Co-occurrence Of Risk Factors Research Articles

Climate change: A pointer to increased small-scale fisher drowning deaths.

Drowning is an overlooked public health concern and drowning risk is dependent on environmental risk factors. The preponderance of drowning deaths occurs in low- and middle-income countries. Small-scale fishers face high occupational risk of drowning. Climate change increases the frequency and intensity of storms, thereby exacerbating fishers' risks and creating a need to examine the contribution of storms to fisher drowning deaths for the development of mitigation strategies. We examined this relationship between weather and fisher drowning deaths in Lake Victoria, which is Africa's largest lake, a site of high fishing pressure, and where climate change is predicted to increase thunderstorms. We conducted a verbal autopsy with people knowledgeable about recent fatal fisher drowning incidents to collect information about the deceased fishers and circumstances surrounding the incidents across 43 landing sites in the Kenyan shore of Lake Victoria. Semi-structured interviews with stakeholders also elucidated community perspectives on drowning risks. Fatal drownings were often attributed to bad weather (41.8%). Other risk factors, such as non-use of life jacket and navigation equipment, co-occurred with bad weather at high rates (69.5% and 67.8%, respectively) to jointly contribute to fatal drowning incidents. Such co-occurrence of risk factors indicates that actions across multiple risk factors can help mitigate the issue. Stakeholder analysis revealed a range of opportunities for improved communication of risks and action to mitigate risks across boat operators and manufacturers, as well as multiple levels of management. Across global small-scale fisheries, limited use of safety equipment and intensive fishing pressure may coincide with increases in extreme weather events, necessitating action to address current and mitigate future drowning risks to small-scale fishers.

Ethnocultural disparities in loneliness among women in Israel: A population-based study.

Loneliness was predicted for women in three ethnocultural groups in Israel: native Jews, Israeli Arabs, and Former Soviet Union (FSU) immigrants. The study was based on Lund et al.'s (2018) conceptualization of social determinant domains of mental health disorders, as in the United Nations Sustainable Development Goals. Social determinants were demographic, economic, social-cultural, and neighborhood factors. We examined whether ethnocultural disparities in loneliness persist when controlling for social determinants in these four domains or whether ethnic disparities are related to other forms of inequality among the three study groups, as reflected in these four domains. Next, we explored associations between the co-occurrence of key social determinants with loneliness. We used cross-sectional representative data of working-age women from the Israeli Social Survey (N = 5,600). Hierarchical logistic regression analyses indicated a higher risk for loneliness among FSU immigrants and Israeli Arabs than among native Jews. Economic risk factors significantly increased the risk of loneliness. Social and cultural factors decreased the risk of loneliness, while discrimination increased it. Improved neighborhood conditions decreased the risk of loneliness. Ethnocultural disparities in loneliness diminished when economic determinants were controlled. Co-occurrence of risk factors greatly increased the risk for loneliness, demonstrating a stepped relationship. Developing supportive networks for women, mainly from minority groups, to increase trust and fight discrimination against any background is necessary. Moreover, significant efforts must be made to combat poverty and narrow socioeconomic inequalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Understanding the risks of co-exposures in a changing world: a case study of dual monitoring of the biotoxin domoic acid and Vibrio spp. in Pacific oyster.

Assessing the co-occurrence of multiple health risk factors in coastal ecosystems is challenging due to the complexity of multi-factor interactions and limited availability of simultaneously collected data. Understanding co-occurrence is particularly important for risk factors that may be associated with, or occur in similar environmental conditions. In marine ecosystems, the co-occurrence of harmful algal bloom toxins and bacterial pathogens within the genus Vibrio may impact both ecosystem and human health. This study examined the co-occurrence of Vibrio spp. and domoic acid (DA) produced by the harmful algae Pseudo-nitzschia by (1) analyzing existing California Department of Public Health monitoring data for V. parahaemolyticus and DA in oysters; and (2) conducting a 1-year seasonal monitoring of these risk factors across two Southern California embayments. Existing public health monitoring efforts in the state were robust for individual risk factors; however, it was difficult to evaluate the co-occurrence of these risk factors in oysters due to low number of co-monitoring instances between 2015 and 2020. Seasonal co-monitoring of DA and Vibrio spp. (V. vulnificus or V. parahaemolyticus) at two embayments revealed the co-occurrence of these health risk factors in 35% of sampled oysters in most seasons. Interestingly, both the overall detection frequency and co-occurrence of these risk factors were considerably less frequent in water samples. These findings may in part suggest the slow depuration of Vibrio spp. and DA in oysters as residual levels may be retained. This study expanded our understanding of the simultaneous presence of DA and Vibrio spp. in bivalves and demonstrates the feasibility of co-monitoring different risk factors from the same sample. Individual programs monitoring for different risk factors from the same sample matrix may consider combining efforts to reduce cost, streamline the process, and better understand the prevalence of co-occurring health risk factors.

Calculating the business continuity value by considering several destructive events and co-occurrence of risk factors

Calculating the business continuity value by considering several destructive events and co-occurrence of risk factors

Calculating the business continuity value by considering several destructive events and co-occurrence of risk factors

Calculating the business continuity value by considering several destructive events and co-occurrence of risk factors

Moringa oleifera Lam. as a potential plant for alleviation of the metabolic syndrome-A narrative review based on in vivo and clinical studies.

The metabolic syndrome (MetS) refers to the co-occurrence of risk factors, including hyperglycaemia, increased body weight, hypertension and dyslipidemia, which eventually lead to diabetes and cardiovascular disease, a common health problem worldwide. Recently, there has been an increasing interest in the use of plant-based products for the management of MetS, because of their less detrimental and more beneficial effects. Moringa oleifera (Moringaceae), commonly known as drumstick, is cultivated worldwide for its nutritional and medicinal properties. This review focuses on the in vivo and human studies concerning the potential of M. oleifera in the alleviation of MetS and its comorbidities. The search for relevant articles was carried out in PubMed and Google Scholar databases. Randomised controlled and clinical trials from the PubMed database were included in this review. The results suggested that the administration of M. oleifera, in vivo, shows clear signs of improvement in MetS indices. Despite fewer human studies, the existing data documented convincing results that uphold the potential of M. oleifera against MetS. Therefore, future research discussing the probable mechanism of action is much needed which could further assure the usage of M. oleifera in the treatment regimen of MetS.

Identifying modifiable factors and their joint effect on dementia risk in the UK Biobank.

Previous hypothesis-driven research has identified many risk factors linked to dementia. However, the multiplicity and co-occurrence of risk factors have been underestimated. Here we analysed data of 344,324 participants from the UK Biobank with 15 yr of follow-up data for 210 modifiable risk factors. We first conducted an exposure-wide association study and then combined factors associated with dementia to generate composite scores for different domains. We then evaluated their joint associations with dementia in a multivariate Cox model. We estimated the potential impact of eliminating the unfavourable profiles of risk domains on dementia using population attributable fraction. The associations varied by domain, with lifestyle (16.6%), medical history (14.0%) and socioeconomic status (13.5%) contributing to the majority of dementia cases. Overall, we estimated that up to 47.0%-72.6% of dementia cases could be prevented.

An Alzheimer's dementia cumulative risk model in a sample of general population over 65: Public health implications

Background and objectivesWith the population ageing, the identification of modifiable risk factors for dementia represents a public health priority. Co-occurrence of risk factors in the same individual is more frequent than an isolated appearance and may create synergistic effects, with an increased risk of negative outcomes such as dementia and mortality. We aim to study the cumulative risk of incident Alzheimer's Dementia (AD) in a community sample aged >65 (n= 3044). MethodsTo this end, we will examine the impact on the risk of AD of the co-occurrence of variables that have previously been shown to increase risk: age, gender, education, marital status, depression, anxiety, body mass index (BMI) and hearing loss. ResultsThe most frequent number of co-occurring risk factors was 3. We found a cumulative increased risk of both death and AD by the confluence of 2 or more risk factors. Using a competing risk regression model, each increase in a co-occurring risk factor was associated with a significant increase in the risk of incident AD of more than two-fold. By the analysis of the Population Attributable Fractions (PAF) of AD due to several risk factors, we found that if 4 or more co-occurring risk factors could be eliminated from the population, the prevalence of AD would be reduced by approximately 38%. ConclusionOur study offers an estimate of the impact that preventive interventions could have if the number of modifiable risk factors of AD at a population level.

Co-occurrence of non-communicable disease risk factors and its determinants among school-going adolescents of Kathmandu Metropolitan City.

Adolescence is a critical transition in human growth and adolescents tend to engage in various risky behaviors which are likely to continue into adulthood. Co-occurrence of non-communicable disease risk factors has the potential to increase risks of chronic disease comorbidity and increased mortality in later life. Behavioral risk factors are adopted due to changes in lifestyle and adolescents are more prone to acquire them. This study aimed to determine the prevalence and associated factors of co-occurrence of non-communicable disease risk factors among school-going adolescents of Kathmandu Metropolitan City. We conducted a cross-sectional study among school-going adolescents of Kathmandu Metropolitan City in January/February 2020. We used stratified random sampling to select 1108 adolescents studying in 9, 10, 11, and 12 grades. We used Global Schools Health Survey tools to collect data. We entered data in EpiData 3.1 and exported it into Statistical Package for Social Science (SPSS) version 20 for statistical analysis. We estimated prevalence of NCDs risk factors and co-occurrence of risk factors. We applied multivariate multinomial logistic regression analysis adjusting for age, gender, ethnicity, religion, education, type of school, and parental education to determine factors associated with co-occurrence of NCDs risk factors. The prevalence of physical inactivity, unhealthy diet, harmful use of alcohol and tobacco among school-going adolescents were 72.3% (95%CI: 69.6-74.9), 41.1% (95%CI: 38.2-44.0), 14.8% (95%CI: 12.8-17.0) and 7.8% (95%CI:6.3-9.5) respectively. The adolescent with co-occurrence of two or more risk factors was 40.7% (95%CI: 37.8-43.7). The school-going adolescents who were in higher age group (AOR = 1.72, 95% CI- 1.06, 2.77), Hindus (AOR = 1.78, 95% CI-1.09, 2.89), other than Brahmin/Chhetri by ethnicity (AOR = 2.11, 95% CI-1.39, 2.22) and with lower education level of mothers (AOR = 2.40, 95% CI- 1.46,3.98) were more likely to have co-occurrence of NCDs risk factors after adjusting for all socio-demographic variables. The co-occurrence of non-communicable disease risk factors was high among school going adolescents and was associated with age, religion, ethnicity and mother's education. Integrated and comprehensive interventional programs should be developed by concerned authorities.

Physical and social environmental factors related to co-occurrence of unhealthy lifestyle behaviors.

Previous work identifying determinants of co-occurrence of behavioral risk factors have focused on their association with individuals' characteristics with scant attention paid to their relationship to contextual factors. Data came from 21,007 individuals ≥15 years of age who participated in the cross-sectional 2011-2012 Spanish National Health Survey. Two indicators were defined by tobacco consumption, alcohol intake, diet, physical activity, and body mass index. The first indicator, based on dichotomized measures, ranges from 0 to 5. The second one (unhealthy lifestyle index), ranges from 0 to 15, with 0 denoting the healthiest score. Among the determinants, we examined social support, five perceived characteristics of the neighborhood, and the socioeconomic deprivation index of the census tract of residence. Data were analyzed using multilevel linear and logistic regression models adjusted for the main sociodemographic characteristics. Using the dichotomized indicator, the probability of having 3-5 risk factors versus <3 factors was associated with low social support (Odds Ratio [OR] 1.50; 95% Confidence Interval [CI]: 1.25-1.80). Issues surrounding neighborhood cleanliness (OR=1.18; 95%CI: 1.04-1.33), air pollution (OR=1.38; 95%CI: 1.16-1.64), and street crime (OR=1.21; 95%CI: 1.03-1.42) were associated with determinants of co-occurrence. Risk factors co-occurrence increased as deprivation level increased: the OR for the highest deprivation quintile versus the lowest was 1.30 (95%CI: 1.14-1.48). Similar results were observed when using the unhealthy lifestyle index. Poorer physical and social environments are related to greater co-occurrence of risk factors for chronic diseases. Health promotion interventions targeting the prevention of risk factors should consider the contextual characteristics of the neighborhood environment.

Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis.

Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.

Risk factors and risk profiles for neck pain in young adults: Prospective analyses from adolescence to young adulthood-The North-Trøndelag Health Study.

The objective was to investigate risk factors and risk profiles associated with neck pain in young adults using longitudinal data from the North-Trøndelag Health Study (HUNT). Risk factors were collected from adolescents (13-19 years of age), and neck pain was measured 11 years later. The sample was divided into two: Sample I included all participants (n = 1433), and Sample II (n = 832) included only participants who reported no neck/shoulder pain in adolescence. In multiple regression analyses in Sample I, female sex (OR = 1.9, 95% CI [1.3-2.9]), low physical activity level (OR = 1.6, 95% CI [1.0-2.5]), loneliness (OR = 2.0, 95% CI [1.2-3.5]), headache/migraine (OR = 1.7, 95% CI [1.2-2.6]), back pain (OR = 1.5, 95% CI [1.0-2.4]) and neck/shoulder pain (OR = 2.0, 95% [CI 1.3-3.0]) were associated with neck pain at the 11-year follow-up. Those with a risk profile including all these risk factors had the highest probability of neck pain of 67% in girls and 50% in boys. In Sample II, multiple regression analyses revealed that female sex (OR = 2.2, 95% CI [1.3-3.7]) and perceived low family income (OR = 2.4, 95% CI [1.1-5.1]) were associated with neck pain at the 11-year follow-up. Girls and boys with a perceived low family income had a 29% and 17% higher probability of neck pain than adolescents with a perceived high family income. The risk profiles in both samples showed that co-occurrence of risk factors, such as headache/migraine, neck/shoulder pain, back pain, low physical activity level, loneliness, and perceived low family income cumulatively increased the probability of neck pain in young adulthood. These results underline the importance of taking a broad perspective when studying, treating, and preventing neck pain in adolescents.

High level of co-occurrence of risk factors for non-communicable diseases among Gambian adults: A national population-based health examination survey

Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality globally. Co-occurrence of risk factors predisposes an individual to NCDs; the burden increases cumulatively with the number of risk factors. Our study aimed to examine the co-occurrence of NCD risk factors among adults in The Gambia. This study is based on a random nationally representative sample of 4111 adults aged 25–64 years (78% response rate) with data collected between January and March 2010 in The Gambia using the WHO STEPwise survey methods. We restricted our analysis to non-pregnant participants with valid information on five NCD risk factors: high blood pressure, smoking, obesity, low fruit and vegetable consumption, and physical inactivity (n = 3000 adults with complete data on all risk factors). We conducted age-adjusted and fully-adjusted gender stratified multinomial logistic regression analysis to identify factors associated with the number of NCD risk factors. More than 90% of adults had at least one risk factor. Only 7% (95% CI: 5.2–9.8) had no risk factor; 22% (95% CI: 19.1–24.9) had at least three. Older age and ethnicity were significantly associated with having three or more risk factors (versus none) among men in the fully adjusted model. Lower education, older age, and urban residence were significantly associated with three or more risk factors (versus none) among women. The burden of NCDs is expected to increase in The Gambia if preventive and control measures are not taken. There should be an integrated approach targeting all risk factors, including wider treatment and control of hypertension.

A novel risk assessment approach using Monte Carlo simulation based on co-occurrence of risk factors: A case study of a petrochemical plant construction

Nowadays, because of the advancement of technology and subsequently unpredictable events, it is important for addressing risk management as an important part of projects and business. In this paper, a novel approach based on Monte Carlo simulation has been proposed for risk assessment, which considers the co-occurrence of risks. In this method, the output of extended and classic Monte Carlo simulation is applied for co-occurrence-based risk assessment (CORA) and prioritization. Also, the magnitude in each source of uncertainty has been determined by a new approach. The proposed model investigates risk’s relationship and determines the type of effect as resonance or reduction in addition to identifying and analyzing the risks. Also, a system dynamic model is applied to illustrate the relationships of risks. Finally, this method is applied to a petrochemical project. Five risks as temperature, rain, labor, cost, and inflation are considered in this project. Based on the numerical results, the most important risk is inflation. Also, there is a significant different between the result of the proposed model in comparison with model that ignore the co-occurrence of risks. CORA helps the manager to consider all aspect of risks and help them to have a better decision.

Trends in the co-occurrence of cardiovascular risk factors by education in Finland, 1997–2017

Abstract Background Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease (CVD) risk factors is crucial for planning public health policy and future prevention strategies. We aimed at examining 1) the co-occurrence of smoking, hypertension, elevated cholesterol and obesity by education, and 2) the trends in educational differences in the co-occurrence of these risk factors in Finland. Methods We used cross-sectional health examination surveys carried out every five years among the general adult population: for 1997-2012 the National FINRISK Study and for 2017 the FinHealth 2017 Survey. Respondents aged 25-64 years were included in the analyses (n = 25,036). Current smoking, obesity (BMI≥30 kg/m2), hypertension (≥140/≥90 mmHg or medication) and elevated serum total cholesterol (≥5.0 mmol/l or medication) were used for the risk factor accumulation score with categories 1) zero, 2) one, 3) two, and 4) three or four elevated risk factors. Multinomial logistic regression was used to estimate predicted probabilities for each category. Results Overall, the risk factor score was more favourable among women than men, and among high education groups than low education groups in both sexes. The lowest risk factor score class became more prevalent in all education groups in both sexes over time. The change in educational differences was not significant. However, the intermediate education group approached the highest education group over time. Conclusions Our data indicate an overall transition towards a more favourable risk factor score in Finland, in 1997-2017. The score among the intermediate education group approached that among the highest education group. The tendency of risk factor accumulation among those with least education remained during the study period, which raises a need to develop and implement interventions and public health policies that would be effective in decreasing the risk factor burden particularly in this group. Key messages Overall, a favourable trend of diminishing risk factor prevalence was seen. The tendency of accumulation of major CVD risk factors among the least educated subjects remained from 1997 to 2017.

Co-occurrence of risk factors for non-communicable diseases among in-school adolescents in Tanzania: an example of a low-income setting of sub-Saharan Africa for adolescence health policy actions

BackgroundChildhood lifestyle, health-risk behaviours contribute to two-thirds of non-communicable diseases (NCDs) premature mortality in adult populations. The co-occurrence of risk factors for NCDs is more harmful to health than that of individual risk factor effects when are added independently. The main objective of the present study was to explore the prevalence, sociodemographic distribution, and the co-occurrence of risk factors for NCDs among in-school adolescents.MethodsThe present study is based on the secondary analysis of the first nationwide representative sample of the 2014 Tanzania Global School-based Student Health Survey (GSHS). A total sample of 3,793 in-school adolescents was included in the present analysis. The dependent variables were as follows: an unhealthy diet, physical inactivity, tobacco use, excessive alcohol use, and suicide attempt. The analysis involved the Chi squire χ2 test, multinomial and multivariate regression models: to determine the association between the variables of interest. In all analyses, the set level of statistical significance was a p-value of less than 0.05 at 95% confidence intervals.ResultsThe most prevalent combination of risk factors for NCDs were as follows: unhealthy diet and physical inactivity 666 (17.6%); unhealthy diet and suicide attempt 151 (4.0); unhealthy diet and tobacco use 98 (2.8); and unhealthy diet, physical inactivity, and suicide attempt 81 (2.1). In the adjusted regression model; having three 0.60 [0.40–0.91], and a sum of four and five 0.46 [0.28–0.79] risk factors than having no risk factor showed a significant declined with increasing in adolescents age. Primary in-school adolescents than secondary in-school adolescents were significantly more likely to have two 1.81 [1.42–2.32], three 2.40 [1.63–3.54]; and a sum of four and five 2.90 [1.61–5.13] combinations of risk factors.ConclusionThe co-occurrence of lifestyle health-risk factors for NCDs was prevalent among in-school adolescents: it was significantly higher among younger adolescents. A multi-strategy public health intervention program may be more effective than that of a single risk factor approach: therefore, suitable for resource-limited settings, such as Tanzania.

Co-occurrence and clustering of the four major non-communicable disease risk factors in Brazilian adolescents: Analysis of a national school-based survey.

BackgroundThe major non-communicable chronic diseases (NCD) are associated with a small group of modifiable lifestyle-related risk factors, including smoking, insufficient physical activity, unhealthy eating, and alcohol abuse. In this study, we evaluated the co-occurrence and clustering of the major NCD risk factors among Brazilian adolescents.MethodsThis cross-sectional study analyzed data of 101,607 adolescents from the Brazilian National Survey of School Health (PeNSE) 2015. The risk factors included were: regular consumption of ultra-processed foods, irregular consumption of fruits and vegetables, insufficient physical activity, smoking, and alcohol consumption. Clustering was defined through the ratio between observed and expected prevalences of combination of risk factors greater than 1. Expected prevalence of the co-occurrence of risk factors was calculated from the joint probability of the behaviors. Additionally, we examined the presence of at least four risk factors according to socioeconomic characteristics.ResultsOf the 32 combinations of risk factors, 13 corresponded to clustering. We observed a strong correlation between alcohol consumption and smoking, which were found together in 8 of the 13 clusters identified. The most frequent combinations of risk factors involved unhealthy eating and insufficient physical activity. Only 2.9% of the adolescents did not present any risk behaviors, while 38.0%, 32.9%, 9.4% and 1.8% accumulated two, three, four and five risk factors, respectively. The accumulation of risk factors was higher in girls, older adolescents, those who did not live with both parents, children of less-educated mothers, students attending public school, and residents of cities in more developed urban areas of the country.ConclusionsThe main risk factors for NCD are frequent and not randomly distributed among Brazilian adolescents. Our results provide information for policymakers to target specific groups and joint behavioral risk factors for health improvement in adolescents.

Patterns and co-occurrence of risk factors for hepatocellular carcinoma in four Asian American communities: a cross-sectional study.

ObjectivesTo investigate risk factor patterns and the simultaneous occurrence of multiple risk factors in the viral, metabolic and lifestyle domains among Asian Americans, who have had the highest mortality rates from hepatocellular carcinoma (HCC).SettingSacramento County, California, USA.ParticipantsEligible participants were county residents ages 18 and older who had not been screened for chronic hepatitis B virus (HBV) and were born in a CDC-defined endemic area or whose parent was born in that area. Of 1004 enrolled, 917 were foreign-born Chinese (130 women, 94 men), Hmong (133 women, 75 men), Korean (178 women, 90 men) or Vietnamese (136 women, 81 men) with complete risk factor data.Primary and secondary outcome measuresWe tested participants for HBV and chronic hepatitis C virus (HCV); measured haemoglobin A1c and waist circumference; and recorded self-reported history of diabetes, hypertension, alcohol use and smoking status. We identified risk factor patterns using cluster analysis and estimated gender-specific age-standardised prevalence rates.ResultsWe identified four patterns: (1) viral (chronic HBV or HCV); (2) lifestyle (current smoker or alcohol user, no viral); (3) metabolic (≥2 metabolic, no lifestyle or viral); and (4) lower risk (≤1 metabolic, no lifestyle or viral). Vietnamese men (16.3%, 95% CI 7.4% to 25.3%) and Hmong women (15.1%, 95% CI 7.8% to 22.5%) had the highest viral pattern prevalence. Hmong women had the highest metabolic (37.8%, 95% CI 29.8% to 45.9%), and Vietnamese men the highest lifestyle (70.4%, 95% CI 59.1% to 81.7%) pattern prevalence. In multiple domains, Hmong men and women were most likely to have viral+metabolic risk factors (men: 14.4%, 95% CI 6.0% to 22.7%; women: 11.9%, 95% CI 5.6% to 18.3%); Vietnamese men were most likely to have lifestyle+viral (10.7%, 95% CI 2.7% to 18.8%), and lifestyle+metabolic but not viral (46.4%, 95% CI 34.4% to 58.5%) risk factors.ConclusionsEfforts to reduce HCC must comprehensively address multiple risk factors.Trial registration number NCT02596438.

Abstract P097: Sociodemographic Differences in the Dietary Quality of Food Purchases Among Participants in the Nationally-Representative Food Acquisition and Purchase Study (FoodAPS)

Background: Self-reported dietary data may not accurately represent usual dietary intake. Grocery purchase records provide an objective measure of diet, but little research has explored whether the diet quality of grocery purchases reflects individual-level diet quality and whether it differentiates between groups with known differences in dietary quality. This study evaluated whether there are sociodemographic differences in the dietary quality of grocery purchases akin to those observed in existing individual-level national data. Hypothesis: The diet quality of grocery purchases will reflect trends observed with individual-level diet quality. Methods: Grocery purchasing data from 3,961 households in the nationally-representative Food Acquisition and Purchase Study (FoodAPS) were used. Dietary data was collected using hand scanners over 7-days, and demographic data was self-reported. The Healthy Eating Index (HEI) 2015 was used to determine grocery purchase quality, and multivariable-adjusted regression with Tukey adjustment or planned contrasts were used to determine whether HEI-15 scores differed according to food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation, obesity within a household, race/ethnicity, and interactions between these variables. FoodAPS sample weights and Taylor series linearization method for variance estimation accounted for the complex sample design. Results: Primary respondents were, on average, 50.6 years, non-Hispanic White (70.3%), female (70.2%) and had attended some college (57.8%). The mean HEI-15 score was 54.7; 14.0% of households were food insecure and 12.7% received SNAP benefits. HEI-15 scores differed across all sociodemographic predictors (p&lt;0.05). Additionally, interactions (p&lt;0.1) were detected between SNAP participation and (1) food insecurity and (2) obesity within the household as well as race/ethnicity and obesity within the household. Food secure, non-SNAP households had higher HEI-15 scores than food insecure, SNAP participating households (53.9±0.5 vs. 50.3±0.7, p=0.007) in models adjusted for age, income, smoking, and education. Similarly, non-SNAP households without obesity present had significantly higher HEI-15 scores than all other households. Obesity presence within a household was associated with lower HEI-15 scores in non-Hispanic White (50.8±0.5 vs. 52.5±0.7, p=0.046), and Black households (48.8±1.5 vs. 53.1±1.4, p=0.018), but not Hispanic households (54.4±1.0 vs. 52.2±1.2, p=0.21). Conclusions: Disparities in the diet quality of grocery purchases reflect individual-level trends and vary based on sociodemographic factors. This analysis highlights the interrelationships between SNAP, food insecurity, race/ethnicity, and obesity within a household, demonstrating how the co-occurrence of risk factors may modify associations with diet quality.

Patterns of Exposure to Cumulative Risk Through Age 2 and Associations with Problem Behaviors at Age 4.5: Evidence from Growing Up in New Zealand.

Exposure to cumulative risk (CR) has important implications for child development, yet little is known about how frequency, persistence, and timing of CR exposure during early childhood predict behavioral problems already before school start. We examine prospective longitudinal associations between patterns of CR exposure from third trimester through 2years and subsequent behavior problems at 4.5years. In 6156 diverse children in the Growing Up in New Zealand longitudinal study, the presence of 12 risk factors, spanning maternal health, social status, and home and neighborhood environment, defined CR and were assessed at last trimester and 9months and 2years of age. At child age 4.5years, mothers completed the Strengths and Difficulties Questionnaire, where a score ≥ 16 indicated an abnormal level of problem behaviors (ALPB). Children exposed to a CR ≥ 1 at least once in early development, compared to those with consistent CR = 0, showed a significantly higher likelihood of ALPB at 4.5years. Consistent high exposure to CR ≥ 4 across all three assessments had the highest prevalence (44%) of ALPB at age 4.5. Children with high CR exposure on two of three, compared to on all three, time points in early development did not evidence a significantly reduced prevalence (32%-41%) of ALPB. The common co-occurrence of risk factors and their significant developmental impact when accumulated early in life underscore the need for systematic multisector intervention and policy implementation during pregnancy and shortly after birth to improve outcomes for vulnerable children.