Community Health Study Research Articles

Depression among Black Youth; Interaction of Class and Place.

Although high socioeconomic status (SES) is traditionally conceptualized as a health protective factor, recent literature has documented positive associations between SES (e.g., income) and depression among Blacks, including Black youth. To extend the results of this recent literature, the current study used the Family and Community Health Study (FACHS) data to examine the multiplicative effects of gender, place, and SES on average depressive symptoms of Black youth over a long period of time. FACHS, 1997–2017, followed 889 Black children aged 10–12 years old for up to 18 years. Depressive symptoms were measured in seven waves. The main predictors of interest were two SES indicators, parent education and family income measured at baseline (1997). Main outcome of interest was average depressive symptoms over the 18 year follow up period. Place of residence and gender were the focal moderators. Linear regression models were used for data analysis. In the pooled sample, living in a predominantly White area was associated with higher average depressive symptoms over time, however, this association was fully explained by higher perceived racial discrimination in the predominantly White areas. We found an interaction between income and place of residence on average depressive symptoms, suggesting that higher income is associated with more depressive symptoms in predominantly White compared to predominantly Black areas. Place did not interact with parent education on average depressive symptoms. Gender also did not interact with education or income on depressive symptoms. Findings suggest that place and SES may interact on depressive symptoms of Black youth, with high income becoming a risk factor for depressive symptoms in predominantly White areas. How SES indicators, such as income, protect or become a risk factor depend on other contextual factors, such as place of residence. There is a need to reduce discrimination experienced by Blacks, especially in predominantly White areas. Meanwhile, Black youth who live in predominantly White areas may require additional help that enhances their coping.

The Effects of Mothers' Protective Parenting and Alcohol Use on Emerging Adults' Alcohol Use: Testing Indirect Effects Through Prototype Favorability Among African American Youth.

We examined how mothers' protective parenting and alcohol use influenced changes in offspring's heavy drinking among a sample of African American youth. The conceptual model also tested indirect effects of mothers' behaviors, through changes in the youths' social images (i.e., prototypes) of heavy drinkers, derived from the prototype willingness (PW) model. Participants were 686 emerging adults (55% female) from the Family and Community Health Study (FACHS), an ongoing prospective study of African American families. Three waves of FACHS data were used as follows: T3 during 10th grade (M age=16.3years), T4 shortly after high school (M age=19.4years), and T5 3years later (M age=22.1years). Mothers' self-reports of protective parenting and alcohol use were assessed at T4. Two separate path models tested the study hypotheses. The first model specified direct and indirect effects of mothers' protective parenting and alcohol use. The second model added interaction terms between the protective parenting behaviors and mothers' alcohol use. The analyses were first conducted using the full sample and then repeated separately for female and male participants. Maternal alcohol use had a positive and direct effect on offspring's alcohol use. Mothers' endorsement of alcohol-related rules inhibited normative increases in the favorability of the offspring's social image of heavy drinkers (prototype) while her warmth was positively related to these increases. Maternal alcohol use amplified the positive association between mothers' warmth and the daughters' increased drinking. For sons, maternal alcohol use increased the positive association between alcohol-related rules and increased prototype favorability. Results indicated clear gender differences in how mothers' behaviors influence her offspring's alcohol use during the transition to emerging adulthood. Interventions that target culturally specific risk and protective factors within the family environment are needed to reduce health disparities among this vulnerable population of youth.

Early Adopters of Human Immunodeficiency Virus Preexposure Prophylaxis in a Population-based Combination Prevention Study in Rural Kenya and Uganda.

Global guidelines recommend preexposure prophylaxis (PrEP) for individuals with substantial human immunodeficiency virus (HIV) risk. Data on PrEP uptake in sub-Saharan Africa outside of clinical trials are limited. We report on "early adopters" of PrEP in the Sustainable East Africa Research in Community Health (SEARCH) study in rural Uganda and Kenya. After community mobilization and PrEP education, population-based HIV testing was conducted. HIV-uninfected adults were offered PrEP based on an empirically derived HIV risk score or self-identified HIV risk (if not identified by score). Using logistic regression, we analyzed predictors of early PrEP adoption (starting PrEP within 30 days vs delayed/no start) among adults identified for PrEP. Of 21212 HIV-uninfected adults in 5 communities, 4064 were identified for PrEP (2991 by empiric risk score, 1073 by self-identified risk). Seven hundred and thirty nine individuals started PrEP within 30 days (11% of those identified by risk score; 39% of self-identified); 77% on the same day. Among adults identified by risk score, predictors of early adoption included male sex (adjusted odds ratio 1.53; 95% confidence interval, 1.09-2.15), polygamy (1.92; 1.27-2.90), serodiscordant spouse (3.89; 1.18-12.76), self-perceived HIV risk (1.66; 1.28-2.14), and testing at health campaign versus home (5.24; 3.33-8.26). Among individuals who self-identified for PrEP, predictors of early adoption included older age (2.30; 1.29-4.08) and serodiscordance (2.61; 1.01-6.76). Implementation of PrEP incorporating a population-based empiric risk score, self-identified risk, and rapid initiation, is feasible in rural East Africa. Strategies are needed to overcome barriers to PrEP uptake, particularly among women and youth. NCT01864603.

Using residential proximity to wind turbines as an alternative exposure measure to investigate the association between wind turbines and human health.

This analysis uses data from the Community Noise and Health Study developed by Statistics Canada to investigate the association between residential proximity to wind turbines and health-related outcomes in a dataset that also provides objective measures of wind turbine noise. The findings indicate that residential proximity to wind turbines is correlated with annoyance and health-related quality of life measures. These associations differ in some respects from associations with noise measurements. Results can be used to support discussions between communities and wind-turbine developers regarding potential health effects of wind turbines.

Perceived Discrimination among Black Youth: An 18-Year Longitudinal Study.

Background: Recent research has suggested vulnerability to perceived racial discrimination (PRD) as a mechanism behind high levels of depression seen in high socioeconomic status (SES) Black males. To better understand the effects of gender and SES on shaping experiences of PRD among Black youth in the United States, we used data from the Family and Community Health Study (FACHS) to explore the trajectory of PRD in Black youth by gender, SES, and place. Methods: Data came from FACHS, 1997–2017, which followed 889 children aged 10–12 years old at Wave 1 (n = 478; 53.8% females and n = 411; 46.2% males) for up to 18 years. Data were collected in seven waves. The main predictors of interest were gender, SES (parent education and annual family income), age, and place of residence. Main outcomes of interest were baseline and slope of PRD. Latent growth curve modeling (LGCM) was used for data analysis. Results: Gender, SES, place, and age were correlated with baseline and change in PRD over time. Male, high family income, and younger Black youth reported lower PRD at baseline but a larger increase in PRD over time. Youth who lived in Iowa (in a predominantly White area) reported higher PRD at baseline and also an increase in PRD over time. High parental education was not associated with baseline or change in PRD. Conclusion: In the United States, Black youth who are male, high income, and live in predominantly White areas experience an increase in PRD over time. Future research is needed on the interactions between gender, SES, and place on exposure and vulnerability of Black youth to PRD. Such research may explain the increased risk of depression in high SES Black males.

Derivation and application of a composite annoyance reaction construct based on multiple wind turbine features

ObjectivesNoise emissions from wind turbines are one of multiple wind turbine features capable of generating annoyance that ranges in magnitude from not at all annoyed to extremely annoyed. No analysis to date can simultaneously reflect the change in all magnitudes of annoyance toward multiple wind turbine features. The primary objective in this study was to use principal component analysis (PCA) to provide a single construct for overall annoyance to wind turbines based on reactions to noise, blinking lights, shadow flicker, visual impacts, and vibrations evaluated as a function of proximity to wind turbines.MethodsThe analysis was based on data originally collected as part of Health Canada’s cross-sectional Community Noise & Health Study (CNHS). One adult participant (18–79 years), randomly selected from dwellings in Ontario (ON) (n = 1011) and Prince Edward Island (PEI) (n = 227), completed an in-person questionnaire. Content relevant to the current analysis included the annoyance responses to wind turbines.ResultsThe first construct tested in the PCA explained 58–69% of the variability in total annoyance. Reduced distance to turbines was associated with elevated aggregate annoyance scores among ON and PEI participants. In the ON sample, aggregate annoyance was effectively absent in areas beyond 5 km (mean 0.12; 95% CI 0.00, 1.19), increasing significantly between (2 and 5] km (mean 2.13; 95% CI 0.92, 3.33), remaining elevated, but with no further increase until (0.550–1] km (mean 3.37; 95% CI 3.02, 3.72). At ≤ 0.550 km, the average overall annoyance was 3.36 (95% CI 2.03, 4.69). In PEI, aggregate annoyance was essentially absent beyond 1 km; i.e., (1–2] km (mean 0.21; 95% CI 0.00, 0.88); (2–5] km (mean 0.00; 95% CI 0.00, 1.37); > 5 km (mean 0.00; 95% CI 0.00, 1.58). Annoyance significantly increased in areas between (0.550 and 1] km (mean 1.59; 95% CI 1.02, 2.15) and was highest within 550 m (mean 4.25; 95% CI 3.34, 5.16).ConclusionThe advantages and disadvantages to an aggregated annoyance analysis, including how it should not yet be considered a substitute for relationships based on changes in high annoyance, are discussed.

The association between self-reported and objective measures of health and aggregate annoyance scores toward wind turbine installations

ObjectiveAn aggregate annoyance construct has been developed to account for annoyance that ranges from not at all annoyed to extremely annoyed, toward multiple wind turbine features. The practical value associated with aggregate annoyance would be strengthened if it was related to health. The objective of the current paper was to assess the association between aggregate annoyance and multiple measures of health.MethodsThe analysis was based on data originally collected as part of Health Canada’s Community Noise and Health Study (CNHS). One adult participant per dwelling (18–79 years), randomly selected from Ontario (ON) (n = 1011) and Prince Edward Island (PEI) (n = 227), completed an in-person questionnaire.ResultsThe average aggregate annoyance score for participants who indicated they had a health condition (e.g., chronic pain, Pittsburgh Sleep Quality Index (PSQI) > 5, tinnitus, migraines/headaches, dizziness, highly sensitive to noise, and reported a high sleep disturbance) ranged from 2.53 to 3.72; the mean score for those who did not report these same conditions ranged between 0.96 and 1.41. Household complaints about wind turbine noise had the highest average aggregate annoyance (8.02), compared to an average of 1.39 among those who did not complain.ConclusionA mean aggregate annoyance score that could reliably distinguish participants who self-report health effects (or noise complaints) from those who do not could be one of several factors considered by jurisdictions responsible for decisions regarding wind turbine developments. However, the threshold value for acceptable changes and/or levels in aggregate annoyance has not yet been established and could be the focus of future research efforts.

Abstract P328: Cardiovascular Disease and Risk Factors Are Associated With Poor Health-Related Quality of Life Among Hispanic/Latino Adults With Arthritis Symptoms: Findings From the Hispanic Community Health Study/ Study of Latinos

Introduction: Despite greater longevity, Hispanics/Latinos have shorter functional limitations-free life and greater prevalence of arthritis-attributable functional limitations compared to non-Hispanic Whites. We assessed the hypothesis that CVD and CVD risk factors (RFs) are independently associated with poor health-related quality of life (HRQOL) among Hispanics/Latinos with arthritis. Methods: HCHS/SOL is a multi-center prospective population-based study of 16,415 diverse Hispanic/Latino adults ages 18-74 years at baseline (2008-11). Data from 2,083 men and women with self-reported arthritis-related symptoms were analyzed. Self-reported HRQOL was assessed using the 12-item Short-Form (SF-12) survey: self-reported health status (fair/poor vs. excellent/very good/good); and physical and mental health component summary scores (PCS and MCS; standardized z scores ranging from 0-100; higher scores indicate better HRQOL). Prevalent CVD (yes/ no) was defined using Framingham CVD Composite Criterion. CVD RFs were diabetes, obesity, hypercholesterolemia, hypertension, smoking, and physical activity. Logistic and linear regression models were used to examine cross-sectional associations of CVD and CVD RFs with HRQOL, after adjustment for relevant covariates and other CVD or CVD RFs. All analyses accounted for the complex study design. Results: In multivariable-adjusted models, CVD, diabetes, and current smoking were associated with 1.73, 2.04, and 1.48 times higher odds of fair/poor general health, compared to absence of CVD, normal glycemic status, and never-smoking, respectively. CVD, diabetes, obesity, physical inactivity, and low activity were associated with lower PCS scores. CVD, obesity, overweight, and current and former smoking were associated with lower MCS scores ( Table ). Conclusions: CVD and CVD RFs are independently associated with poorer HRQOL among Hispanic/Latino adults with arthritis, suggesting presence of unmet health and lifestyle management needs in this group.

Abstract P332: Socio-environmental Influences on Youth Total Sedentary Time: Results From the Hispanic Community Health Study / Study of Latino Youth

Introduction: Sedentary behavior (SED) is associated with higher obesity and cardiometabolic risk in youth, independent of physical activity. Studies showing the association between screen time and SED among Hispanics/Latinos, have primarily focused on Mexican-origin Hispanics. Additional research is needed to examine other socio-environmental factors that can influence SED among diverse Hispanics/Latinos. This cross-sectional study examined the home-, neighborhood-, and school- environment to identify factors associated with total sedentary time among youth. Methods: Data from 1,104 youth ages 8-16 years and 728 caregivers (mean age 43.1 ± 8.2 years) from four U.S. cities, who participated in the Study of Latino Youth (2012-2014), were examined. Associations between socio-environmental factors (measured by self-report) and total sedentary time (measured by one-week Actical accelerometry) were examined in linear regression models that included MVPA minutes/day, demographic covariates, and accounted for the complex survey design and sampling weights. Results: Mean sedentary time was 10.1 ± 1.8 hours/day. Home environment factors, such as electronics in the bedroom and parent limit setting, were not associated with total sedentary time. Presence of barriers to physical activity in the neighborhood (e.g., muggings, gangs) was associated with 13.4 more minutes of sedentary time per day. Attending a school that never/rarely compared to sometimes offered after school physical activity opportunities was associated with more sedentary time (B=38.0 minutes/day; 95% Confidence Interval: 13.5-62.4). Conclusions: The study findings highlight the need for future research to investigate other sources of sedentary behavior in the home for interventionist to focus on specific SED-based strategies to decrease sedentary time among youth. Minimizing barriers by identifying safe places to be active in participant’s neighborhoods may also support youth to spend less time indoors where sedentary time is prevalent.

Abstract P006: Cardiovascular Disease Risk Factor Burden is Associated With Hearing Loss in Young Men: The Hispanic Community Health Study/Study of Latinos

Introduction: Over 30 million Americans suffer from hearing loss (HL). Studies suggest that established cardiovascular disease (CVD) risk factors may contribute to the pathophysiology of the inner ear. However, the aggregate effect of CVD risk factors on hearing is not well understood. Hypothesis: We hypothesized that high CVD risk burden is associated with worse hearing. Methods: We assessed younger (ages 18-34) and older (ages 55-64) Hispanic Community Health Study / Study of Latinos participants who underwent audiometry in 2008-11. After excluding those with conductive pathology and asymmetric HL, we randomly chose one ear for analysis. Puretone thresholds were obtained at 0.5-8 kHz; puretone average (PTA) was calculated using thresholds at 0.5, 1, 2, and 4 kHz. Low CVD risk burden was defined as having all of: blood pressure (BP) <120/<80 mmHg; total cholesterol <180 mg/dL; not currently smoking; and not having prevalent diabetes. High CVD risk burden was defined as ≥ 2 of: diabetes; currently smoking; BP >160/>100 mmHg (or antihypertensive use); and total cholesterol >240 mg/dL (or statin use). By age group and sex, we estimated hearing thresholds per frequency with linear regression models adjusted for noise exposure. Least squares estimates were calculated using strata-specific means of covariates. Estimates were compared via t-tests. Data were weighted for all analyses and accounted for clustering. Results: Among younger and older individuals in the target population (51.9% female), 28.8% had low and 5.5% had high CVD risk. Younger men with high CVD risk had worse PTA than young men with low risk (7.7 dB HL [7.0-8.4] vs. 10.5 dB HL [8.4-12.5], p =0.02), and had significantly worse thresholds at 1,3,4,6 kHz than those with low risk ( Figure ). There was no difference in PTA or thresholds at any frequency by CVD risk burden in young women, older men, or older women. Conclusions: CVD risk burden is associated with HL among young men, but not young women or older adults. CVD risk burden may be useful for identifying young men at risk for HL.

Abstract P264: Six-Year Incidence of Overweight and Obesity Among Diverse Hispanic/Latino Adults in the US: The Hispanic Community Health Study/ Study of Latinos

Baseline HCHS/SOL data recently showed that prevalence of obesity varied markedly by sex and Hispanic/Latino background. Despite increasing prevalence of obesity in the US, little data exist on incidence of overweight and obesity in diverse US Hispanic/Latino adults. This study examined ~6-year incidence rate of overweight and obesity in this population by demographic factors. Methods: HCHS/SOL is a multi-center prospective community-based study of 16,415 diverse Hispanic/Latino adults in the US, ages 18-74 at Visit 1 (2008-11). Visit 2 (2014-17) is ongoing, with 10,914 persons reexamined by August 2017. Analyses included 10,427 persons with complete data on body mass index (BMI) at both visits and on other variables of interest; underweight persons were excluded. Age-adjusted incidence rate of overweight (BMI 25.0-29.9 kg/m 2 ; among those normal-weight at baseline), and obesity (BMI > 30 kg/m 2 ; in those non-obese at baseline) was computed by sex and Hispanic/Latino background, accounting for the complex study design. Results: In ~6 years, 572 and 765 new cases of overweight and obesity were seen among baseline normal-weight (n=1924) and non-obese (n=5912) participants, respectively. Among men and women, age-adjusted incidence of overweight was 5.45 and 5.33 per 100 person years (PY); age-adjusted obesity incidence was 2.00 and 2.56 /100 PY. Incidence rates varied by background. Among men, overweight incidence was highest in those of Mexican background (6.95 /100 PY), and among women, in those of Puerto Rican background (6.94/ 100 PY). Incidence of obesity was highest in Dominican-background men (2.35/ 100 PY) and Cuban-background women (3.85/ 100 PY) ( Table ). Incidence rates varied slightly by age group, from 4.06 to 5.98/100 PY in those ages 18-44 and 65+ years. Conclusion: Of every 100 US Hispanic/Latino adults about 5 and 2 became overweight and obese each year, augmenting the existing high prevalence. Greater efforts are needed to prevent onset of overweight and obesity in this population from young adulthood onwards.

Stress and Resilience: Key Correlates of Mental Health and Substance Use in the Hispanic Community Health Study of Latino Youth.

This study examined associations of immigrant generation, acculturation, and sources of stress and resilience with four outcomes-depression symptoms, anxiety symptoms, alcohol susceptibility, and smoking susceptibility. We used data from 1466 youth (ages 8-16) enrolled in the Hispanic Community Health Study of Latino Youth (SOL Youth), a probability sample of Hispanic/Latino youth living in Chicago (IL), Miami (FL), Bronx (NY), and San Diego (CA). We found no evidence of an immigrant paradox. Greater children's acculturative stress was associated with depression/anxiety symptoms; greater parent's acculturative stress was associated with smoking susceptibility. Family functioning and children's ethnic identity were associated with fewer depression/anxiety symptoms and lower alcohol/smoking susceptibility. Although acculturation-related stressors increase youths' risks for poor mental health and substance use, the development of positive ethnic identities and close, well-functioning family support systems can help protect Latino/Hispanic children from the negative behavioral and health-related consequences of stress.

Life Course Adversity and Prior Miscarriage in a Pregnancy Cohort

BackgroundPrior studies indicate associations between preconception adversities and risk of miscarriage, but few have considered type (e.g., financial, substance use, abuse) or timing (e.g., childhood, adulthood) of adversities. We examined relationships between life course adversities in multiple domains and probability of miscarriage. MethodsData came from women with at least one previous pregnancy in the Pregnancy Outcomes and Community Health (1998–2004) study (n = 2,106). Life course adversities in domains of abuse/witnessing violence, loss of someone close, economic hardship, and substance abuse were assessed via questionnaire and categorized as occurring during childhood only, adulthood only, both childhood and adulthood, or neither. We also calculated a cumulative adversity score. We used logistic regression models to estimate associations between life course adversity measures and the probability of miscarriage, and examined effect modification by race/ethnicity and maternal education. All models were adjusted for maternal age, race/ethnicity, education, and marital status. ResultsThe odds of miscarriage were higher among women experiencing legal adversities during both childhood and adulthood (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3–2.8) compared with women not experiencing legal adversities, and higher among women experiencing substance use adversities in childhood only (OR, 1.4; 95% CI, 1.1–1.7) compared with women not experiencing substance use adversities. Each additional adversity was marginally significantly associated with a 10% increase in odds of preterm birth (OR, 1.1; 95% CI, 1.0–1.1). Among women with only one prior miscarriage, no adversity measures were associated with miscarriage. ConclusionsExposure to adversity in certain domains and across the life course modestly increased the odds of miscarriage.

Religiosity prevalence and its association with depression and anxiety symptoms among Hispanic/Latino adults.

ObjectivesReligion plays an important role in the lives of people in the United States. We examined the prevalence of religiosity among Hispanic/Latinos in four regions of the United States and looked at its correlation to depression and anxiety symptoms.DesignThe population-based Hispanic Community Health Study/ Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18–74 in four US cities from June 2008 to June 2011. Participants with complete data on religiosity (i.e., religious affiliation, frequency of attending religious activities and importance of religion), depression (assessed with the CESD-10), and trait anxiety (assessed with the STAI-10) were included in the present study. Distribution of religiosity is described by sociodemographic characteristics. Associations between religiosity with depression and anxiety were examined with logistic regression models controlling for sex, age group, education, Hispanic/Latino background, clinical center, and nativity.ResultsThe majority of the population (89.5%) reported having a religious affiliation. Weekly attendance at religious activities was reported by 41.6% of participants, while 20.6% did not attend any religious activities. Religion was very important to 63.9% and not at all important to 6.7% of the population. The CES-D scores and trait anxiety scores were not significantly related in the overall group to frequency of attending religious activity or perceived importance of religion. However, in age-stratified analyses, among older individuals (65+ years old) reporting “never” participating in religious activities compared to more than once per week was associated with an 80% higher likelihood of having high depressive symptomatology. Similarly, in the older age group, no religious affiliation or reporting that religion is “not at all important” was associated with greater anxiety symptomatology.ConclusionReligiosity varied by Hispanic/Latino background. Lack of religiosity was associated with elevated depressive or anxiety symptomology in older adults but not in young or middle-aged adults.

Clarifications on the Design and Interpretation of Conclusions from Health Canada\u2019s Study on Wind Turbine Noise and Health

It has been extensively communicated that Health Canada’s Community Noise and Health Study (CNHS) did not find positive associations between wind turbine noise (WTN) levels and any of the evaluated health outcomes, beyond an increase in the prevalence of high annoyance toward several wind turbine features. The authors emphasize that this general conclusion remains bound by the study strengths and limitations. Following the publication of the CNHS findings, there has been interest among some individuals to present alternative interpretations of the results originally reported by Michaud et al. (J Acoust Soc Am 139(3):1443–1454, 2016. https://doi.org/10.1121/1.4942391). While recognizing the importance of independent scientific re-evaluation and/or reinterpretation, this commentary serves to clarify and, where necessary, correct some of the information put forward by others. One factor that has been re-evaluated by external stakeholders is the subsample of participants that comprise the lowest WTN category. In their reanalysis, they have eliminated this category, or introduced alternative comparative data. This paper identifies substantial issues associated with the re-evaluation put forth. To thoroughly address these issues and to avoid further confusion or misinterpretation, the authors of the CNHS provide a comparison between the CNHS health condition prevalence data and nationally representative health-based surveys conducted in Canada during the same calendar year. In addition, this paper responds to comments received to date on the CNHS, including the study’s age range, the generalization of findings, the provision of raw data, and conclusions on the association between WTN level and health.

Maternal serum uric acid levels and blood pressure during pregnancy: A community-based cohort study

ObjectiveStudies find both very low and high serum uric acid (UA) levels are related to oxidative stress and to conditions such as cardiovascular diseases and chronic kidney disease in the general population. Pregnancy studies have focused only on high maternal UA. In present study, we tested whether unusually high and low levels of maternal serum UA are associated with increases in blood pressure (BP) during pregnancy. Study designThe Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th–27th week of pregnancy from 52 clinics in 5 Michigan communities (1998–2004). UA levels were measured in maternal blood collected at enrollment from a sub-cohort of 1223 participants. BP was abstracted from prenatal medical records; these analyses used highest recorded diastolic BP (DBP) and its companion systolic BP (SBP). Mean arterial pressure (MAP) was calculated using the formula of (2 × DBP + SBP)/3. Covariates, including maternal race/ethnicity, age at enrollment, education level, medical insurance status, body mass index before pregnancy, parity, smoking during pregnancy, alcohol use during pregnancy, and gestational week at blood collection, were considered as potential confounding variables. Associations between UA levels and BP were evaluated with linear spline or multiple linear regression models. Models’ robustness was examined with bootstrap estimation of variance, sensitivity analysis, and 10-fold cross-validation. ResultsBoth DBP and MAP had a J-shaped relationship with maternal UA; the breakpoints (nadirs) were 0.153 and 0.161 mmol/L UA, respectively. For DBP versus UA, adjusted regression coefficient (β) = −95.67 (standard error (SE) = 37.67 and p = 0.01) for the left and adjusted β = 48.95 (SE = 9.56 and p < 0.01) for the right; for MAP versus UA, adjusted β = −58.48 (SE = 31.42 and p = 0.06) for the left and adjusted β = 52.23 (SE = 11.39 and p < 0.01) for the right. Maternal SBP followed a positive linear trend with UA levels (adjusted β = 37.75, SE = 12.93, and p < 0.01). All results were robust. ConclusionExtreme high and low maternal serum UA levels may be informative in studying maternal blood pressure during pregnancy.

Resistance and Susceptibility to Mycobacterium tuberculosis Infection and Disease in Tuberculosis Households in Kampala, Uganda.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a major public health problem. Household contact studies identify children and adults along the spectrum from Mtb exposure to disease. In the Kawempe Community Health Study (conducted in Kampala, Uganda), 872 culture-confirmed pulmonary TB cases and their 2,585 contacts were enrolled during 2002-2012 and followed for up to 2 years each. Risk factors identified by time-to-event analysis for secondary TB differed among children, women, and men. Younger age (P = 0.0061), human immunodeficiency virus (HIV) (P = 0.0002), thinness (P = 0.01), absent bacille Calmette-Guérin vaccination (P = 0.002), and epidemiologic risk score (P < 0.0001) were risks for children. For women, risks were HIV (P < 0.0001), thinness (World Health Organization criteria; P < 0.0001), and epidemiologic risk score (P = 0.003). For men, HIV (P = 0.0007) and low body mass index (P = 0.008) resulted in faster progression to TB. Tuberculin skin testing (TST) identified contacts with Mtb infection and those with persistently negative TST. Risks for faster time to Mtb infection were identified, and included age (P = 0.0007), baseline TST induration (P < 0.0001), and epidemiologic risk score (P < 0.0001) only in children. Those with persistently negative TST comprised 10% of contacts but had no unique epidemiologic characteristics among adults. The burden of Mtb infection and disease is high in TB households, and risk factors for progression from exposure to infection and disease differ among children, women, and men.

Gender Difference in the Relationship of Albuminuria and Arterial Stiffness in Chinese Adults - a 6.6-Year Follow-Up Longitudinal Study

Background/Aims: Brachial–ankle pulse wave velocity (baPWV) reflects the stiffness of muscular arteries. Albuminuria is recognized as a marker of vascular dysfunction. We assessed the association between arterial stiffness and albuminuria in a population-based longitudinal study. Methods: 1116 adults aged ≥ 40 years in the Taichung Community Health Study (TCHS) in 2004 attended a follow-up visit in 2011. Albuminuria was defined as an urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. Arterial stiffness was defined as BaPWV ≥ 1540 cm/sec in males and BaPWV ≥ 1480 cm/sec in females, respectively. ∆baPWV was calculated as baPWV at follow-up minus baPWV at baseline, while ∆UACR was calculated as UACR at follow-up minus UACR at baseline. Multiple linear and logistic regression analyses were used to explore the relationship between albuminuria and arterial stiffness. Results: Among 652 subjects without arterial stiffness at baseline, 209 (32%) subjects developed incident arterial stiffness after an average of 6.6 years. In male subjects, baseline albuminuria was associated with development of arterial stiffness (odds ratio: 4.47, 95% confidence interval [CI]: 1.04–19.31) and ∆baPWV was modestly positively associated with ∆UACR. Conclusion: Our results indicated that male adults with albuminuria had an increased risk for developing arterial stiffness.

Cerebral hemodynamics in sleep apnea and actigraphy-determined sleep duration in a sample of the Hispanic community health study: study of Latinos

Cerebral hemodynamics in sleep apnea and actigraphy-determined sleep duration in a sample of the Hispanic community health study: study of Latinos

Genetic architecture of lipid traits in the Hispanic community health study/study of Latinos

BackgroundDespite ethnic disparities in lipid profiles, there are few genome-wide association studies investigating genetic variation of lipids in non-European ancestry populations. In this study, we present findings from genetic association analyses for total cholesterol, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides in a large Hispanic/Latino cohort in the U.S., the Hispanic Community Health Study / Study of Latinos (HCHS/SOL).MethodsWe estimated a heritability of approximately 20% for each lipid trait, similar to previous estimates in Europeans. To search for novel lipid loci, we performed conditional association analysis in which the statistical model was adjusted for previously reported SNPs associated with any of the four lipid traits. SNPs that remained genome-wide significant (P < 5 × 10−8) after conditioning on known loci were evaluated for replication.ResultsWe identified eight potentially novel lipid signals with minor allele frequencies <1%, none of which replicated. We tested previously reported SNP-trait associations for generalization to Hispanics/Latinos via a statistical framework. The generalization analysis revealed that approximately 50% of previously established lipid variants generalize to HCHS/SOL based on directional FDR r-value < 0.05. Some failures to generalize were due to lack of power.ConclusionsThese results demonstrate that many loci associated with lipid levels are shared across populations.