Exposure In Adolescents Research Articles

Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in adolescence: a cross-cultural study in Japan and Lithuania

Abstract Aims Cross-cultural studies of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on ICD-11 diagnostic criteria are scarce, especially in adolescence. The study aimed to evaluate the trauma exposure, prevalence and factors associated with PTSD and CPTSD in general populations of adolescents in Lithuania and Japan. Methods The study sample comprised 1746 adolescents from Lithuania (n = 832) and Japan (n = 914), 49.8% female. The mean age of study participants was 15.52 (s.d. = 1.64), ranging from 12 to 18 years. ICD-11 posttraumatic disorders were assessed using the International Trauma Questionnaire – Child and Adolescent version (ITQ-CA). Results More than half of the adolescents in a total sample (61.5%) reported exposure to at least one traumatic event in their lifetime, 80.0% in Lithuania and 44.6% in Japan, with a higher prevalence of interpersonal trauma in Lithuania and more natural disaster exposure in Japan. The prevalence of PTSD was 5.2% (95% CI 3.8–6.9%) and 2.3% (95% CI 1.4–3.5%), CPTSD 12.3% (95% CI 10.1–14.7%) and 4.1% (95% CI 2.9–5.5%) in Lithuanian and Japanese samples, respectively. Cumulative trauma exposure, female gender, loneliness and financial difficulties in family predicted both PTSD and CPTSD in the total sample. Loneliness discriminated CPTSD v. PTSD in both Lithuanian and Japanese samples. Conclusions This cross-cultural study is among the first which reported different patterns of trauma exposure in Asian Japanese and Lithuanian adolescents in Europe. Despite differences in trauma exposure and PTSD/CPTSD prevalence, we found similar predictors in both studies, particularly the importance of cumulative trauma exposure for PTSD/CPTSD, and social interpersonal factors for the risk of CPTSD. The study supports the universality of traumatic stress reactions to adverse life experiences in adolescence across cultures and regions and highlights different levels of traumatisation of adolescents in various countries.

Residential proximity to crops in relation to pesticide exposure and mental health in Ecuadorian children and adolescents: The ESPINA study

Residential proximity to crops in relation to pesticide exposure and mental health in Ecuadorian children and adolescents: The ESPINA study

Smoking exposure and allergic rhinitis in children and adolescents

Smoking exposure and allergic rhinitis in children and adolescents

Intensive outpatient acceptance and commitment therapy with exposure and response prevention for adolescents

Intensive treatments for youth obsessive-compulsive disorder (OCD) are important and underresearched. This study used three adolescent cases to assess the preliminary efficacy of an intensive treatment combining acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) for OCD. Participants received intensive treatment for 15 h per week for three weeks. Assessments were collected at pre-treatment, weekly during treatment, and at posttreatment. All participants ended treatment in the mild range of OCD severity with 32–60% reductions in symptoms.Participants also reported notable improvements in psychological flexibility and ended treatment in the non-clinical range of depression, anxiety, and stress. These results indicate promise and preliminary support for the use of ACT+ERP in intensive settings for adolescents with OCD. This paper focuses on the clinical application of these techniques.

The role of dietary factors on blood lead concentration in children and adolescents - Results from the nationally representative German Environmental Survey 2014–2017 (GerES V)

In industrialized nations, human lead exposure has decreased significantly in recent decades. Nevertheless, due to its toxic effects, this heavy metal remains a public health concern with children and adolescents being particularly at risk. In Europe nowadays, oral intake via food and drinking water is the predominant exposure pathway for lead. The objective of the present study was to investigate the association between dietary factors and blood lead (PbB) level of 3- to 17-year-old children and adolescents living in Germany, using data from the fifth German Environmental Health Survey (GerES V) and the Child and Adolescent Health Survey (KiGGS Wave 2). GerES V and KiGGS Wave 2 are two national population-representative studies conducted between 2014 and 2017, including measurement of lead concentrations in blood from 720 children and adolescents aged 3–17 years (mean age = 10.21, SD age = 4.36). Using multiple linear regression, sociodemographic and environmental characteristics as well as dietary factors could be identified as significant exposure determinants of PbB concentrations. Lead intake via domestic tap water was the strongest predictor of elevated PbB levels with 27.6% (p-value< .001) higher concentrations of highest compared to none lead intake via tap water. Other foods which were found to be relevant to PbB levels were meat, fruit, and fruit juice. While meat or fruit consumption were each associated with about 13% (p-value < .05) lower PbB levels, fruit juice drinking was associated with up to 12.2% (p-value = .04) higher PbB levels. In conclusion, results indicate the importance of dietary habits for lead exposure in children and adolescents. To protect vulnerable groups, it is recommended that future research and lead-reducing measures pay more attention to dietary links.

Chronic ethanol exposure during adolescence impairs simple spike activity of cerebellar Purkinje cells in vivo in mice

Cerebellar Purkinje cells (PCs) play critical roles in motor coordination and motor learning through their simple spike (SS) activity. Previous studies have shown that chronic ethanol exposure (CEE) in adolescents impairs learning, attention, and behavior, at least in part by impairing the activity of cerebellar PCs. In this study, we investigated the effect of CEE on the SS activity in urethane-anesthetized adolescent mice by in vivo electrophysiological recordings and pharmacological methods. Our results showed that the cerebellar PCs in CEE adolescent mice expressed a significant decrease in the frequency and an increase in the coefficient of variation (CV) of SS than control group. Blockade of ɤ-aminobutyric acid A (GABAA) receptor did not change the frequency and CV of SS firing in control group but produced a significant increase in the frequency and a decrease in the CV of SS firing in CEE mice. The CEE-induced decrease in SS firing rate and increase in CV were abolished by application of an N-methyl-D-aspartate (NMDA) receptor blocker, D-APV, but not by anα-amino-3-hydroxy-5-methyl −4-isoxazolepropionic acid (AMPA) receptor antagonist, NBQX. Notably, the spontaneous spike rate of molecular layer interneurons (MLIs) in CEE mice was significantly higher than control group, which was also abolished by application of D-APV. These results indicate that adolescent CEE enhances the spontaneous spike firing rate of MLIs through activation of NMDA receptor, resulting in a depression in the SS activity of cerebellar PCs in vivo in mice.

Optimising exposure for adolescents with public speaking anxiety: Affect labelling or positive coping statements?

Cognitive Behavioural Therapy (CBT) is the first line treatment for anxiety disorders in youth however many adolescents do not benefit. Behavioural exposure is believed to be the critical ingredient of CBT and research with adults has shown that labelling affect, but not positive coping statements, enhances exposure outcomes. However, many CBT protocols for young people involve using positive coping statements alongside exposure. We compared the effects of exposure with positive coping statements, affect labelling, and neutral statements on fear responses in adolescents (age 13–14 years) with public speaking anxiety as they delivered a series of speeches in front of a pre-recorded classroom audience. Self-rated anxiety, heart rate, and observer ratings of expressed anxiety were assessed pre-test, immediate post-test and at 1-week follow-up. Neither affect labelling nor positive coping statements enhanced exposure on any measure from pre-test to 1-week follow-up. While there was an initial advantage of exposure with positive coping statements for post-speech self-reported anxiety, this effect was not maintained, and there was a significant increase in anxiety from immediate post-test to 1-week follow-up in this condition, compared to the other conditions. The short-term benefits from generating positive coping statements may explain why this is often employed in the treatment of anxiety problems in young people, but also indicate that it may not confer any advantage in the longer term. These intriguing findings highlight the urgent need for further attention to improve understanding of how to optimise exposure in young people and maximise treatment outcomes.

Negative affect, childhood adversity, and adolescents' eating following stress

Obesity commonly emerges by adolescence and is associated with serious health consequences. Emotional eating (consuming calories, fats, and sugars in response to negative affect) may promote obesity; however, evidence is mixed as to whether negative affect increases obesogenic eating. Early-life adversity may shape malleable neurobiological systems that govern inhibitory control, physiological regulation, coping strategies, and eating behavior, contributing to greater obesogenic eating in response to negative affect. Therefore, this study tested whether childhood adversity moderates the association between negative affect and food consumption in a diverse sample of female adolescents. After completing a childhood adversity assessment, 157 female adolescents (13–17 years; 28.7% African American, 39.5% Hispanic/Latina, 31.8% Non-Hispanic White) rated their negative affect in response to a standard social stress paradigm before consuming a buffet lunch, which was evaluated for calories, added sugars, and solid fats consumed. Results did not support that negative affect exerted a main effect on eating behavior. However, negative affect and childhood adversity interacted to predict calories and solid fats consumed, such that negative affect was associated with more obesogenic eating for those with high adversity exposure but not for those with low adversity exposure. Adversity and affect did not interact to predict added sugars consumed. Findings support that eating patterns in response to negative affect may differ by childhood adversity history. Reducing children's adversity exposure and bolstering emotion regulation techniques for adolescents who have been exposed to adversity may provide pathways to protect health and well-being by reducing maladaptive eating patterns.

P049 Sleep Regularity is Associated with Stability of Daily Light Exposure in Adolescents During School and Vacation

Abstract Study Objectives Light is the main time cue for the human circadian system. Irregular sleep/wake patterns are associated with poor health outcomes, which could be mediated by irregular patterns of light exposure. The relationship between sleep and light regularity has not been directly explored. We investigated the relationship between sleep and light regularity in adolescents, across school-term and vacation, using novel metrics for measuring light regularity. Methods Daily sleep and light patterns were measured via wrist actigraphy in 104 adolescents (54% male, age M±SD = 17.17±0.80 years) over two weeks of school-term and a subsequent two-week vacation. The Sleep Regularity Index (SRI) was computed for each two-week block. Stability of daily light exposure was assessed using variation of mean daily light timing (MLiT), variation in daily photoperiod, and the Light Regularity Index. Associations between SRI and each light regularity metric were examined, and within-individual changes in metrics were examined between school and vacation. Results More regular sleep was significantly associated with more regular scores for each light variability metric, during school and vacation. Between school and vacation sleep regularity decreased and nuanced changes in light patterns were observed. Variability measured by the MLiT variable increased, whereas variability measured by the LRI and photoperiod variable decreased. Conclusions Adolescents with irregular sleep also have irregular patterns of light exposure. These findings suggest sleep regularity may be a useful proxy for variability in the main circadian time cue, meaning that irregular light exposure may carry implications for the developing adolescent circadian system.

Bidirectional association between light exposure and sleep in adolescents.

Sleep behaviour is controlled by both circadian and homeostatic influences. Changes in both factors are related to the delayed sleep timing observed in adolescence, which also generates restrictions in their sleep duration. In addition, the circadian factor explains part of the observed influence of light on sleep duration. We recorded 15high-school students for 23days (vacation: 11days; school term: 12days) using GENEactive accelerometers. We employed a repeated-measures analysis to explore the day-to-day bidirectional association between mean light exposure and sleep behaviour across a period with extreme variability in social pressures. Sleep onset was more than 30min earlier and sleep duration almost 20min longer when previous day light was 10 times more intense. Light intensity had a reduction of more than 20% as sleep ended 1hr later. Besides, sleep onset and offset were both later during vacation than on school days (almost 2hr and 4hr, respectively) and free days (almost 1hr, respectively). Therefore, sleep duration was almost 2hr longer on vacation and free days than on school days. On the other hand, light exposure intensity was twice as high during vacation days when adjusted by sleep timing. Insufficient sleep duration is a major problem for adolescents. Although we found that light exposure was associated with longer sleep duration, the influence of school start times was greater and ended up prevailing, which explained the short sleep durations observed on school days.

Urinary Polycyclic Aromatic Hydrocarbon Metabolites Are Associated with Biomarkers of Chronic Endocrine Stress, Oxidative Stress, and Inflammation in Adolescents: FLEHS-4 (2016-2020).

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants of public health concern. Multiple biological mechanisms have been hypothesized to contribute to PAHs-associated adverse health effects. Little is known about the impact of PAHs on endocrine stress and inflammation in adolescence. We examined 393 Flemish adolescents (14–15 years) cross-sectionally, measured urinary concentrations of hydroxylated naphthalene, fluorene, phenanthrene and pyrene metabolites, and calculated the sum of all measured metabolites. We determined hair cortisol concentration (HCC) as endocrine stress biomarker, leucocyte counts and neutrophil–lymphocyte ratio (NLR) in peripheral blood as inflammatory biomarkers, and urinary 8-oxo-7,8-dihydro-2’-deoxyguanosine (8-oxodG) concentration as oxidative stress biomarker. Exposure–response associations were analyzed by multiple regression, adjusted for a priori selected covariates. A doubling of 1-hydroxypyrene concentration was associated with a factor of 1.13 (95% CI: 1.03, 1.24) increase in HCC and a factor of 1.07 (95% CI: 1.02, 1.13) increase in 8-oxodG. Doublings of 2- and 3-hydroxyphenanthrene concentrations were associated with a factor of 1.08 (95% CI: 1.02, 1.14) and 1.06 (95% CI: 1.00, 1.12) increase in 8-oxodG, respectively. Doubling of 2-hydroxyphenanthrene and of the sum of 2- and 3-hydroxyfluorene was associated with, respectively, a factor of 1.08 (95% CI: 1.02, 1.14) and 1.06 (95% CI: 1.01, 1.13) increase in NLR. Our results indicate the glucocorticoid pathway as a potential target for PAH exposure in adolescents and suggest oxidative stress, endocrine stress, and inflammation in adolescence as underlying mechanisms and early markers for PAH-related adverse health effects.

Physiological Responses at Rest and Exercise to High Altitude in Lowland Children and Adolescents.

During the last decades, the number of lowland children exposed to high altitude (HA) has increased drastically. Several factors may influence the development of illness after acute HA exposure on children and adolescent populations, such as altitude reached, ascent velocity, time spent at altitude and, especially, their age. The main goal of this study was to evaluate the resting cardiorespiratory physiological and submaximal exercise responses under natural HA conditions by means of the six-minute walking test (six MWT). Secondly, we aimed to identify the signs and symptoms associated with acute mountain sickness (AMS) onset after acute HA exposure in children and adolescents. Forty-two children and adolescents, 18 boys and 24 girls aged from 11 to 15 years old, participated in this study, which was performed at sea level (SL) and during the first 42 h at HA (3330 m). The Lake Louise score (LLS) was recorded in order to evaluate the evolution of AMS symptoms. Submaximal exercise tests (six MWT) were performed at SL and HA. Physiological parameters such as heart rate, systolic and diastolic blood pressure, respiratory rate and arterialized oxygen saturation were measured at rest and after ending exercise testing at the two altitudes. After acute HA exposure, the participants showed lower arterial oxygen saturation levels at rest and after the submaximal test compared to SL (p < 0.001). Resting heart rate, respiratory rate and diastolic blood pressure presented higher values at HA (p < 0.01). Moreover, heart rate, diastolic blood pressure and dyspnea values increased before, during and after exercise at HA (p < 0.01). Moreover, submaximal exercise performance decreased at HA (p < 0.001). The AMS incidence at HA ranged from 9.5% to 19%, with mild to moderate symptoms. In conclusion, acute HA exposure in children and adolescent individuals produces an increase in basal cardiorespiratory parameters and a decrement in arterial oxygen saturation. Moreover, cardiorespiratory parameters increase during submaximal exercise at HA. Mild to moderate symptoms of AMS at 3330 m and adequate cardiovascular responses to submaximal exercise do not contraindicate the ascension of children and adolescents to that altitude, at least for a limited period of time.

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

BackgroundDuring the first wave of COVID‐19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID‐19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID‐19 and the previous year. For poisoning admissions during COVID‐19, we also evaluated the cause by age and clinical outcomes.MethodsThis retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol‐poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre‐COVID‐19 reference period (same dates in 2019).ResultsHospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID‐19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15‐ to 18‐year‐olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15‐ to 18‐year‐olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001).ConclusionThe Iranian methanol poisoning outbreak during the first wave of COVID‐19 was associated with significantly increased hospitalization rates among children and adolescents—including at least six pediatric in‐hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.

An Examination of Risk Factors for Tobacco and Cannabis Smoke Exposure in Adolescents Using an Epigenetic Biomarker.

Objective: Evolving patterns of nicotine and cannabis use by adolescents require new tools to understand the changing epidemiology of these substances. Here we describe the use of a novel epigenetic biomarker sensitive to both tobacco and cannabis smoke in a longitudinal sample of high-risk adolescents. We examine risk factors for positivity for this epigenetic biomarker in comparison to positivity for conventional serum biomarkers of nicotine and cannabis use.Method: Eastern Iowa 10th graders who had a friend or family member who smoked were eligible to participate in a longitudinal study over 10–12th grades. Subjects provided self-report data on nicotine, tobacco, and cannabis use patterns as well as blood samples that were used for serum cotinine and THC assays. DNA was prepared for analysis of methylation at the CpG cg05575921, a sensitive indicator of smoke exposure. Relationships between positivity for each these biomarkers and a variety of risk factors, including demographics, family and peer relationships, psychopathology, willingness to smoke, and perceptions of typical cigarette and cannabis users, were examined at the 10th (n = 442), 11th (n = 376), and 12th (n = 366) grade timepoints.Results: A increasing proportion of subjects were positive for cotinine (5–16%), THC (3–10%), and cg05575921 methylation (5–7%) across timepoints, with some overlap. Self-reported combusted tobacco and cannabis use was strongly correlated with all biomarkers, whereas cg05575921 methylation was not correlated with reported e-cigarette use. Dual users, defined as those positive for nicotine and THC in the 12th grade showed the greatest cumulative smoke exposure, indicated by cg05575921 methylation. Subjects reported more positive attitudes toward cannabis users than cigarette smokers, and willingness to smoke and positive perceptions of tobacco and cannabis smokers were significant risk factors for biomarker positivity across timepoints.Conclusion: We conclude that measurement of cg05575921 methylation in adolescents is a useful tool in detecting tobacco smoking in adolescents, and may be a novel tool for the detection of cannabis smoking and cannabis and tobacco co-use, though non-combusted forms of nicotine use do not appear to be detectable by this method.

Long-term residential exposure to air pollution is associated with hair cortisol concentration and differential leucocyte count in Flemish adolescent boys

BackgroundExposure to air pollution and traffic noise are associated with adverse health outcomes in adolescents. Chronic endocrine stress and systemic inflammation have been hypothesized to underlie the adverse health effects. Simultaneous assessment of inflammation and chronic endocrine stress in epidemiological studies is lacking. The aim of the study was to investigate biomarkers of chronic endocrine stress and inflammation in relation to long-term residential exposure to air pollution and traffic noise in adolescents. MethodsIn Flemish adolescents (14–15 years), we determined hair cortisol concentration (HCC) as a chronic stress biomarker in 3-cm scalp-near hair sections (n = 395), and leucocyte and leucocyte subtype counts (neutrophils, monocytes, lymphocytes) as inflammatory biomarkers in peripheral blood (n = 385). Daily particulate matter (PM2.5, PM10), nitrogen dioxide (NO2) and black carbon (BC) concentrations were modelled at the residential address and averaged over 3-month and 1-year periods prior to sampling. Residential traffic noise level was estimated and classified in 5 dB intervals. Sex-specific associations between residential exposures and effect biomarkers were studied using linear regression models, adjusted for a priori selected covariates. ResultsIn boys, HCC increased with a factor 1.30 (95% CI: 1.10, 1.54) for an increase in 1-year mean NO2 from the 25th to 75th percentile (p75/p25), after adjustment for age, BMI, personal and neighborhood socioeconomic status. The corresponding estimate for PM10 was 1.24 (95% CI: 1.02, 1.51). Total leucocyte count in boys, adjusted for the aforementioned covariates and recent health complaints, was positively associated with PM2.5, PM10, NO2 and BC. In particular, the neutrophil count increased with a factor 1.11 (95% CI: 1.03, 1.19) for a (p75/p25)-factor increase in 1-year mean BC, corresponding estimates for PM2.5, PM10 and NO2 were 1.10 (95% CI: 1.01, 1.19), 1.10 (95% CI: 1.01, 1.20) and 1.08 (95% CI: 1.00, 1.16). Lymphocyte count increased with a factor 1.05 (95% CI: 1.01, 1.10) for a (p75/p25)-factor increase in 1-year mean NO2. Similar results were observed for 3-month mean exposures. Results were robust to adjustment for recent air pollution exposure. In girls, air pollutants were not associated with HCC or differential leucocyte count. Residential traffic noise level was not associated with HCC or leucocyte counts in boys nor girls. ConclusionsLong-term residential exposure to air pollutants was positively associated with chronic endocrine stress and inflammation in adolescent boys, not in girls. This study may contribute to a better understanding of the early pathophysiological changes that may underlie adverse health effects of air pollution exposure in adolescents.

Relationships between di-(2-ethylhexyl) phthalate exposure and lipid metabolism in adolescents: Human data and experimental rat model analyses

In recent years, the incidence of lipid metabolism disorders in adolescents has gradually increased, and the effects of DEHP on lipid metabolism have received widespread attention. In this study, 463 adolescents aged 16–19 years were enrolled as subjects. This study analyzed the associations between the urinary levels of DEHP metabolites (MEHP, MEOHP, MEHHP, MECPP, MCMHP, and ∑DEHP) and BMI, WHR, WtHR, VAI, LAP, the plasma levels of lipids (TC, TG, HDL-C, and LDL-C), and the peripheral blood leukocyte mRNA levels of SREBP-2, SR-BI, LDLR, and NR1H3. Animal experiments were performed to confirm and expand findings. Wistar rats were administered DEHP at 0, 5, 50, and 500 mg/kg/d for 8 weeks. The serum and liver levels of TC, TG, HDL-C, and LDL-C, and the liver mRNA and protein levels of SREBP-2, SR-BI, LDLR, and NR1H3 were measured. The results showed that WHR, VAI, and LAP were significantly positively associated with the urinary levels of MECPP and ∑DEHP; the plasma HDL-C level was significantly negatively associated with the levels of MECPP, MCMHP and ∑DEHP; the peripheral blood leukocyte mRNA levels of SREBP-2, NR1H3, and LDLR were significantly positively correlated with the MCMHP level; and the SR-BI mRNA level was significantly positively correlated with the levels of MECPP and MCMHP in adolescents. Moreover, the results of animal experiments showed that DEHP exposure significantly increased the serum levels of TC, HDL-C, and LDL-C in 500 mg/kg/d group, as well as the liver levels of TC and HDL-C, up-regulated SREBP-2 mRNA and protein expression in 50 and 500 mg/kg/d groups. DEHP exposure significantly down-regulated SR-BI and NR1H3 protein expression in the liver of the 500 mg/kg/d group rats. Our findings indicate that DEHP exposure can affect lipid metabolism in adolescents by regulating the expression of lipid metabolism-related genes.

Abstract 027: Individual-level Fine Particulate Air Pollution Is Associated With Arrhythmia In Adolescents

Introduction: Fine particulate (PM 2.5 ) exposure has been related to higher propensity of arrhythmias in adults. However, the association between PM 2.5 exposure and arrhythmia in adolescents remains unclear. Hypothesis: PM 2.5 exposure is related to an acute increase in numbers of arrhythmic heartbeats in adolescents. Methods: We used data collected from 421 adolescents in the Penn State Child Cohort (PSCC) follow-up examination for this report. From each participant, we obtained 24-hour beat-to-beat ECG data using a 12-lead Holter ECG. From which, arrhythmias, including premature ventricular contraction (PVC) and premature atrial contraction (PAC), were identified. The number of PVCs and PACs every 30 minutes were analyzed with individual-level 30-minute average PM 2.5 concentrations obtained by using a personal minute-by-minute PM 2.5 monitor for 24 hours in parallel to the ECG. Thus, each participant contributed 48 30-minute segments of arrhythmia and PM 2.5 data. Polynomial distributed lag models within a framework of a negative binomial model were used to assess the segment-specific and cumulative effect of PM 2.5 concentration on numbers of PVC and PAC, adjusting for age, race, sex, BMI percentile, temperature, and humidity. Results: The mean (SD) age of PSCC was 16.9 (2.2) years, with 54% males, and 78% whites. The 30-minute mean (SD) of PM 2.5 concentration was 14.4 (45.4) μg/m 3 , while PVC and PAC counts were 0.2 (2.0) and 0.5 (4.0). As shown in the table, 10 μg/m 3 increases in PM 2.5 concentration 0.5-2.0 hours prior to the ECG measures (lags 1-3) each were associated with 2% increase in PVC counts (all p&lt;0.05). Cumulatively, a 10 μg/m 3 increment in PM 2.5 was associated with a 5% (1% - 10%) increase in PVC counts within 2 hours after exposure. PM 2.5 was not related to PAC counts. Conclusion: Individual-level exposure to PM 2.5 is associated with an acute increased number of ventricular arrhythmia in population-based adolescents. The time course of the effect of PM 2.5 on ventricular arrhythmia is within 2 hours after exposure.

Liraglutide pharmacokinetics and exposure-response in adolescents with obesity.

SummaryBackgroundObesity in adolescence presents a major public health challenge, often leading to obesity in adulthood with associated chronic disease.ObjectivesThis study aimed to perform a population pharmacokinetic and exposure‐response analysis of liraglutide by meta‐analysis of data from trials conducted in children, adolescents and adults with obesity.MethodsThe population pharmacokinetic analysis investigated the effect of covariates body weight, age group (children, adolescents and adults) and sex on liraglutide exposure in adolescents compared with previous results in adults. The exposure‐response relationship of liraglutide for the change from baseline in body mass index standard deviation score (BMI SDS) was evaluated in adolescents and compared to that in adults.ResultsBody weight was the main covariate affecting liraglutide exposure, with lower exposures at higher body weights, whereas age group was of no importance and sex was of little importance. An exposure‐response relationship was demonstrated for liraglutide in both adolescents and adults as the decrease in BMI SDS from baseline increased in an exposure‐dependent manner with increasing liraglutide exposure.ConclusionsThe population pharmacokinetic analysis supported similar liraglutide exposures in adolescents and adults; body weight was the most important covariate affecting exposure. An exposure‐response relationship was established for liraglutide.

Firearm Exposure and Storage Practices in the Homes of Rural Adolescents.

IntroductionRural areas have higher rates of firearm-related unintentional and suicide deaths. Having access to a firearm greatly increases suicide risk. Safe firearm storage can be a major factor in preventing these tragedies. In this study we evaluated firearm exposure and storage practices in rural adolescents’ homes.MethodsAn anonymous survey was administered to a convenience sample of attendees at the 2019 Iowa FFA (formerly Future Farmers of America) Leadership Conference. We performed descriptive, bivariate and multivariable logistic regression analyses.ResultsA total of 1,382 adolescents participated; 51% were males and 49% were females. Respondents were 13–18 years old, and 53% lived on a farm, 18% in the country/not on a farm, and 29% in town. Almost all (96%) self-identified as White/Caucasian. In their homes, 84% reported having rifles/shotguns, 58% reported having handguns, and 56% reported having both rifles/shotguns and handguns. Males were significantly more likely than females to report having firearms in their home (P<0.001). The likelihood of having rifles/shotguns was greater if living on a farm (odds ratio (OR) 4.19, 95% confidence interval (CI), 2.99–5.88) or in the country/not a farm (OR 2.74, 95% CI, 1.78–4.24) compared to those in town. Similarly, the presence of handguns in the home was increased if living on a farm compared to in town (OR 1.70, 95% CI 1.32–2.18). Rifles/shotguns and handguns were stored unlocked and/or loaded at least some of the time in 62% and 58% of homes, respectively. Those who lived on farms compared to in towns were more likely to have rifles/shotguns (OR 1.83, 95% CI 1.35–2.46) and handguns (OR 1.58, 95% CI 1.10–2.27) stored unlocked. For homes with unlocked rifles/shotguns, 46% stored ammunition unlocked. For homes with unlocked handguns, 38% stored ammunition unlocked. Among those aware of firearm storage in their home, 82% (802/974) reported at least one firearm stored either unlocked and/or loaded at least some of the time.ConclusionThe vast majority of rural adolescents we surveyed live in homes with firearms, and a large proportion of those firearms are not stored safely. Widespread efforts are needed to educate rural families about the importance of proper firearm and ammunition storage.

Exposure to PM2.5 and Obesity Prevalence in the Greater Mexico City Area.

Exposure to PM2.5 has been associated with the prevalence of obesity. In the Greater Mexico City Area (GMCA), both are ranked among the highest in the world. Our aim was to analyze this association in children, adolescents, and adults in the GMCA. We used data from the 2006 and 2012 Mexican National Surveys of Health and Nutrition (ENSANUT). Participants’ past-year exposure to ambient PM2.5 was assessed using land use terms and satellite-derived aerosol optical depth estimates; weight and height were measured. We used survey-adjusted logistic regression models to estimate the odds ratios (ORs) of obesity (vs. normal-overweight) for every 10 µg/m3 increase in annual PM2.5 exposure for children, adolescents, and adults. Using a meta-analysis approach, we estimated the overall odds of obesity. We analyzed data representing 19.3 million and 20.9 million GMCA individuals from ENSANUT 2006 and 2012, respectively. The overall pooled estimate between PM2.5 exposure and obesity was OR = 1.96 (95% CI: 1.21, 3.18). For adolescents, a 10 µg/m3 increase in PM2.5 was associated with an OR of 3.53 (95% CI: 1.45, 8.58) and 3.79 (95% CI: 1.40, 10.24) in 2006 and 2012, respectively. More studies such as this are recommended in Latin American cities with similar air pollution and obesity conditions.