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The Supreme Court decision to overturn Roe v. Wade and the growing onslaught of state laws that criminalize abortion are part of a long history of maintaining White supremacy through reproductive control of Black and socially marginalized lives. As public health continues to recognize structural racism as a public health crisis and advances its measurement, it is imperative to explicate the connection between abortion criminalization and White supremacy. In this essay, we highlight how antiabortion policies uphold White supremacy and offer concrete strategies for addressing abortion criminalization in structural racism measures and public health research and practice. (Am J Public Health. 2022;112(11):1662–1667. https://doi.org/10.2105/AJPH.2022.307014 )

Background Although surveillance systems used to mitigate disasters serve essential public health functions, communities of color have experienced disproportionate harms (eg, criminalization) as a result of historic and enhanced surveillance. Methods To address this, we developed and piloted a novel, equity-based scoring system to evaluate surveillance systems regarding their potential and actual risk of adverse effects on communities made vulnerable through increased exposure to policing, detention/incarceration, deportation, and disruption of access to social services or public resources. To develop the scoring system, we reviewed the literature and surveyed an expert panel on surveillance to identify specific harms (eg, increased policing) that occur through surveillance approaches. Results Scores were based on type of information collected (individual and/or neighborhood level) and evidence of sharing information with law enforcement. Scores were 0 (no risk of harm identified), 1 (potential for risk), 2 (evidence of risk), and U (data not publicly accessible). To pilot the scoring system, 44 surveillance systems were identified between June 2020 and October 2020 through an environmental scan of systems directly related to COVID-19 (n=21), behavioral and health-related services (n=11), and racism and racism-related factors (n=12). A score of 0-2 was assigned to 91% (n=40) of the systems; 9% were scored U; 30% (n=13) scored a 0. Half scored a 1 (n=22), indicating a “potential for the types of harm of concern in this analysis.” “Evidence of harm,” a score of 2, was found for 12% (n=5). Conclusions The potential for surveillance systems to compromise the health and well-being of racialized and/or vulnerable populations has been understudied. This project developed and piloted a scoring system to accomplish this equity-based imperative. The nobler pursuits of public health to improve the health for all must be reconciled with these potential harms.

Background: Racism persists, underscoring the need to rapidly document the perspec­tives and experiences of Black, Indigenous and People of Color (BIPOC) groups as well as marginalized populations (eg, formerly incarcerated people) during pandemics.Objective: This methods paper offers a model for using Public Health Critical Race Praxis (PHCRP) and related critical meth­odologies (ie, feminist and decolonizing methods) to inform the conceptualization, methods, and dissemination of qualitative research undertaken in response to the evolving COVID-19 pandemic.Sample: Using purposive snowball sam­pling, we identified organizations involved with health equity and social justice advo­cacy among BIPOC and socially marginal­ized populations. Focus group participants (N=63) included community members, organizers, activists, and health workers.Design: We conducted topic-specific (eg, reproductive justice) and population-specific (eg, Asian and Pacific Islander) focus groups (N=16 focus groups) in rapid succes­sion using Zoom software.Methods: A self-reflexive, iterative praxis guided theorization, data collection and analysis. We obtained community input on study design, the semi-structured discussion guide, ethical considerations and dissemi­nation. Applying PHCRP, we assessed our assumptions iteratively. We transcribed each interview verbatim, de-identified the data, then used two distinct qualitative tech­niques to code and analyze them: thematic analysis to identify unifying concepts that recur across focus groups and narrative analysis to keep each participant’s story intact.Results: The praxis facilitated relationship-building with partners and supported the iterative assessment of assumptions. Logisti­cal constraints included difficulty ensuring the confidentiality of virtual discussions.Conclusions: These novel approaches provide an effective model for community-engaged qualitative research during a pandemic. Ethn Dis. 2022;32(3):243-256; doi:10.18865/ed.32.3.243

Background The number of cancer patients with CIED receiving radiotherapy has increased dramatically with improving life expectancy in both patients with cardiovascular disease and cancer. The advent of proton therapy adds new concern for potential malfunction in CIED devices, both due to significant neutron scatter and its use of strong magnets to focus radiation beams. Therefore, we aimed to assess the incidence of CIED malfunction secondary to proton therapy in this patient cohort. Methods We retrospectively analyzed patients with CIED undergoing proton therapy at our institute between 2011–2021. Each device was programmed pre-treatment and monitored post-treatment according to a special protocol developed in our centre. Treatments were prescribed to doses up to 70 Gy (RBE) and delivered using either passive-scattering or pencil beam techniques. Distances between the CIED and treated volumes ranged from 10–50 cm. We analyzed baseline patient demographics, CIED demographics, CIED outcomes pre-proton therapy as well as post-proton therapy including device reset and requirement for replacement, analyzing up to most recent check. Results Fifty-one patients with CIED underwent proton therapy during the study period. Estimated neutron dose ranged from 0.05–2.0 mSv/GyRBE for this patient cohort. Baseline demographics outlines in table 1. Of note 26/51 patients underwent proton therapy for ophthalmic malignancies, 6/51 for brain/skull malignancies. CIED comprised of 39 pacemakers and 12 implantable cardioverter defibrillators. Fourteen patients were pacemaker-dependent. Using 95% Confidence Interval, ventricular threshold, impedance, and amplitude, as well as atrial threshold and amplitude were unchanged, whereas atrial impedance measurements had a change pre- and post-proton therapy (Table 2). No patients had a device reset. One patient had a premature battery depletion three months post-radiotherapy for pancreatic cancer. Conclusions Our findings suggest that proton therapy does not significantly impact CIED function. Whilst caution remains as further data is accrued, close monitoring, particularly with the advent of remote monitoring, of these patients should be recommended. Funding Acknowledgement Type of funding sources: None.

To examine the prevalence of young childrens’ reported experiences of racial discrimination and to assess whether discriminatory experiences vary by gender, religion and country of birth. Data came from Speak Out Against Racism (SOAR), a cross-sectional study of 4664 public school students in grades 5–9 in two Australian states in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), as a measure of discrimination, was used across four Indigenous and ethnic categories (Indigenous, Asian and non-Asian visible minorities, Anglo/European). Effect-measure modification (EMM) examined how experiences of racial discrimination across ethnic groups varied by gender, country of birth and religion. A sizeable proportion (40%) of students reported experiencing racial discrimination. Indigenous, Asian and non-Asian visible minority students reported higher rates of experiencing racial discrimination than their Anglo-European peers. Male students reported higher rates of experiencing racial discrimination than female students. Foreign-born students reported experiencing racial discrimination more often than native-born students, and both Christian and religious minorities experienced racial discrimination more often than students identifying with the dominant “No religion” group. The findings highlight the prevalence of racial discrimination among adolescents and how gender, country of birth and religion can increase risk of these experiences.

Racism is a key driver of the social, political, and economic injustices that cause and maintain health inequities. Over centuries and across continents, racism has become deeply ingrained within societies. Therefore, we believe that it is our professional and ethical obligation as scientists, and public health scholars specifically, to address racism head on in order to ameliorate racialized health disparities. We argue that greater focus is needed on addressing racism rather than race and how race is described or defined. We offer input from public health scholarship to help bioethicists and other scientists contribute to addressing racism. To do so effectively and comprehensively, public health scholars, bioethicists, and other scientists should work together to identify and implement equity-driven collaborations to eliminate the deleterious effects of racism on individuals, families, and communities.

Objective To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship. Methods Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States. Results White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76). Conclusion Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens. Policy implications This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.

Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent’s measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included an interaction term in our model to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each group. Hopefulness was associated with lower allostatic load scores (b=−0.043, SE=0.007) but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites (b=−0.051, SE=0.008) and not associated with allostatic load among Hispanics (b=−0.013; SE=0.022) irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.

This paper explores the effects of a group-randomized controlled trial, Community Partners in Care (CPIC), on the development of interagency networks for collaborative depression care improvement between a community engagement and planning (CEP) intervention and a resources for services (RS) intervention that provided the same content solely via technical assistance to individual programs. Both interventions consisted of a diverse set of service agencies, including health, mental health, substance abuse treatment, social services, and community-trusted organizations such as churches and parks and recreation centers. Participants in the community councils for the CEP intervention reflected a range of agency leaders, staff, and other stakeholders. Network analysis of partnerships among agencies in the CEP versus RS condition, and qualitative analysis of perspectives on interagency network changes from multiple sources, suggested that agencies in the CEP intervention exhibited greater growth in partnership capacity among themselves than did RS agencies. CEP participants also viewed the coalition development intervention both as promoting collaboration in depression services and as a meaningful community capacity building activity. These descriptive results help to identify plausible mechanisms of action for the CPIC interventions and can be used to guide development of future community engagement interventions and evaluations in under-resourced communities.

Introduction: Equity-oriented efforts to mitigate and prevent COVID-related disparities are hindered due to methodological limitations of the categorization of racial and ethnic groups, including Arabs and Middle Eastern and North African (MENA) communities, which remain invisible in national data collection efforts. This study highlights the disparities in COVID-related outcomes in Toronto, Canada and supports ongoing calls to collect public health data among MENA communities in the United States. Methods: Data on racial/ethnic identity and hospitalizations were collected by the Toronto Public Health (TPH) of the Ontario Ministry of Public Health Case between May 20, 2020, and September 30, 2021 from people with a confirmed or probable case of COVID-19. Results: The reported COVID-19 infection rate for Arab, Middle Eastern, West Asians (i.e., categories used to self-identify as MENA in Canada) relative to Whites in Toronto was 3.51. The age-standardized hospitalization rate ratio between Arab, Middle Eastern, West Asians and Whites was 4.59. Discussion: Data from Toronto highlight that Arab, Middle Eastern, and West Asians have higher rates of COVID-19 infections and hospitalizations than their White counterparts. Comparable studies are currently not possible in the United States due to lack of data that can disaggregate MENA individuals. This study underscores the critical need to collect data among MENA communities in the United States to advance our field’s goal of promoting and advancing equity.

The performance of a Structural Health Monitoring (SHM) system can be assessed using Probability of Detection (PoD) curves, which is a common tool for the evaluation of Non-Destructive Testing (NDT) methods. This study presents a novel digital clone platform to quantify and account for uncertainties that can be detrimental to the reliability of a SHM system. Uncertainties relating to experimental measurement noise and Environmental and Operational Conditions (EOC) are considered during the definition of a threshold value that aims at reliably distinguishing between pristine and damaged signals. At the same time, the variability of impact damage characteristics and uncertainties associated with Lamb waves interaction in composites are captured though the Bayesian calibration of a Finite Element (FE) model using experimental observations. The FE model is integrated within the digital clone testing platform to substitute the experimental testing and generate a statistical sample of distributed impact events at different locations on a composite plate and compute the Model Assisted Probability of Detection (MAPOD). This approach allows the estimation of the system’s performance under different EOC that can be used during the selection and operation of a specific SHM configuration.

Highlights • The killed oral ETEC vaccine ETVAX ± dmLT adjuvant was safe in Bangladeshi adults. • All vaccinees responded to all 5 primary vaccine antigens in ALS specimens. • A majority of vaccinees responded to ≥4 antigens in plasma specimens. • A sensitive electrochemiluminescence assay was established for small sample volumes. • ALS responses measured by electrochemiluminescence and ELISA assays correlated well., The safety and immunogenicity of the second generation oral enterotoxigenic Escherichia coli (ETEC) vaccine ETVAX, consisting of inactivated recombinant E. coli strains over-expressing the colonization factors (CFs) CFA/I, CS3, CS5 and CS6 and the heat labile toxoid LCTBA, were evaluated in Bangladeshi volunteers. To enable analysis of antibody responses against multiple vaccine antigens for subsequent use in small sample volumes from children, a sensitive electrochemiluminescence (ECL) assay for analysis of intestine-derived antibody-secreting cell responses using the antibodies in lymphocyte secretions (ALS) assay was established using Meso Scale Discovery technology. Three groups of Bangladeshi adults (n = 15 per group) received two oral doses of ETVAX with or without double mutant LT (dmLT) adjuvant or placebo in the initial part of a randomized, double-blind, placebo-controlled, age-descending, dose-escalation trial. CF- and LTB-specific ALS and plasma IgA responses were analyzed by ECL and/or ELISA. ETVAX was safe and well tolerated in the adults. Magnitudes of IgA ALS responses determined by ECL and ELISA correlated well (r = 0.85 to 0.98 for the five primary antigens, P

To assess how the Affordable Care Act (ACA) impacted changes in access and utilization of health care between groups by examining differences across groups of immigrants and by citizenship status. Data came from respondents of the 2011-2016 National Health Interview Survey aged 18 to 64 who were born outside of the U.S. or were native-born non-Latino whites (N = 119,198). Outcome measures included (all in the past 12 months): being currently uninsured, being insured via Medicaid, visiting the emergency department, visiting a doctor at least once, delaying care due to costs, not getting needed care because respondent was unable to afford it and being told by doctor office that they would not accept you as a new patient. The ACA was associated with greater healthcare access and utilization for some groups, but heterogeneously across all groups. For example, some immigrant groups had better access and utilization than others, and similar variation was revealed across citizenship groups. This study underscores the importance of disentangling how policies can affect immigrants from different regions of the world, which has implications for healthcare utilization and disparities.

In this paper, an energy-efficient cyber-physical system using piezoelectric transducers (PZTs) and wireless sensor networks (WSN) is proposed, designed and experimentally validated for on-board aircraft structural health monitoring (SHM). A WSN is exploited to coordinate damage detection using PZTs distributed on the whole aircraft. An active sensing methodology is adopted for PZTs to evaluate the structural integrity in a pitch-catch manner. The system configuration and operation principle are discussed in the first place. Then, the detailed hardware design was introduced. The proposed system is not only characterized as low-power, high-compactness and wireless, but also capable of processing actuating-sensing signals at megahertz, generating actuating signals with great flexibility, handling multiple actuating-sensing channels with marginal crosstalk. The design was implemented on a 4-layer printed circuit board (8 × 6.5 cm) and evaluated on a large-scale composite fuselage. A 5 MHz sampling rate for actuating and 1.8 MHz for sensing (8 channels) were realized, and the accuracy was validated by comparing the results with those from an oscilloscope. The crosstalk issue caused by actuation on sensing channels is properly addressed using a 2-stage attenuation method. An ultra-low current (81.7 μA) was measured when no detection was required; the average current was 0.45 mA with a detection rate of twice per hour, which means the system can continuously work for up to 12.6 months for 2 AA batteries. Eventually, an example of damage detection is provided, showing the capability of such a system in SHM.

Background Religious-based hate crimes are on the rise worldwide. However, the relationship of religious discrimination on health and well-being, especially earlier on the lifecourse, is largely understudied. This study examines the prevalence of religious discrimination and the relationship it has on social-emotional adjustment and sleep outcomes among a diverse sample of students in Australia. Methods Data came from Speak Out Against Racism, a population-representative cross-sectional study of 4664 public school students in grades 5–9 in Australia in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), was used to derive four measures of religious discrimination (peer, school, societal and the sum of those as a “total” score). The Strengths and Difficulties Questionnaire measured the total difficulties, conduct, emotional, and prosocial behavior subscales. Measures of sleep outcomes included duration, latency, and disruption. Results 27 % (95 % CI 22.82, 31.12) of students reported experiences of direct total religious discrimination with higher levels being reported by students identifying as a religious minority. There was strong evidence that experiences of religious discrimination (across all four sources) was related to all measures of socioemotional adjustment and sleep outcomes. Discussion Religious discrimination is an understudied form of social disadvantage that has implications for adolescents’ development, health and well-being. Conclusion: More programs, particularly in the school-context, address religious-based discrimination may reduce inequities in health., Highlights • There is a noted gap in population health research examining how religion operates as a structural determinant of health. • The relationship between discrimination and indicators of health and wellbeing have been understudied among young children. • Religious discrimination is associated with poor indicators of social-emotional adjustment across all four measures. • Religious discrimination is associated with adverse sleep outcomes (duration and latency) among young school-aged children.

Family and domestic violence (FDV) is a major public health and social issue that is associated with a range of physical, mental and behavioural health outcomes. Religion and faith are powerful and influential in shaping the lives of many individuals and societies, in addition to the social practices, norms and structures that are significant in understanding and responding to FDV. This qualitative study aims to deepen understanding of the influence of religious beliefs and values on attitudes and beliefs of FDV among culturally diverse faith communities in Australia. Interviews and focus groups were conducted with 64 participants from a diverse range of cultural and religious backgrounds which included faith leaders, community members and FDV sector workers. Six main themes were identified describing attitudes, beliefs and knowledge about FDV: 1) Faith and religion do not condone violence; 2) Awareness of FDV is increasing, yet remains often poorly understood; 3) FDV is still a taboo topic; 4) Denial and defensiveness about FDV persist; 5) Patience, endurance and forgiveness is often prioritised over safety; 6) Gender roles and norms founded on religious beliefs and interpretations underpin many FDV understandings and responses. These findings demonstrate the tensions between expressions of faith and attitudes to women and FDV. Further exploration of these issues within specific faith communities, as well as how to support and engage with these communities in increasing understandings of FDV and developing effective responses, is needed in the Australian context.

Accurate numerical tools for the simulation of wave propagation are essential for the development and optimization of guided wave based Structural Health Monitoring systems. This article aims in delivering a systematic comparison of the Finite Element simulation of Lamb wave propagation using different types of elements. The numerical simulations are all realized within the environment of the commercial software Abaqus. In total three different element types are considered: conventional shell, continuum shell and 3D solid elements. To evaluate the performance of each element type, the numerically simulated signals are compared with experimental measurements from two panels. The first panel is made of Aluminium while the second is a layered composite panel. When continuum or 3D solid elements are used, the numerical predictions are closely correlated to the experimental observations. Accurate predictions were also made using conventional shell elements to model wave propagation in the first panel however, the group velocity for the first symmetric wave mode is over-estimated for the second panel when the excitation frequency is fc = 250kHz.

Introduction The latest ESC guidelines on Infective Endocarditis (IE) included the use of PET-CT as an additional diagnostic criterion, particularly for prosthetic valve endocarditis, and several studies showed enhanced sensitivity for the modified Duke criteria. This audit was designed to assess if there was incremental clinical benefit of PET CT imaging in patients suspected of having IE. Methods A two year retrospective audit was performed on consecutive patients diagnosed with IE, or had a PET-CT for investigation for IE in a large teaching hospital. The modified Duke criteria were used to establish a likelihood of IE and final diagnosis of IE was made based on all clinical information on discharge. The PET-CT scans were classified as having uptake at the site of interest, showed metastatic spread from endocarditis or were negative for either. Results The audit identified 58 patients with a diagnosis IE or who had a PET-CT for investigation of IE. The mean patient age was 66 years and the in-hospital mortality was 14%. In all of these cases apart from 1 the final diagnosis was infective endocarditis, either clinically or pathologically (after valve replacement). Of these 11 patients (19%) had a PET-CT as part of their work up during their inpatient stay. Table 1 provides baseline demographics and clinical details of our cohort. For the patients that had a PET CT the mean age was younger at 55 years compared to 68 years (p value 0.003). As expected, the percentage of patients with prosthetic valves was also higher in the PET CT group at 55% versus 13% (P value 0.006). Otherwise there was no significant differences between the two groups. Table 2 outlines the results of the 11 patients who had a PET CT scan as part of their diagnostic work up with 7 patients (64%) having a prosthetic valve (all AVR). All patients had a TOE and this showed a vegetation in 6 patients (50%), with 4 patients also having an abscess. In 5 cases the scans showed increased FDG activity; 2 scans with peri-aortic valve uptake, 2 scans showing increased aortic mural uptake of unknown significance and one scan showing an embolic phenomenon. In 6 cases there was no increased FDG uptake in the mediastinum/emboli. However, in 5 of these cases the final diagnosis was IE, including 3 who had surgical valve replacement and a pathological diagnosis. There was one case that was a true negative result, resulting in the cessation of antibiotic treatment. Overall, there were 3 true positive results, 1 true negative and 7 false negative results. Conclusion In this study almost 20% of the cohort underwent PET CT scanning, often in the most clinically challenging and complex cases where the diagnosis is uncertain and guiding surgical referral. Of these only three results were positive for peri-valvular uptake or embolic spread. Two patients had increased uptake in the ascending aorta which was of unknown significance, but was not counted as a positive scan result. The results in our cohort were not as helpful as reported in other international series. Despite the fact that our numbers were small and used in highly selected cases, they suggest caution in the use of PET-CT in IE. This is particularly pertinent for negative scan results, as 3 of our patients with no cardiac uptake on PET-CT had IE diagnosed pathologically. This highlights the importance of including all the clinical and imaging information in the decision-making algorithm for IE.

Aims To review the ICD implantation rate in our institution, as well as to assess overall survival following ICD implantation, and to review the rate of early mortality ( Methods Using the HeartRhythmIreland.com database, where all new ICD implants have been registered since 2005, we obtained information on demographics, implantation date, last registered visit, and notification of death. Date of death was confirmed with our own institution’s electronic patient manager. Survival probability was calculated using the Kaplan-Meier method, using the most recent attended ICD check, or the date of death. Survival was defined as freedom from death at most recent check. (Figure 1). Results 415 ICDs were implanted in our institution between 2005 and 2018. The mean (mean (± SD)) age was 58.9 years (± 14.00) and 333 (80.2%) of the patients were male. These include 80 CRT-Ds, 121 Dual chamber ICDs, 206 Single Chamber ICDs, and 7 Subcutaneous-ICDs (SICD). (Figure 2). In the case of upgrades, only the most recent device was included. 3 ICDs were explanted without replacement, 2 due to infection, and 1 due to heart transplant. 95 patients (22.9%) with local follow up died (in whom a date of death is available in 87 patients). 4 (1.0%) patients were lost to follow up. 6 (1.4%) patients emigrated, and 21 (5.1%) patients moved hospital within the state. Among the patients not known to have died or moved centre, the mean duration since the most recent ICD check was 4.8 months. Of the patients who died, the mean time between device insertion and death was 51.6 months ± 30.2, and 6 (1.4%) patients died within a year of ICD insertion. Survival probability at 1, 3 and 5 years was 97.9%, 88.7% and 79.6% respectively. Discussion This study shows the increasing burden, and complexity, of devices being implanted within our centre. Despite our study not differentiating between primary and secondary prevention, our study shows reassuring survival probability at 5 years when compared with SCD HEF (71.1%) and at 3 years when compared with MADIT (78%).

To examine the prevalence of young childrens' reported experiences of racial discrimination and to assess whether discriminatory experiences vary by gender, religion and country of birth.Data came from Speak Out Against Racism (SOAR), a cross-sectional study of 4664 public school students in grades 5-9 in two Australian states in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), as a measure of discrimination, was used across four Indigenous and ethnic categories (Indigenous, Asian and non-Asian visible minorities, Anglo/European). Effect-measure modification (EMM) examined how experiences of racial discrimination across ethnic groups varied by gender, country of birth and religion.A sizeable proportion (40%) of students reported experiencing racial discrimination. Indigenous, Asian and non-Asian visible minority students reported higher rates of experiencing racial discrimination than their Anglo-European peers. Male students reported higher rates of experiencing racial discrimination than female students. Foreign-born students reported experiencing racial discrimination more often than native-born students, and both Christian and religious minorities experienced racial discrimination more often than students identifying with the dominant "No religion" group.The findings highlight the prevalence of racial discrimination among adolescents and how gender, country of birth and religion can increase risk of these experiences.

OnBehalf Cardiac Risk in the Young (CRY) Ireland Background Cardiac conduction disease (CCD) is a potentially fatal entity. The spectrum ranges from benign clinical course to potentially precipitating sudden cardiac death. Permanent pacemaker (PPM) may benefit affected individuals but the genetic basis of CCD may be underestimated. No prior study has investigated the utility of screening relatives of victims of Sudden Arrhythmic Death Syndrome (SADS) with implantable loop recorders (ILR). Methods We describe 7 families referred to our inherited cardiac conditions service with a family history of SADS, in whom we identified premature CCD. ILR was utilized in screening the majority of families. Results Of 63 individuals screened, 31 (49%) had ILR insertion with 7 (11%) requiring PPM implant. 2/31 had normal baseline tests, and were identified post ILR implant. Other CCD not yet meeting clinical significance was detected in 10/31 (32%) individuals. These findings (documented 11 to 330 days post implant) included pauses of 3-5.8 seconds (n = 7), nocturnal bradycardia Conclusions Inherited premature CCD with variable penetrance may be an under-recognized cause of SADS. To date 12/31 (39%) of individuals with ILR have findings suggesting inherited CCD. As inheritance pattern suggests autosomal dominant transmission, longer follow up may identify more affected individuals. Clinicians involved in SADS family evaluations should consider adding ILR implantation to routine assessment to improve diagnostic yield. We suggest a larger prospective study of consecutive families whose initial investigations following a SADS death have not identified a cause. Summary of Findings Screening Abnormality Family 1 Family 2 Family 3 Family 4 Family 5 Family 6 Family 7 Bradycardia Yes Yes Yes Yes Yes Yes Yes PR >200 Yes No No No No No No 3s Holter/Telemetry Yes No Yes No Yes No Yes High grade AV block Holter Yes Yes No No No No No ILR: significant to date Yes Yes No No No No - ILR: findings to monitor Yes No Yes Yes No Yes - Provocation Testing No Negative No No No No No Genetics Negative Negative Awaited Awaited Awaited Awaited Negative PTHR predicted target heart rate, EST: exercise stress test

Objective To evaluate associations between spousal caregiving and mental and physical health among older adults in Mexico. Methods Data come from the Mexican Health & Aging Study, a national population-based study of adults ≥50 years and their spouses (2001-2015). We compared outcomes for spousal caregivers to outcomes for those whose spouses had difficulty with at least one basic or instrumental activity of daily living (I/ADL) but were not providing care; the control group conventionally includes all married respondents regardless of spouse's need for care. We used targeted maximum likelihood estimation to evaluate the associations with past-week depressive symptoms, lower-body functional limitations, and chronic health conditions. Results At baseline, 846 women and 629 men had a spouse with ≥1 I/ADL. Of these, 60.9% of women and 52.6% of men were spousal caregivers. Spousal caregiving was associated with more past-week depressive symptoms for men (Marginal Risk Difference (RD): 0.27, 95% confidence internal [CI]: 0.03, 0.51) and women (RD: 0.15, 95% CI: 0.07, 0.23). We could not draw conclusions about associations with lower-body functional limitations and chronic health conditions. On average, all respondents whose spouses had caregiving needs had poorer health than the overall sample. Conclusion We found evidence of an association between spousal caregiving and mental health among older Mexican adults with spouses who had need for care. However, our findings suggest that older adults who are both currently providing or at risk of providing spousal care may need targeted programs and policies to support health and long-term care needs.

Racism is a key driver of the social, political, and economic injustices that cause and maintain health inequities. Over centuries and across continents, racism has become deeply ingrained within societies. Therefore, we believe that it is our professional and ethical obligation as scientists, and public health scholars specifically, to address racism head on in order to ameliorate racialized health disparities. We argue that greater focus is needed on addressing racism rather than race and how race is described or defined. We offer input from public health scholarship to help bioethicists and other scientists contribute to addressing racism. To do so effectively and comprehensively, public health scholars, bioethicists, and other scientists should work together to identify and implement equity-driven collaborations to eliminate the deleterious effects of racism on individuals, families, and communities.

The design and development of robust and reliable guided wave Structural Health Monitoring systems require accurate information of the structure’s material properties. This is needed by various analysis tools for the determination of wave propagation characteristics in order to evaluate and optimize the system’s performance. Estimation of the mechanical properties of composite materials using Lamb wave measurements is not straightforward as it requires the solution of an inverse problem. In this study, a numerical procedure is presented for the material properties estimation. The aim is to obtain estimates of the unknown material properties using circular surface mounted piezoelectric transducers that can be used for material characterization or calibration of numerical models. The procedure utilizes the Semi-analytical finite element method for the efficient computation of the dispersion curves and a genetic algorithm for the extraction of the material properties that fit best the experimental observations.

Edible bird's nests (EBNs) are the nests of swiftlets, made from the saliva of the male swiftlet (Aerodramus fuciphagus). Due to their nutritional value, EBNs are recognized as a premium food and highly in demand among the Chinese community. EBNs are commonly adulterated with cheaper ingredients and efforts are being made to combat these activities using different analytical techniques. In this study, nuclear magnetic resonance (1H-NMR) metabolomic fingerprinting combined with chemometrics, particularly principal component analysis (PCA) and orthogonal partial least square-discriminant analysis (OPLS-DA), was employed to detect adulteration in EBNs. Authentic EBN samples from different locations in Malaysia were used and adulteration was simulated using nutrient agar, collagen, gelatine, karaya gum and melamine at 1, 5 and 10% w/w, respectively. Overall, unsupervised PCA was able to distinguish authentic EBNs from those adulterated with nutrient agar, collagen and gelatine down to 5% w/w adulteration level. As for EBN adulterated with karaya gum and melamine, a distinct peak can be observed at 1.91 ppm and 6.10 ppm, respectively. The supervised OPLS-DA predictive model was able to differentiate authentic EBNs from simulated adulterated EBNs with 100% accuracy. Conclusively, 1H-NMR metabolomics combined with chemometrics could be a potential tool for the detection of adulteration in EBN.

Objective: Depressed individuals may require help from different agencies to ad­dress health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, ex­plore whether service providers understand client priorities, and describe how providers address them. Methods: Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depres­sion quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients’ needs and explained how they addressed them. Results: Physical and mental health were clients’ top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program repre­sentatives identified housing, employment, mental health, and improving relationships with others as clients’ top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strate­gies used to address client needs. Conclusion: Depressed clients have mul­tiple health and social needs, and program representatives in under-resourced commu­nities understand the complexity of clients’ needs. Agencies rely on needs assessment and referrals to meet their clients’ needs, which enhances the importance of agency partnership in “whole person” initiatives. Our results illustrate agency capacity to adopt integrated care models that will ad­dress clients’ multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care. Ethn Dis. 2018;(Suppl 2): 371- 380; doi:10.18865/ed.28.S2.371.

Background. In 2017, a “Muslim ban” on immigrants to the United States was coupled with a continued rise in Islamophobia and hate crimes toward Muslims. Islamophobia undermines health equity, yet delineating the effects of Islamophobia globally is challenging as it affects a myriad of groups (geographically, racially, and socially). Additionally, stereotypes equate all Muslims with populations from the Middle East and South Asia. To date, health research pays insufficient attention to Islamophobia, Muslims, and those racialized to be Muslim. Objectives. This literature review advances our understanding of racism and health by examining the racialization of religion, by specifically examining Islamophobia as a form of discrimination. Search Methods. Per PRISMA guidelines, we conducted a search in October 2017 using PubMed–MEDLINE and a combination of terms. We identified additional articles using other search engines. For inclusion, articles needed to include a descriptor of discrimination, contain an identifier of Muslim or Muslim-like identity (i.e., groups commonly perceived as Muslim, including Arabs, Middle Easterners, North Africans, and South Asians), include a health outcome, be in English, and be published between 1990 and 2017. Selection Criteria. We identified 111 unique peer-reviewed articles. We excluded articles that did not meet the following criteria: (1) examined Islamophobia, discrimination, or racism among a Muslim or Muslim-like population; (2) included a health outcome or discussion of health disparities; and (3) was conducted in North America, Europe, Australia, or New Zealand. This yielded 53 articles. Results. The majority of studies (n = 34; 64%) were quantitative. The remaining studies were qualitative (n = 7; 13%), mixed methods (n = 2; 4%), or reviews (n = 10; 19%). Most studies were based in the United States (n = 31; 58%). Nearly half of the reviewed studies examined mental health (n = 24; 45%), and one fourth examined physical health or health behaviors (n = 13; 25%). Others focused on both physical and mental health (n = 10; 19%) or health care seeking (n = 7; 13%). Studies showed associations between Islamophobia and poor mental health, suboptimal health behaviors, and unfavorable health care–seeking behaviors. Conclusions. This study elucidates the associations between Islamophobia, health, and socioecological determinants of health. Future studies should examine the intersectional nature of Islamophobia and include validated measures, representative samples, subgroup analyses, and comparison groups. More methodologically rigorous studies of Islamophobia and health are needed. Public Health Implications. Addressing the discrimination-related poor health that Muslims and racialized Muslim-like subgroups experience is central to the goals of health equity and assurance of the fundamental right to health.

Objectives We assessed the odds of having a family dinner by parental gender, family structure and parental employment. Methods This study used data from the American Time Use Survey (ATUS) (2006–2008). Multivariate analyses assessed the odds of two outcomes among parents: 1) eating at all with children and 2) having a family dinner. Results Single men had lower odds of eating at all with children and eating a family dinner in comparison to partnered/married males. Partnered/married women had increased odds of eating at all with children and eating a family dinner compared to their partnered/married male counterparts. While single women had increased odds of eating at all with children compared to partnered/married males, no difference was detected in the odds of having a family dinner. Among dual-headed households, women had lower odds of eating a family dinner when both parents were employed compared a dual-headed household with employed male/non-employed female. There were no differences among men regardless of their employment status or that of their partner/spouse. Conclusions Family structure, parental gender and employment status all influence the odds of having a family dinner. Future research on family meals should consider all of these factors to better understand trends and disparities across household compositions.

ObjectiveTo determine if the association between soda consumption and obesity is uniform among Asian-American population subgroups.DesignWe conducted multivariate logistic regression analyses on odds of being obese among seven Asian subgroups and by place of birth using data from the 2009 California Health Interview Survey.SettingAn omnibus population-based health survey.SubjectsNon-institutionalized adults, aged 18 years or over, residing in California (n 36 271).ResultsDespite low levels of soda consumption in several Asian-American ethnic groups, soda consumption increased the odds of being obese among Chinese, Koreans and Other Asians but not for Whites. Obesity risk varied across Asian subgroups and by place of birth within these subgroups.ConclusionsMore public health efforts addressing soda consumption in Asian-American communities are needed as a strategy for not only preventing chronic diseases but also disparities, considering the varying levels of soda intake across subgroups. Results support the growing body of literature critiquing acculturation theory in immigrant health research by documenting inconsistent findings by place of birth. Future research should take into account the heterogeneity among Asian Americans to advance our understanding of health outcomes and disparities.

Background Recent large-scale studies have observed a gradual decline in the prevalence of abnormal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) studies. The declining frequency and severity of myocardial ischaemia may reflect a broader temporal change toward milder presentations of coronary artery disease (CAD). Our aim was to assess the frequency of test abnormality and inducible myocardial ischaemia over the past five years at our Tertiary Academic Centre. Methods Consecutive patients undergoing stress-rest MPI between 2012 and 2017 were identified in a retrospective observational analysis. We included both internal and external referrals for scans performed at Cork University Hospital. Patients were assessed for change in demographics, clinical symptoms, risk factors and frequency of abnormal and ischaemic SPECT-MPI. Results Annual utilisation of stress-rest MPI at our tertiary care centre increased by 26.7% from 101 studies in 2012 to 128 in 2017. There was a progressive decline in the prevalence of abnormal stress-rest MPI studies from 34.7% in 2012 to 26.9% in 2017 although this did not reach statistical significance (p=0.391). Similarly, the prevalence of ischaemic stress-rest MPI declined, from 22.8% to 18.0% (p=0.408) with a non-significant increase in severe ischaemic detection (3.0% vs. 5.5%, p=0.519). Conversely, there was a progressive increase in the prevalence of hypertension (43.6% vs. 79.7%, p Conclusion Over the past five years, the frequency and severity of abnormal stress-rest MPI studies has progressively declined. Notably, the frequency of abnormal stress-rest MPI is now very low among patients without typical angina and known cardiac risk factors. These findings suggest the need for developing alternative strategies for evaluating patients who present with a low risk of manifesting inducible myocardial ischaemia during cardiac imaging procedures.

Background Optimal Reperfusion in STEMI is the key goal of the National ACS Programme. The aims of the programme are a diagnosis to door time [DDT] Methods Consecutive patients from January 2016 to December 2017 diagnosed as STEMI or transferred to CUH as part of the National ACS Programme were identified. Patients initially referred to CUH from University Hospital Kerry and appropriately advised to refer to Limerick were excluded. Results 451 patients met CODE STEMI acceptance criteria at CUH within the study period of which 79% were male, with an average age of 63 year. 104 patients were transfers from other hospitals within the PPCI catchment area. 34/451 (7.5%) patients were thrombolysed, 5/34 of which underwent rescue PCI (table 1). The mean time between diagnostic ECG and thrombolysis was 105.4 minutes. 1/34 cases thrombolytic therapy was administered within 10 minutes of STEMI diagnosis. 32/34 survived to discharge [Both deaths had delay until thrombolysis], 30-day and 1-year mortality were both 5.9%. Mean Left ventricular ejection fraction (LVEF) where measured was 42±10%. 7/34 had ventricular arrhythmia (2 in the context of resuscitated out of hospital cardiac arrest pre diagnosis), 0/34 had mechanical complications. 55/451 (12.2%) Patients had DDT > 90 minutes [average 118±62 minutes] and were not thrombolysed; 17/53 were transfers from other hospitals. 52/55 survived to discharge. Of those who underwent PPCI 30-day and 1 year mortality was 6 and 10% respectively. Mean LVEF was 41.6±9%. 8/55 had ventricular arrhythmia. 2/55 were in cardiogenic shock, 2/55 suffered mechanical complications of their ACS. Compared to those were accepted for PPCI with DDT Conclusion Compared to patients who underwent PPCI with a DDT 90 minutes had a trend to inferior outcomes at one year (p=0.23). Delay until thrombolysis was common in our group undergoing thrombolysis. Where diagnosis to door is over 90 minutes thrombolysis should be administered if no contraindications in a time critical fasion. PPCI remains the method of reperfusion in >80% STEMIs referred to CUH.

Background Cardiac conduction disease (CCD) is a potentially fatal entity. The spectrum ranges from a benign clinical course to severe dysfunction, which may precipitate sudden cardiac death. Permanent pacemaker (PPM) implant may benefit affected individuals but the genetic basis of CCD may be underestimated. No prior study has investigated the utility of screening relatives of victims of Sudden Arrhythmic Death Syndrome (SADS) with implantable loop recorders (ILR). Methods We describe 7 families referred to our inherited cardiac conditions service with a family history of SADS, in whom we identified premature CCD. ILR was utilized in screening the majority of families. Results Of 63 individuals screened, 31 (49%) had ILR insertion with 7 (11%) requiring PPM implant. 2/31 had normal baseline tests, and were identified only after ILR implant. Other CCD not yet meeting clinical significance was detected in 10/31 (32%) individuals. These findings (documented 11 to 330 days post implant) included pauses of 3–5.8 seconds (n=7), nocturnal bradycardia Conclusions Inherited premature CCD with variable penetrance and dynamic clinical manifestation may be an under-recognized cause of SADS. To date 12/31 (39%) of individuals with ILR have findings suggesting inherited CCD. As inheritance pattern suggests autosomal dominant transmission, longer follow up may identify more affected individuals. Clinicians involved in SADS family evaluations should consider adding ILR implantation to routine assessment to improve diagnostic yield. We suggest a larger prospective study of consecutive families whose initial investigations following a SADS death have not identified a cause.

Introduction Inherited Cardiac Conditions (ICCs) have previously been shown to account for the majority of sudden cardiac deaths in the young in Ireland. It is recommended that those affected by ICCs are referred to specialised clinics that incorporate cardiology and clinical genetics. Emulating international models, two such ICCs clinics were established in Ireland approximately ten years ago. Together they accept referrals from all regions of the country. A review of these clinics will therefore provide an estimate of the number of families affected by ICCs in Ireland. This study will also elucidate the proportion of genetic testing and the spectrum of pathogenic mutations. Methods The Family Heart Screening Clinic (FHSC) at the Mater University Hospital and the Cardiac Risk in the Young (CRY) unit at Tallaght University Hospital, are the only adult ICCs clinics in Ireland. These collaborate with National Centre of Medical Genetics and Health-in-code based in A Coruna, Spain. This study reviewed all families that attended since the clinics’ foundation in 2007 until November 2017. ICCs diagnostic criteria and Sudden Adult Death Syndrome (SADS) family screening protocols as published previously. Results A total of 10,118 patients, comprising 4,319 families, of which 2,170 (50.2%) met criteria for an ICC or SADS. An overview of the family diagnoses is provided by figure 1. Genetic testing was performed in 39% of families. A breakdown of genetic testing for cardiomyopathies and channelopathies is included in tables 1 and 2. SADS family screening was positive in 21%, results as per figure 2. Molecular autopsy was performed in only 4% (18/406 ), with a pathogenic mutation identified in 5 cases (2 RYR2, 1 SNC5A, 2 ANK-2). Conclusions This ten year review provides an estimate of the prevalence and spectrum of ICCs in Ireland. Expansion of the project to include other cardiology clinics which manage such conditions would further improve accuracy. Greater utilization of genetic testing, particularly molecular autopsy is required. The yield of genetic testing for LQTS and HCM is significantly lower than widely purported figures. A higher preponderance of MYBPC3 for HCM and LMNA for DCM was observed in this Irish cohort. Rare aetiologies of note include LAMP2 and PRKAG2. SADS family screening was positive in 21%.

Energy harvesting for low-power sensing has drawn great attention, but still faces challenges in harnessing broadband random motions. Inspired by the parasitic relationship in plants, a host-parasite vibration harvester is designed to scavenge random low-frequency vibrations by incorporating bi-stability and frequency up-conversion within such a design. A hosting beam is formed in a buckled condition by clamping it at both ends and applying an axial compression load. Two parasitic piezoelectric beams are fixed at the center of the hosting beam and plucked at the free ends by two plectra on the hosting beam, while it oscillates in an inter-well mode. The low-frequency hosting beam oscillation is converted to high-frequency parasitic beam's vibration at resonance due to the plucking effect, allowing the harvester to convert the broadband low-frequency motion into electricity effectively. The electromechanical dynamics are modeled and the design is validated experimentally. The harvester is capable of harnessing low-frequency random vibration (0.0018 g2/Hz @ 5–400 Hz) over a wide bandwidth. More than 1 mJ energy was collected over 100 s under this pseudorandom vibration. Energy harvesting has been recognized as one of the key enablers for self-powered sensing applications in the era of Internet of things.1–4 However, enhancing the energy harvesting effectiveness requires significant efforts, especially for different energy sources under various conditions, such as low-frequency human motion,5,6 random aircraft vibrations7 or ocean waves.8 Harnessing a random, broadband and low-frequency kinetic energy is one of the key challenges, and different mechanisms have been developed to enhance the conversion performance. Nonlinear dynamics are one major consideration to enhance the operation bandwidth.9–11 Different harvesters have been developed with monostable,12–14 bistable15–17 and multistable behaviors.18–20 The aim is to alter harvesters' potential shape by applying preloads using magnetic forces21–23 or displacement constraints.24,25 A good example of a bistable harvester using displacement constraints is a device designed for harvesting energy from the passing traffic and pedestrians.26 A scissor-like structure was adopted to transfer the vertical passing weight to a horizontal axial force for buckling and excitation. In addition to nonlinearity, frequency up-conversion is another mechanism that is often employed in harvesting low-frequency motions, especially human motion.27–29 This mechanism uses a beam plucking effect to convert the low-frequency plucking motion into high-frequency transducers' vibration, in which the transducers normally operate at resonance after each plucking. Direct impact30 and magnetic plucking31 are typical methods to achieve the plucking motion and activate the transducers. In a recent work, Halim and Park developed an impact-driven harvester for harvesting the human-limb motion.32 A metal ball was designed to impact a flexible side-wall where a piezoelectric beam is fixed. The impact motion excited the beam, and the low-frequency limb motion was up-converted to a high-frequency beam vibration. The parasitic relationship is a well-known phenomenon in nature. Figure 1(a) provides a good example in plants, where a dodder is reliant on a host plant. In terms of motion and dynamics, the parasitic plant intertwines with the hosting plant and moves along with the host; however, due to the freedom of its own structure, the parasitic plant exhibits more complex dynamics even under simple hosting plant's motions, such as airflow-induced low-frequency vibration.

In this work, the development of a planar interdigital capacitive sensor, directly onto the surface of a composite, for determining the initial quality of curing of bonded composite joints and assessing their long-term durability is presented. The sensor consisted of an interlocking comb-shaped array of silver electrodes and used to monitor the progress of cure of an adhesive resin and the subsequent damage state of the bond line in adhesively-bonded composite joints using impedance spectroscopy . The obtained results from the mechanical characterization indicated that the developed sensor did not affect the quality of the bondline while the added weight of the sensor is negligible. The curing process of the adhesive epoxy was successfully monitored while the ability of the sensor to assess the developed damage created by the mechanical loading was confirmed using transient infrared thermography .

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.

Introduction The smoking behavior of adults can negatively impact children through exposure to environmental tobacco smoke and by modeling this unhealthy behavior. Little research has examined the role of the social environment in smoking behaviors of adults living with children. The present study specifically analyzed the relationship between social cohesion and smoking behaviors of adults living with children. Methods Data from the 2009 California Health Interview Survey, a random-digit dial cross-sectional survey of California Adults, were used. Adults living with children reported their levels of social cohesion and smoking behaviors (N = 13,978). Logistic regression models were used to predict odds of being a current smoker or living in a household in which smoking was allowed, from social cohesion. Results Overall, 13% of the sample was current smokers and 3.74% lived in households in which smoking was allowed. Logistic regression models showed that each one-unit increase in social cohesion is associated with reduced odds of being a current smoker (AOR = 0.92; 95% CI = 0.85–0.99) and reduced odds of living in a household in which smoking is allowed (AOR = 0.84; 95% CI = 0.75–0.93), after controlling for sociodemographic characteristics. Conclusions Among adults living with children, higher social cohesion is associated with a lower likelihood of both being and smoker and living in a home where smoking is allowed. Thus, future research is needed to better understand mechanisms that explain the relationship between social cohesion and smoking-related behavior in order to prevent smoking-related health consequences and smoking initiation among children and adults.