Adverse Adult Health Outcomes Research Articles

Exposure to air pollution is associated with DNA methylation changes in sperm.

Exposure to air pollutants has been associated with adverse health outcomes in adults and children who were prenatally exposed. In addition to reducing exposure to air pollutants, it is important to identify their biologic targets in order to mitigate the health consequences of exposure. One molecular change associated with prenatal exposure to air pollutants is DNA methylation (DNAm), which has been associated with changes in placenta and cord blood tissues at birth. However, little is known about how air pollution exposure impacts the sperm epigenome, which could provide important insights into the mechanism of transmission to offspring. In the present study, we explored whether exposure to particulate matter less than 2.5 microns in diameter, particulate matter less than 10 microns in diameter, nitrogen dioxide (NO2), or ozone (O3) was associated with DNAm in sperm contributed by participants in the Early Autism Risk Longitudinal Investigation prospective pregnancy cohort. Air pollution exposure measurements were calculated as the average exposure for each pollutant measured within 4 weeks prior to the date of sample collection. Using array-based genome-scale methylation analyses, we identified 80, 96, 35, and 67 differentially methylated regions (DMRs) significantly associated with particulate matter less than 2.5 microns in diameter, particulate matter less than 10 microns in diameter, NO2, and O3, respectively. While no DMRs were associated with exposure to all four pollutants, we found that genes overlapping exposure-related DMRs had a shared enrichment for gene ontology biological processes related to neurodevelopment. Together, these data provide compelling support for the hypothesis that paternal exposure to air pollution impacts DNAm in sperm, particularly in regions implicated in neurodevelopment.

EARLY-LIFE ORIGINS OF LATER-LIFE HEALTH AMONG OLDER BRAZILIANS: DIFFERENCES IN ASSOCIATIONS BY HEALTH CONDITION

Abstract Background A rich body of literature has linked poor childhood health to adverse adult health outcomes in later life. This association, however, has largely been studied in high-income countries. Less attention has been given to other country contexts where childhood exposures and adulthood socioeconomic conditions are vastly different. Brazil represents an important context due to the significant growth in older adult population, significant rise in life expectancy, and rapid industrialization that occurred since the 20th century. Method. Data come from the ELSI-Brazil Study, a nationally representative sample of older Brazilians. Logistic regression was used to predict the association between childhood conditions (socioeconomic adversity and poor health) and adult health conditions (heart conditions, heart failure, diabetes, and stroke). Results Poor child health was positively associated with stroke, heart disease, and heart failure, but was not associated with diabetes or high blood pressure. Poor child socioeconomic status was associated with diabetes and stroke but not associated with heart conditions, heart failure, or high blood pressure. Discussion The importance of childhood conditions for later life remained important in Brazil, but questions remain as to why certain conditions were found to be significant while others were not. Differences may stem from larger contextual changes such as the impact of globalization on food choices during adulthood for these cohorts. This study highlights the significance of contextual and conditional factors in comprehending the multifaceted dynamics underlying the association between early life conditions and later life health.

Long-lasting mechanical hypersensitivity and CRF receptor type-1 neuron activation in the BNST following adolescent ethanol exposure.

Adolescent alcohol use can produce long-lasting alterations in brain function, potentially leading to adverse health outcomes in adulthood. Emerging evidence suggests that chronic alcohol use can increase pain sensitivity or exacerbate existing pain conditions, but the potential neural mechanisms underlying these effects require further investigation. Here, we evaluate the impact of chronic ethanol vapor on mechanical sensitivity over the course of acute and protracted withdrawal in adolescent and adult male and female mice, and its potential association with alterations in corticotropin-releasing factor (CRF) signaling within the bed nucleus of the stria terminalis (BNST). Adolescent and adult male and female mice underwent intermittent ethanol vapor exposure on 4 days/week for 2 weeks. Mechanical thresholds were evaluated 5 h and 7, 14, 21, and 28 d after cessation of ethanol exposure using the von Frey test. For mice with a history of adolescent ethanol exposure, brains were collected for insitu RNAscope processing after the final test. Messenger RNA expression of c-Fos, Crfr1, and Crf in the BNST subregions was examined. Exposure to intermittent ethanol vapor induced persistent mechanical hypersensitivity during withdrawal in both adolescent and adult mice. Notably, the effect was more transient in mice exposed to ethanol during adulthood, resolving by day 28 after ethanol exposure. Furthermore, both male and female mice with a history of adolescent ethanol exposure exhibited increased activation of CRF receptor type 1 (CRFR1) neurons within the dorsolateral BNST. Our results support the conclusion that intermittent ethanol exposure can induce mechanical hypersensitivity, potentially through the activation of BNST CRFR1 neurons. These findings provide a basis for future studies aimed at evaluating specific subpopulations of BNST neurons and their contribution to pain in individuals with a history of alcohol use.

The association between Adverse Childhood Experiences and HPV vaccination coverage in U.S. young adults: a cross-sectional study.

Adverse childhood experiences (ACEs) contribute to adverse health outcomes in adulthood. Access to preventive healthcare services, including HPV vaccinations, may mitigate the impact of ACEs on adverse health outcomes. Our objective was to assess associations between ACEs and HPV vaccination coverage among young adults. We included 3415 18-29-year-old respondents to the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) ACE and HPV vaccination modules. ACEs included emotional, physical and sexual abuse; household intimate partner violence, substance abuse, mental illness; and parental separation/divorce and incarcerated household member. We used log-binomial regression models to calculate prevalence ratios (PRs) with 95% confidence intervals for associations between ACEs and self-reported HPV vaccination and completion. Secondary outcomes included influenza vaccination uptake, time since routine checkup, HIV testing history, and HIV-related risk behavior. Several ACEs were positively associated with HPV vaccine initiation, including emotional abuse (PR:1.29, 95%CI:1.17-1.43), intimate partner violence (PR:1.14, 95%CI:1.00-1.30), substance abuse (PR:1.20, 95%CI:1.08-1.33), and mental illness (PR:1.35, 95%CI:1.22-1.50). Similar associations were observed for completion. Conversely, most ACEs were negatively associated with influenza vaccination (PRs from 0.72-1.00), and with recent checkup (PRs from 0.92-1.00). ACEs were positively associated with having had an HIV test (PRs from 1.19-1.56) and HIV-related risk behavior (PRs from 1.19-2.07). The unexpected positive associations between ACEs and HPV vaccination coverage could be due to opportunities to receive HPV vaccination in late adolescence or early adulthood while accessing STI/HIV prevention or treatment services. Future studies should evaluate associations between ACEs and timely HPV vaccination in early adolescence.

0158 Preliminary Study of the Links Between Adverse Childhood Experiences and Actigraphy-Measured Sleep Characteristics in Young Adults

Abstract Introduction Adverse Childhood Experiences (ACEs) are highly stressful events during the first 18 years of life that have been linked with adverse adult health outcomes. Sleep is an important behavioral risk factor for a myriad of health outcomes that have been linked to ACE exposure. A growing body of evidence indicates that ACEs are associated with low self-reported sleep durations, but these findings should be verified using objectively measured sleep characteristics. The purpose of this study was to examine associations of ACE exposure with actigraphy-measured sleep duration, timing, and variability. Methods Methods: In twenty-four young adults (20F/4M; mean±SD, age=24±5 y), we assessed ACE exposure using the 10-item ACE scale and measured sleep characteristics over a ≥6 day period using a wrist-worn actigraphy device. Participants with 0–1 ACEs were characterized as low-ACE (ACE-low, n=10) and participants with 2+ ACEs were characterized as moderate-high-ACE exposure (ACE-mh, n=14). Independent samples t-tests and Hedges’ g effect sizes were used to compare total sleep duration, bed-time, get-up time, time-in-bed, sleep onset latency and the standard deviation of bed time and total sleep duration between groups. Results Time-in-bed was greater in ACE-mh than in ACE-low (mean±SE difference=-60±25 min; p=0.027; g=-0.95), yet there was no difference in total sleep duration (-9±10 min; p=0.46; g=-0.37). This discrepancy was accompanied by a non-significant, but large-effect size difference between ACE-mh and ACE-low (-15±7 min; p=0.051; g=-0.83) in sleep onset latency. There were no differences between groups in either bed-time (p=0.34; g=0.39) or get-up time (p=0.35; g=-1.2), nor in either bed-time (p=0.84; g=-0.08) or total sleep duration (p=0.36; g=-0.37) variability. Conclusion In contrast to prior evidence based on self-report, our initial evidence indicates that ACE exposure is not linked with shorter sleep durations or higher sleep variability when measured using actigraphy. Instead, ACE exposure is linked to greater time in bed and greater sleep onset latencies, suggesting that individuals exposed to ACEs may have less efficient sleep. Support (if any) Support: Research reported in this publication was supported in part by the NCATS of the NIH (UL1TR002537) and by the Injury Prevention Research Center through the CDC (R49 CE003095).

The co-occurrence and cumulative prevalence of hypertension, rheumatoid arthritis, and hypothyroidism in preterm-born women in the Women's Health Initiative.

Emerging evidence suggests that preterm-born individuals (<37 weeks gestation) are at increased risk of developing chronic health conditions in adulthood. This study compared the prevalence, co-occurrence, and cumulative prevalence of three female predominant chronic health conditions - hypertension, rheumatoid arthritis [RA], and hypothyroidism - alone and concurrently. Of 82,514 U.S. women aged 50-79 years enrolled in the Women's Health Initiative, 2,303 self-reported being born preterm. Logistic regression was used to analyze the prevalence of each condition at enrollment with birth status (preterm, full term). Multinomial logistic regression models analyzed the association between birth status and each condition alone and concurrently. Outcome variables using the 3 conditions were created to give 8 categories ranging from no disease, each condition alone, two-way combinations, to having all three conditions. The models adjusted for age, race/ethnicity, and sociodemographic, lifestyle, and other health-related risk factors. Women born preterm were significantly more likely to have any one or a combination of the selected conditions. In fully adjusted models for individual conditions, the adjusted odds ratios (aORs) were 1.14 (95% CI, 1.04, 1.26) for hypertension, 1.28 (1.12, 1.47) for RA, and 1.12 (1.01, 1.24) for hypothyroidism. Hypothyroidism and RA were the strongest coexisting conditions [aOR 1.69, 95% CI (1.14, 2.51)], followed by hypertension and RA [aOR 1.48, 95% CI (1.20, 1.82)]. The aOR for all three conditions was 1.69 (1.22, 2.35). Perinatal history is pertinent across the life course. Preventive measures and early identification of risk factors and disease in preterm-born individuals are essential to mitigating adverse health outcomes in adulthood.

Social needs screening and referral in pediatric primary care clinics: a multiple case study

BackgroundUnmet social risks such as housing, food insecurity and safety concerns are associated with adverse health outcomes in adults and children. Experimentation with social needs screening in primary care is currently underway throughout the United States. Pediatric primary care practices are well-positioned to amplify the effects of social needs screening and referral programs because all members of the household have the potential to benefit from connection to needed social services; however, more research is needed to determine effective implementation strategies.MethodsTo describe common implementation barriers and facilitators, we conducted 48 in-depth qualitative interviews with leadership, providers and staff between November 2018 and June 2019 as part of a multiple case study of social needs screening and referral programs based out of four pediatric ambulatory care clinics in New York City. Interviews were recorded, transcribed and coded using a protocol-driven, template-based rapid analysis approach designed for pragmatic health services research. In addition to analyzing content for our study, we delivered timely findings to each site individually in order to facilitate quality improvement changes in close-to-real time.ResultsEffective implementation strategies included tailoring screening tools to meet the needs of families seen at the clinic and reflect the resources available in the community, hiring dedicated staff to manage the program, building strong and lasting partnerships with community-based organizations, establishing shared communication methods between partners, and utilizing technology for efficient tracking of screening data. Respondents were enthusiastic about the value of their programs and the impact on families, but remained concerned about long-term sustainability after the grant period.ConclusionImplementation of social needs screening and referral interventions is dependent on contextual factors including the nature of family needs and the availability of intraorganizational and community resources to address those needs. Additional research is needed to prospectively test promising implementation strategies that were found to be effective across sites in this study. Sustainability of programs is challenging, and future research should also explore measurable outcomes and payment structures to support such interventions in pediatric settings, as well as aim to better understand caregiver perspectives to improve engagement.

Associations between biomass fuel use and child health: a community-based study in Bhaktapur, Nepal

Abstract Background Biomass fuel use for cooking is widespread in low- and middle-income countries. Previous studies have mainly focused on adverse health outcomes in adults or specific diseases. In a cohort among young children living in Bhaktapur, Nepal, we aimed to describe the association between the use of biomass cooking fuels in families with child health using measures of linear growth, cognition and chronic illness. Methods Caregivers of 600 marginally stunted children aged 6-11 months were interviewed about their primary source of cooking fuel at enrolment into a randomized controlled trial. Children's body length (n = 572) was measured at age 18-23 months. At the same time, blood samples (n = 497) were taken, and we measured leukocyte telomere length (LTL) as a marker of chronic disease risk. We chose LTL expressed as z-scores as a measure of chronic disease. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and NEPSY-II subtests when the children were 4 years old (n = 531). Associations were estimated in multiple regression models. Results About 18% of all families used biomass as primary cooking fuel. Children from families using biomass fuel were on average slightly shorter (mean difference 0.14 Z-scores, 95% CI: 0.28, 0.00), had lower IQ scores (mean difference 2.2 (95% CI: 0.5, 3.9), and shorter LTL (mean difference: 0.09 (95% CI: 0.05 to 0.13) compared to those not using biomass fuel. The observed associations were unaltered after adjusting for relevant confounders. Conclusions In children from households in poor, urban neighborhoods in Nepal, biomass fuel use for cooking was associated with health indicators for child growth and cognition as well as longevity and chronic illnesses reflected in shortening of telomeres. As this was an observational study, residual confounding cannot be excluded. Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings. Key messages

94 Common Social Determinants of Health as Independent Predictors of Adverse Childhood Experiences and the Derivation of a Clinical Prediction Rule: Findings from a Longitudinal Quality Improvement Study

Abstract Background Adverse Childhood Experiences (ACEs) are a group of early life events that lead to toxic stress and adverse adult health outcomes. Screening for ACEs can be challenging due to sensitivity and re-traumatization. There is a paucity of evidence regarding whether other social determinants of health (SDoH) might be independent predictors of an ACE score &amp;gt;=4. Likewise, no effective prediction rule exists for an elevated ACE score based on SDoH in children. Objectives 1) Identify independent predictors of elevated ACE score from commonly screened SDoH. 2) Derive a clinical prediction rule based on the available data. Design/Methods Data were drawn from a longitudinal quality improvement SDoH study in pediatric surgical clinics at a provincial children’s hospital. Primary outcome of interest was an ACE score &amp;gt;=4. Multivariable logistic regression was utilized to identify independent predictors among other SDoH. Prediction methods and ROC analyses were completed to derive a prediction rule. Results 515 respondents answered ACE screening; 63 (12.2%) reported &amp;gt;=4 ACEs. SDoH that were strong independent predictors of ACE score &amp;gt;=4 included poverty (OR 2.34, 95% CI 1.19-4.91), parental education (OR 2.76, 95% CI 1.17-6.54), and household income (OR 2.17, 95% CI 1.09-4.32). Housing status, Indigenous status, and disability status were not associated with elevated ACE score. A clinical prediction rule derived using four SDoH questions with a cut-off score of 1 had 96.67% sensitivity but only 21.54% specificity for an ACE score &amp;gt;=4 (AROC 0.75, 95% CI 0.69-0.81). Conclusion Several adverse SDoH were identified as independent predictors of an ACE score &amp;gt;=4 in children. A clinical prediction rule based on SDoH screening was sensitive but poorly specific for ACE &amp;gt;=4. Further research is required.

Adverse Childhood Experiences, Positive Childhood Experiences, and Adult Health

Objective: This study investigates the associations between positive childhood experiences and adult well-being, examining the moderating role of childhood social support in the relationship between adverse childhood experiences (ACEs) and adult health outcomes. Method: Data were from the 2015 Wisconsin Behavioral Risk Factor Surveillance System survey. The sample included 4,849 individuals ages ≥18 years who were asked about their ACEs, childhood social support, and a range of health outcomes. We used logistic regression and subgroup moderation tests to predict health outcomes. Results: Adults with high ACE scores and lower levels of childhood social support had worse health outcomes than those with low ACE scores and higher levels of childhood social support. In addition, adults with lower ACE scores and lower levels of childhood social support had worse health outcomes than the reference group, indicating that inadequate childhood social support itself may contribute to negative health outcomes in later life. Conclusions: Both ACEs and childhood social support were independently associated with adult health problems, and the combination of high levels of ACEs and low childhood social support was the most significant predictor of adverse health outcomes in adulthood, controlling for adult sociodemographic indicators. Building and enhancing supportive relationships in childhood may buffer the negative effects of early adversities on adult well-being.

Adolescence exposure to China\u2019s great famine period and the association of metabolic syndrome in adulthood: a retrospective study

BackgroundExposure to famine during early life is related to several adverse health outcomes in adulthood, but the effect of famine exposure during adolescence is unclear. This study aims to examine whether exposure to famine in adolescence is associated with metabolic syndrome (MetS) in adulthood.MethodsThis study included 4130 Chinese adults (2059 males and 2071 females) aged 59–71 from the 2011 China Health and Retirement Longitudinal Study (CHARLS). All the selected participants were exposed to the three-year time period (1959–1961) of China’s Great Famine. Participants were categorized into an adolescent-exposed group (born 01/01/1944–12/31/1948) and a non-adolescent-exposed group (born 01/01/1940–12/31/1941 and 01/01/1951–12/31/1952). Sex-stratified multiple logistic regression models were used to estimate the association between exposure to famine in adolescence and MetS.ResultsParticipants exposed to famine during adolescence were more likely to report MetS (aOR = 1.35; 95%CI 1.01–1.78) compared to the non-adolescent-exposed group. Further, males were 45% less likely to report MetS than females (aOR = 0.55; 95%CI 0.36–0.83). After stratification by sex, the effects of famine exposure during adolescence on MetS were detected among males only (aOR = 1.97; 95%CI 1.20–3.24). Additionally, males with a history of drinking were more likely to report MetS compared to those with no history of drinking (aOR = 2.63; 95%CI 1.41–4.90).ConclusionsOur findings reveal that exposure to famine during adolescence is associated with higher odds of MetS in adulthood overall, and this association is only pronounced among males. This study emphasizes that undernutrition in early life, including adolescence, may have a long-term effect and be associated with adverse health events in middle-to-late life. Targeting those elderly people who suffered famine during adolescence may help prevent the development of MetS in later life.

Predictive Validity of Motor Fitness and Flexibility Tests in Adults and Older Adults: A Systematic Review.

Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults.

Associations of adverse childhood experiences (ACEs) with sleep duration and quality: the BCOPS study

BackgroundAdverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. MethodsACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures. ResultsThe mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7–89.6 vs. 90.2%, 89.2–91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8–89.7 vs. 90.1%, 88.9–91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs. ConclusionExposure to ≥1 ACE was associated with worse sleep measures.

Season of Birth and Cardiovascular Mortality in Atrial Fibrillation: A Population-Based Cohort Study.

Background: The fetal origins hypothesis have associated early life exposures with the development of adverse health outcomes in adulthood. Season of birth has been shown to be associated with overall and cardiovascular mortality. Methods: We performed a retrospective database study to explore the association between season of birth and mortality in patients with atrial fibrillation. Results: A total of 8962 patients with AF were identified in the database with 1253 deaths recorded. AF patients born in spring and summer had a higher mortality rate when compared to those born in autumn and winter (hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.01–1.26, p = 0.03). This effect was consistent in the male subgroup (HR 1.25, 95% CI 1.03–1.51, p = 0.02 for males born in spring; HR 1.24, 95% CI 1.03–1.51, p = 0.03 for males born in summer when compared to winter as the reference) but not in females (HR 1.02, 95% CI 0.79–1.31, p = 0.88 for females born in spring; HR 1.11, 95% CI 0.87–1.42, p = 0.39 for females born in summer when compared to winter as the reference). Results persisted after adjustment for baseline characteristics and clinical risk profile. A similar pattern was observed with cardiovascular mortality. Conclusion: Birth in spring or summer is associated with a higher risk of cardiovascular mortality in male AF patients, but not in females. This could be related to the underlying differences in rates of major adverse clinical events between genders. Further studies should aim at clarifying the mechanisms behind this association, which may help us understand the higher level of risk in female patients with AF.

Emotion Regulation Difficulties Mediate the Relationship between Neuroticism and Health-Risk Behaviours in Adolescents

Health-Risk-Behaviors (HRBs) are significant antecedent conditions of adolescents’ poor health and mortality. Prevention of avoidable adverse health outcomes requires an in-depth understanding of the factors associated with such outcomes. Among other possible pathways, the ‘Neuroticism- HRBs-adverse health’ link has been supported in previous studies. However, more extensive exploration of this link is required to identify the underlying modifiable risk factors. In the present study, one such factor, namely, emotion regulation difficulties, was explored to see its mediating effect in the relationship between neuroticism and HRBs—the first two constructs of the mentioned link. In this quantitative study, a total of 759 adolescents belonging to the Indian state of Punjab (Males= 402; M(age)=16.08) provided relevant information on a set of standardized questionnaires. Mediation analysis supported the major hypothesis of the present study. The results suggest that emotion regulation difficulty may be a significant mediator in the neuroticism-HRBs link. One’s difficulty in regulating emotions might be an underlying mechanism through which high neuroticism increases the probability of indulging in HRBs, resulting in adverse health outcomes. The study implies that the assessment of emotion regulation difficulties should be included in interventional programs aimed at achieving adolescents’ wellbeing, and early intervention may avoid progression toward adverse health outcomes in adulthood.

Trend of substance abuse among medical students at University of Zagreb from 2008/2009 to 2018/2019

Abstract Background Risk behavior of youth could have adverse health outcomes in adulthood, with an impact on individual and general population health. The aim of this study was to determine the prevalence and trend of cigarette smoking, alcohol consumption and experimentation with illicit drugs among first year students at School of Medicine, University of Zagreb, Croatia. Methods Retrospective study included first year medical students, from academic year 2008/2009 to 2018/2019. Data were collected each academic year by anonymous questionnaire, and analysed by descriptive (χ2 test, Fisher's exact test) and analytical statistics (simple linear regression model using the least squares method, t-test) with a significance level of α = 0.05. Results Data analysis included a total of 3155 medical students (96.7%), 62.6% girls. Prevalence of daily smoking varied across generation from 11.6% in 2008/2009 to 9.6% in 2018/2019, and although a slight decline is observed, no statistically significant difference in daily smoking was found among generations of students from the academic year 2008/2009 to 2018/2019 (t-test=-0.169; P = 0.869). Prevalence of occasional smoking ranged from 12.0% in 2008/2009 to 18.1% in 2018/2019, and showed a statistically significant increase (t-test=3.064; P = 0.014), respectively. The prevalence of binge drinking ranged from 60.3% in 2008/2009 to 72.5% in 2018/2019, and showed a statistically significant increase (t-test=2.3515; P = 0.043) across generation. The prevalence of illicit drug experimentation varied from 17.9% in 2008/2009 to 34.4% in 2018/2019, and showed a statistically significant increase (t-test = 3.0798; P = 0.013) across generations. Conclusions Results showed increase in occasionally smoking, binge drinking and experimentation with illicit drugs among first-year medical students in the eleven-year period, and indicate the need of comprehensive public health interventions to reduce risky behavior in the student population. Key messages Occasionally smoking, binge drinking and experimentation with illicit drugs are increasing problem among students. Comprehensive public health interventions are needed to reduce risky behavior in the population of students and youth.

50.11 Reported Discrimination Predicts Biomarkers of Adverse Medical Outcomes Using Machine Learning Methodology

Within the past decade, there has been increased attention to the relationship between stress, its physical manifestations, and complex psychosocial, interpersonal interactions. One such stressor that has been shown to significantly impact is the experience of perceived discrimination for members of African American (AA) communities. Racial trauma (or race-based stress response) is defined as the traumatic response to negative race-related experiences that are collectively characterized as racism, including acts of prejudice, discrimination, or violence against a subordinate racial group. Consistently, it has been shown that African Americans are among the hardest hit by this sociopolitical phenomenon, racism, in the United States. For African Americans, the experience of racism has been linked to earlier onset (and greater prevalence) of disability, reduced life expectancy, and various cardiometabolic, neurological, or mental health disorders than any other racial or ethnic minority group in the United States. In this study, we are interested in utilizing machine-based learning methodologies to investigate if such intrinsic factors, such as perceived prejudice or discrimination in childhood/adolescence, are predictive of poorer health outcomes in adulthood. Utilizing the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset, we utilized a recursive feature elimination regression analysis to investigate the relationship between reported discrimination and potential biomarkers of adverse health outcomes in adulthood. We found that reported discrimination was predictive of elevated levels of high-sensitivity C-reactive protein (hsCRP) (R2 = 0.2579), increased BMI, in adulthood. Our findings are proof of concept that machine learning methodology can be applied to large datasets to understand the potential health consequences of racial disparities in a hypothesis-free manner.

Eye Movements During Reading and Cognitive Skills in 4th Grade Children

Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance among disadvantaged children.We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107) to examine the impact of socioeconomic disadvantage (0–1 year) on children's reading skills (8–9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2–5 years) and preschool attendance (4–5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills.Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference = 20.1% (95% confidence interval [CI]: 16.0%–24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0%–22.7%) higher risk of poor reading outcomes in absolute terms.There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women.

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.

Childhood Obesity-Related Mechanisms: MicroRNome and Transcriptome Changes in a Nested Case-Control Study.

Childhood obesity could contribute to adulthood obesity, leading to adverse health outcomes in adults. However, the mechanisms for how obesity is developed are still unclear. To determine the epigenome-wide and genome-wide expression changes related with childhood obesity, we compared microRNome and transcriptome levels as well as leptin protein levels in whole bloods of 12 obese and 24 normal children aged 6 years. miR-328-3p, miR-1301-3p, miR-4685-3p, and miR-6803-3p were negatively associated with all obesity indicators. The four miRNAs were also associated with 3948 mRNAs, and separate 475 mRNAs (185 among 3948 mRNAs) were associated with all obesity indicators. The 2533 mRNAs (64.2%) among the 3948 mRNAs and 286 mRNAs (60.2%) among the 475 mRNAs were confirmed as targets of the four miRNAs in public databases through miRWalk 2.0. Leptin protein was associated with miR-6803-3p negatively and all obesity indicators positively. Using DAVID bioinformatics resources 6.8, top three pathways for obesity-related gene set were metabolic pathways, pathways in cancer, and PI3K-Akt signaling pathway. The top three obesity-related disease classes were metabolic, cardiovascular, and chemdependency. Our results support that childhood obesity could be developed through miRNAs-related epigenetic mechanism and, further, these obesity-related epigenetic changes could control the pathways related with the development of various diseases.