephone. Among those who heard the news in person, a steady 40% were alone. Characteristics of those who received the news over the telephone included having identified support members, heterosexual identity, and a diagnosis of in situ breast cancer. Receiving a telephone call about breast cancer diagnosis may be the norm rather than the exception in health care today. Trends in practice, as well as current best practices based primarily on expert opinion, may not provide optimal care for women diagnosed with breast cancer. Patient outcome research to guide future practice, such as the impact of modes of delivery of bad news, is urgently needed to determine appropriate patient-centered approaches for notification of breast cancer diagnoses.

Background: Childhood obesity in the United States is a critical public health issue. Although multiple child and parental factors are associated with childhood obesity, few models evaluate how socioeconomic status influences these risk factors. We aimed to create a model to examine how socioeconomic status modifies risk factors for child obesity. Methods: We conducted a secondary data analysis of the Early Childhood Longitudinal Birth Cohort. Using logistic regression, we modeled childhood obesity status from known parental and child risk factors for childhood obesity and tested interactions with socioeconomic status. Results: Compared with healthy-weight children, socioeconomic status, race, birth weight, parental smoking, and not eating dinner as a family were associated with kindergarten-aged children being overweight or obese. Parental smoking increased the odds of a child being overweight or obese by 40%, and eating dinner as a family reduced the odds of a child being overweight or obese by 4%. In addition, black or Hispanic children had a 60% increased odds of being overweight or obese when compared with their white counterparts. Native American children had almost double the odds of being overweight or obese compared with white children. Socioeconomic status did not modify any of these associations. Conclusion: Parental smoking, birth weight, and not eating dinner as a family were two modifiable factors associated with overweight and obesity in kindergarten-age children, regardless of socioeconomic status. Changing these life-style factors could reduce the child9s risk for obesity.

This study explored sources of stress and support experienced by sexual and gender minority (SGM) breast cancer survivors and the impact of treatment on their lives. SGM breast cancer survivors were identified through purposive and referral sampling and invited to participate in a web-based survey containing both closed- and open-ended items. Sixty-eight SGM breast cancer survivors aged 18–75 years completed the survey between May 2015 and January 2016. Bivariate analyses of quantitative data reveal that queer-identified (in either sexual orientation or gender identity (SOGI)) SGM survivors are more likely to report having bilateral mastectomy without reconstruction and to think that disclosing SOGI to providers affected their care. Queer-identified SGM survivors are also more likely to use LGBT-specific support groups and to report that their current level of social support is below average. Thematic analysis of qualitative comments revealed themes related to self-disclosure of SOGI to providers, need for recognition and support of partners, need for appropriate social supports for patients and partners, and impact of breast cancer treatment on intimate relationships. This study provides quantitative and qualitative evidence that many SGM breast cancer patients face a dearth of appropriate social supports, both from breast cancer survivor organizations and from within the medical system. These findings confirm the need for research on the physical and emotional effects of breast cancer treatment on SGM breast cancer survivors, as well as further exploration of the social support needs and experiences of SGM breast cancer patients and their partners.

The speciation analysis of As in urine samples can provide important information for epidemiological studies. Considering that these studies involve hundreds or thousands of samples, a fast and reliable method using a simple LC system with short-length mixed bed ion exchange chromatographic column coupled to ICP-MS for As speciation in human urine samples was developed in this work. Separation of AB+TMAO, DMA, AC, MMA and As III +As V was accomplished within 5 min with good resolution when ammonium carbonate solutions were used as mobile phases and H 2 O 2 was added to samples to quantitatively convert As III –As V . Repeatability studies yielded RSD values from 2.0% to 4.8% for all species evaluated. Limits of detection (LOD) for As species ranged from 0.003 to 0.051 ng g −1 . Application of the method to human urine samples from a non-contaminated area showed that the sum of species measured corresponded to 62–125% of the total As in the sample. The recovery values for these species in urine SRM 2669 were in the range of 89–112% and demonstrated the suitability of the proposed method for epidemiological studies.

Exposure to volatile organic compounds (VOCs) in child care environments has raised a public concern. This study aimed to characterize indoor VOCs in four facilities of Head Start programs in Kansas city, Missouri, investigate seasonal and spatial variations in VOC levels, and assess health risks associated with children's VOC exposure. In total, 49 VOCs including aromatic and aliphatic hydrocarbons, aldehydes, glycol ethers, esters and chlorinated hydrocarbons were identified and quantified in the facilities. Significant differences were noted for the VOC concentrations among the facilities. Toluene was the most abundant aromatic hydrocarbon detected in all the air samples, with a narrow median concentration range of 2.17–3.07 μg/m3. 2-(2-Methoxyethoxy)ethanol never reported in prior research was detected in only one facility in this study, with the median (range) concentration of 0.83 (

Purpose The purpose of this study was to describe fitness characteristics of metabolically healthy sexual minority women who are obese. Methods As part of the Healthy Weight in Lesbian and Bisexual Women Initiative funded by the U.S. Office on Women's Health, one site enrolled self-identified lesbian or bisexual women age 40 and older in a randomized controlled trial that evaluated interventions to improve health. Women with waist-to-height ratio of 0.5 or greater were classified as obese. Women without diabetes or cardiovascular disease and with normal range fasting blood level measurements of glucose, triglycerides, high-density cholesterol, and blood pressure were classified as metabolically healthy but obese (MHO). Otherwise, women were classified as metabolically unhealthy obese (MUHO). Fitness measurements included predicted VO 2 maximum, 1-minute heart rate recovery, and strength (single maximal leg lift and chest press). Self-reported demographic and physical activity level data were obtained by standardized questionnaires. Results Of the 53 participants who completed the eligibility screener in Columbia, Missouri, 47 were enrolled in the study (89% participation proportion) with 45 categorized as obese. Approximately one-third (38%) were MHO. The majority of MHO and MUHO participants ranked poor or very poor on a composite fitness score that included measures of strength, flexibility, and aerobic fitness (75.0% and 77.8%, respectively). In the logistic regression models, better 1-minute heart rate recovery after peak exercise performance was significantly associated with MHO individuals (odds ratio, 2.92; 95% CI, 1.13–9.10) compared with MUHO. No other fitness measure was significantly different between the two groups. Conclusion Consistent with other studies, we identified more than one-third of our obese sexual minority women as MHO. Fitness measures may be potential predictors of MHO status because one measure, heart rate recovery, was significantly associated with MHO status. With the population prevalence of obesity high and even higher among lesbian or bisexual women, sexual minority women are an ideal population for a longitudinal study to better understand MHO characteristics.

Purpose Adult lesbian and bisexual (LB) women are more likely to be obese than adult heterosexual women. To address weight- and fitness-related health disparities among older LB women using culturally appropriate interventions, the Office on Women's Health (OWH) provided funding for the program, Healthy Weight in Lesbian and Bisexual Women (HWLB): Striving for a Healthy Community. This paper provides a description of the interventions that were implemented. Methods Five research organizations partnered with lesbian, gay, bisexual, and transgender community organizations to implement healthy weight interventions addressing the needs of LB women 40 years and older. The interventions incorporated evidence-based recommendations related to physical activity and nutrition. Each group intervention developed site-specific primary objectives related to the overall goal of improving the health of LB women and included weight and waist circumference reduction as secondary objectives. A 57-item core health survey was administered across the five sites. At a minimum, each program obtained pre- and post-program assessments. Results Each program included the OWH-required common elements of exercise, social support, and education on nutrition and physical activity, but adopted a unique approach to deliver intervention content. Conclusion This is the first time a multisite intervention has been conducted to promote healthy weight in older LB women. Core measurements across the HWLB programs will allow for pooled analyses, and differences in study design will permit analysis of site-specific elements. The documentation and analysis of the effectiveness of these five projects will provide guidance for model programs and future research on LB populations.

Background Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks. Methods Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report. Analytical Plan Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models. Results Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer ( n = 43) and mindfulness ( n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18–2.36; p = .004; RR, 1.38; 95% CI, 1.01–1.89; p = .042, respectively) and those in the gym program ( n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97–3.68, p = .06) compared with the comparison group ( n = 67). Conclusion This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.

Research increasingly suggests that moderate to vigorous physical activity (MVPA) is essential to children's health. However, little is known about the extent to which and when different urban environments influence the extent to which children engage in MVPA. To this end, this study explores the relationship between children's MVPA and urban land use and land cover (LULC) for several temporal subdivisions of children's weekly routines (before school, after school and weekends). In particular, the location and corresponding level of physical activity of 4th grade students (n = 134) was recorded using paired global positioning system (GPS) receivers and accelerometers over 33 days for each student. GPS locations were temporally related to accelerometry records and then geographically related to 13 categories of LULC. Mixed linear models were fitted to evaluate the extent to which duration spent in each LULC category can explain individuals' time in MVPA before school, after school, and during the weekends. Geographic cluster analysis was also applied to assess whether any significant spatial relationships between observations of MVPA may exist. Duration of exposure to vegetated parks/open spaces, built residential, and built institutional LULC was found to significantly increase children's time spent in MVPA. Further, most observations of MVPA were found to exhibit significant geographic clustering and were predominately associated with built residential areas (particularly those near schools), indicating the importance of neighborhoods and areas in close proximity to children's households on their level of physical activity.

Background Hydraulic fracturing technologies, developed over the last 65 years, have only recently been combined with horizontal drilling to unlock oil and gas reserves previously deemed inaccessible. Although these technologies have dramatically increased domestic oil and natural gas production, they have also raised concerns for the potential contamination of local water supplies with the approximately 1,000 chemicals that are used throughout the process, including many known or suspected endocrine-disrupting chemicals. Objectives We discuss the need for an endocrine component to health assessments for drilling-dense regions in the context of hormonal and antihormonal activities for chemicals used. Methods We discuss the literature on a) surface and groundwater contamination by oil and gas extraction operations, and b) potential human exposure, particularly in the context of the total hormonal and antihormonal activities present in surface and groundwater from natural and anthropogenic sources; we also discuss initial analytical results and critical knowledge gaps. Discussion In light of the potential for environmental release of oil and gas chemicals that can disrupt hormone receptor systems, we recommend methods for assessing complex hormonally active environmental mixtures. Conclusions We describe a need for an endocrine-centric component for overall health assessments and provide information supporting the idea that using such a component will help explain reported adverse health trends as well as help develop recommendations for environmental impact assessments and monitoring programs. Citation Kassotis CD, Tillitt DE, Lin CH, McElroy JA, Nagel SC. 2016. Endocrine-disrupting chemicals and oil and natural gas operations: potential environmental contamination and recommendations to assess complex environmental mixtures. Environ Health Perspect 124:256–264; http://dx.doi.org/10.1289/ehp.1409535

Rationale Intimate partners and other informal caregivers provide unpaid tangible, emotional, and decision-making support for patients with cancer, but relatively little research has investigated the cancer experiences of sexual minority women (SMW) with cancer and their partners/caregivers. Objective This review addressed 4 central questions: 1) What social support do SMW with cancer receive from partners/caregivers? 2) What effect does cancer have on intimate partnerships or caregiving relationships of SMW with cancer? 3) What effects does cancer have on partners/caregivers of SMW with cancer? 4) What interventions exist to support partners/caregivers of SMW or to strengthen the patient-caregiver relationship? Method This systematic review, conducted in 2018 and updated in 2020, was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent coders screened abstracts and articles. Results In total, 550 unique records were screened; 42 articles were assessed for eligibility, and 18 were included in a qualitative synthesis. Most studies were U.S.-based, involved breast cancer, included intimate partners, had primarily white/Caucasian samples, and were cross-sectional. Sexual minority female participants reported that partners/caregivers often provide important social support, including emotional support, decision-making support, and tangible support. Effects of cancer on relationships with partners/caregivers were mixed, with some studies finding relationships remained stable and others finding cancer either increased closeness or disrupted relationships. Participants reported partners/caregivers often experience distress and may experience discrimination, discomfort disclosing sexual orientation, and a lack of sexual minority-friendly services. No studies involved an intervention targeting partners/caregivers or the dyadic relationship. Conclusions More work is needed to understand SMW with cancers other than breast cancer, and future work should include more racially, ethnically, and economically diverse samples. Longitudinal research will allow an examination of patterns of mutual influence and change in relationships. These steps will enable the development of interventions to support SMW with cancer and people close to them.

BackgroundUnderstanding the role of environmental toxicant exposure on children’s development is an important area of inquiry in order to better understand contextual factors that shape development and ultimately school readiness among young children. There is evidence suggesting negative links between exposure to environmental toxicants and negative physical health outcomes (i.e. asthma, allergies) in children. However, research on children’s exposure to environmental toxicants and other developmental outcomes (cognitive, socioemotional) is limited.ObjectivesThe goal of the current review was to assess the existing literature on the links between environmental toxicants (excluding heavy metals) and children’s cognitive, socioemotional, and behavioral development among young children.MethodsThis literature review highlights research on environmental toxicants (i.e. pesticide exposure, bisphenol A, polycyclic aromatic hydrocarbons, tobacco smoke, polychlorinated biphenyls, flame retardants, phthalates and gas pollutions) and children’s development across multiple domains.ResultsThe results highlight the potential risk of exposure to multiple environmental toxicants for young children’s cognitive and socioemotional development.DiscussionDiscussion will focus on the role of environmental toxicants in the cognitive and socioemotional development of young children, while highlighting gaps in the existing literature.

Children are among the most vulnerable to certain air pollutants, such as volatile organic compounds. Analysis of indoor air has been analytically challenging and costly. The objectives of this study were to (1) develop and validate a sensitive analytical method for assessing the exposure of children to volatile organic compounds at child care centers and (2) characterize the indoor concentrations of target volatile organic compounds in classrooms at child care centers. The volatile organic compounds were sampled by using thermal desorption samplers and the concentrations of the volatile organic compounds were determined by a thermal desorption gas chromatography-mass spectrometry method. Among the 73 target indoor volatile organic compounds, 47 were identified and quantified in the air samples collected from the selected child care center. The limits of detection and limits of quantitation ranged from 0.001 to 0.123 μg m-3, and 0.002 to 0.406 μg m-3, respectively. The correlation coefficients (R2) of the calibration were between 0.982 and 0.999. The mean recoveries of the analytes ranged from 87% to 112%. The precision expressed as the coefficient of variation was between 0.6% and 16.2%. The volatile organic compounds identified in our pilot study include a wide range of potential toxic chemicals and endocrine disruptors, such as the ingredients in dry cleaning agents (e.g., tetrachloroethylene), surfactants (e.g., butoxyethanol), and personal care products (e.g., homosalate). Due to the portability, affordability, and flexibility, the developed sampling and analytical method has several advantages over conventional techniques for large-scale multi-position air quality monitoring studies at child care centers.

Research in the sexual and gender minority population (SGM) tends to focus on describing risk factors for negative health outcomes and identification of stressors, which tend to be higher in this population compared to the non-SGM (i.e., mainstream heterosexual) population. This study examines the intersection between perceived stress and resilience associated with self-reported depressive symptoms using standardised instruments, such as the Patient Health Questionnaire (PHQ-2), among SGM adults (n = 3017) and youths (n = 232). A higher proportion of SGM individuals are stressed and report depressive symptoms compared to non-SGM individuals, whereas the mean resilience scores were similar to the general population. For SGM adults, but not youths, we found an association between lower resilience scores and higher perceived stress scores. SGM adults who had a ‘higher’ depressive symptom score (PHQ-2 ≥ 3) were more likely to have a lower resilience score, a higher stress score, be unemployed or disabled, and...

Sexual and gender minorities (SGM) smoke cigarettes at higher rates than the general population. Historically, research in SGM health issues was conducted in urban populations and recent population-based studies seldom have sufficient SGM participants to distinguish urban from rural. Given that rural populations also tend to have a smoking disparity, and that many SGM live in rural areas, it is vitally important to understand the intersection of rural residence, SGM identity, and smoking. This study analyzes the patterns of smoking in urban and rural SGM in a large sample.We conducted an analysis of 4280 adult participants in the Out, Proud, and Healthy project with complete data on SGM status, smoking status, and zip code. Surveys were conducted at 6 Missouri Pride Festivals and online in 2012. Analysis involved descriptive and bivariate methods, and multivariable logistic regression. We used GIS mapping to demonstrate the dispersion of rural SGM participants.SGM had higher smoking proportion than the non-SGM recruited from these settings. In the multivariable model, SGM identity conferred 1.35 times the odds of being a current smoker when controlled for covariates. Rural residence was not independently significant, demonstrating the persistence of the smoking disparity in rural SGM. Mapping revealed widespread distribution of SGM in rural areas.The SGM smoking disparity persists among rural SGM. These communities would benefit from continued research into interventions targeting both SGM and rural tobacco control measures. Recruitment at Pride Festivals may provide a venue for reaching rural SGM for intervention.

The authors examined the influence of social media involvement on health issues in sexual and gender minorities (SGMs). Demographic and technological characteristics of social media users and nonusers were identified, and the influence of social media involvement on these factors was assessed for its potential to influence health information needs and preferences. A survey of 2,274 SGM individuals revealed that age, sexual orientation, number of Internet access points, and use of smartphones predicted levels of social media involvement. Results suggest that a broader range of traditional and nontraditional communication channels is needed to meet a diversity of health information needs in SGMs.

Background: Cadmium is a human lung carcinogen, and recent evidence suggests it may play a role in hormone-related cancers because of its estrogenic activity. Case-control studies consistently show higher cadmium concentrations in urine from women diagnosed with breast cancer compared with control women. Our aim was to investigate the association between urinary cadmiumand breast cancer in a prospective design.Methods: We conducted a case-cohort study using the population-based Danish Diet Cancer and Health Cohort. Women age 50 to 64 years were recruited in 1993-1997 and provided urine for analysis. We identified 900 incident case patients in the Danish Cancer Registry and compared with 898 individuals in a subcohort. Urine samples collected at enrollment into the cohort were analyzed for cadmium and creatinine. We estimated incidence rate ratios (IRRs) for breast cancer in Cox proportional hazards models with age as time axis and calculated 95% confidence intervals (CIs).Results: The linear analysis showed no association between urinary cadmiumand risk for breast cancer (IRR = 1.00, 95% CI = 0.81 to 1.24 per ng Cd/mL urine). The categorical analyses showed a slightly higher risk for breast cancer for the second (IRR = 1.10, 95% CI = 0.86 to 1.42) and third (IRR = 1.14, 95% CI = 0.83 to 1.55) exposure tertiles compared with the lowest tertile. Results were similar in analyses of breast cancer subtypes defined by estrogen and progesterone receptor status and by histology, and analyses stratified by years from baseline to diagnosis.Conclusions: This large prospective study showed no association between urinary concentration of cadmium and subsequent risk for development of postmenopausal breast cancer.

Background As rates of inactivity in the United States increase, the proportion of adults who are overweight in the United States continues to grow with concurrent increases in risk of weight-related morbidity and mortality. Sparse data are available on physical activity and weight in college-age sexual minority females, and none examine this relationship by age. To address this gap, we examined two age cohorts of female college students who self-identified as lesbian, bisexual, and questioning (LBQ), to 1) explore the relationship between physical activity, weight, and sociodemographic factors and 2) identify characteristics associated with sufficient physical activity in college females. Methods Data were from the 2010 American College Health Association National College Health Assessment survey. Descriptive statistics and chi-square tests were used to describe LBQ college women by age cohort (≤23 years, typical age vs. ≥24 years, mature age) and physical activity level (sufficiently active vs. insufficiently active). Odds ratio and 95% confidence intervals from logistic regression were used to estimate the likelihood of meeting the physical activity guidelines. Findings Only one out of three LBQ college women report meeting the national physical activity guidelines. Characteristics of typical age and mature age LBQ college women varied by physical activity level. In a logistic regression model of LBQ college women, two characteristics increased the likelihood of being sufficiently activity: Reporting very good/excellent health and self-describing as “about the right weight.” Three characteristics decreased the likelihood: Self-describing as “very overweight,” reporting action taken toward weight as “do nothing,” and current smoking. Conclusions With only one out of three LBQ college women meeting the national physical activity guidelines, interventions to increase physical activity, improve fitness, and potentially reduce unhealthy weight gain must start early to prevent the morbidity and mortality associated with inactivity.

We examined the association of nitrate-nitrogen exposure from rural private drinking water and incidence of age-related macular degeneration (AMD). Participants of the Beaver Dam Eye Study living in rural areas within the 53916 zone improvement plan code but outside the city limits of Beaver Dam, Wisconsin (Beaver Dam Township) completed a questionnaire and ocular examination including standardized, graded fundus photographs at five examinations. Data from an environmental monitoring study with probabilistic-based agro-chemical sampling, including nitrate-nitrogen, of rural private drinking water were available. Incidence of early AMD was associated with elevated nitrate-nitrogen levels in rural private drinking water supply (10.0% for low, 19.2% for medium, and 26.1% for high nitrate-nitrogen level in the right eye). The odds ratios (ORs) were 1.77 (95% confidence interval [CI]: 1.12–2.78) for medium and 2.88 (95% CI: 1.59–5.23) for high nitrate-nitrogen level. Incidence of late AMD was increased for those with medium or high levels of nitrate-nitrogen compared to low levels (2.3% for low and 5.1% for the medium or high nitrate-nitrogen level, for the right eye). The OR for medium or high nitrate-nitrogen groups was 2.80 (95% CI: 1.07–7.31) compared to the low nitrate-nitrogen group.