aOR Range Research Articles

Using high-resolution residential greenspace measures in an urban environment to assess risks of allergy outcomes in children

Despite reported health benefits of urban greenspace (gs), the epidemiological evidence is less clear for allergic disease. To address a limitation of previous research, we examined the associations of medium- and high-resolution residential gs measures and tree and/or grass canopies with allergic outcomes for children enrolled in the longitudinal cincinnati childhood allergy and air pollution study (ccaaps). We estimated residential gs based on 400 m radial buffers around participant addresses (n = 478) using the normalized differential vegetation index (ndvi) and land cover-derived urban greenspace (ugs) (tree and grass coverage, combined and separate) at 30 m and 1.5–2.5 m resolution, respectively. Associations between outdoor aeroallergen sensitization and allergic rhinitis at age 7 and residential gs measures at different exposure windows were examined using multivariable logistic regression models. A 10% increase in ugs-derived grass coverage was associated with an increased risk of sensitization to grass pollens (adjusted odds ratio [aor]: 1.27; 95% confidence interval = 1.02–1.58). For each 10% increase in ugs-derived tree canopy coverage, nonstatistically significant decreased odds were found for grass pollen sensitization, tree pollen sensitization, and sensitization to either (aor range = 0.87–0.94). Results similar in magnitude to ugs-tree canopy coverage were detected for ndvi and allergic sensitizations. High-resolution (down to 1.5 m) gs measures of grass- and tree-covered areas showed associations in opposite directions for different allergy outcomes. These data suggest that measures strongly correlated with tree canopy (e.g., ndvi) may be insufficient to detect health effects associated with proximity to different types of vegetation or help elucidate mechanisms related to specific gs exposure pathways.

Chronic medical conditions in U.S. adults with incarceration history.

To examine the associations between incarceration history and chronic medical conditions in a nationally representative sample of U.S. adults and whether risk for chronic medical conditions differ by sex and race among those with incarceration history. The data were from the 2012-2013 National Survey of Alcohol and Related Conditions III (N = 36,133). Multiple logistic regression was used to compare odds of a self-reported diagnosis for 24 chronic medical conditions by incarceration history, as well as by sex and race within those with incarceration history. 12.4% of adults (SE = 0.35) reported a history of incarceration. When adjusted for sociodemographic characteristics, smoking status, and past year alcohol use, incarceration history was associated with significantly increased odds of most chronic medical conditions (adjusted odds ratio [AORs] range = 1.20-3.41). When additionally adjusted for childhood adversity and stressful life events, odds remained significantly elevated for hypertension, myocardial infarction, minor heart conditions, stomach ulcers, arthritis, sleep problems, anemia, bowel, lung, and nerve problems, liver diseases, HIV/AIDS, and sexually transmitted diseases (AORs range = 1.14-2.78). Relative to men with incarceration history, women with incarceration history reported significantly increased odds of multiple chronic disease conditions (AORs range = 1.22-6.60). Hispanic or non-Hispanic Black individuals with incarceration history showed significantly reduced risk for several chronic medical conditions, relative to their non-Hispanic White counterparts (AORs range = 0.30-0.75). This study suggests that incarceration may be an important factor when considering health disparities, and also highlights the importance of acknowledging early adversity and ongoing life stressors when providing comprehensive health care for individuals with incarceration history. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Who experiences unmet need for mental health services and what other barriers to accessing health care do they face? Findings from Australia and Canada

To examine factors associated with unmet need for mental health services and links with barriers to access to care more broadly. The Commonwealth Fund International Health Policy Surveys from 2013 and 2016 were used to explore factors associated with unmet need for adults who experienced emotional distress for 1320 respondents in Australia and 2284 in Canada. Over one in five adults in Australia (21%) and in Canada (25%) experienced emotional distress, just over half said they received professional help (51% in Australia, 59% in Canada). The majority of those who did not get help indicated did not want to see a professional (37% in Australia, 30% in Canada). For those who did seek help, the factors associated with not receiving care included lower income, higher out-of-pocket health care costs, and poorer health. When compared with people with met needs, those with unmet needs for mental health services were more likely to also experience affordability, medication, and trust-related access barriers (AOR range 2.41 to 7.49 for the two countries, P<0.01). Including unmet needs for mental health services as part of regular reporting on access to care may bring attention to access barriers for people with mental health conditions.

Ambient ozone and fine particulate matter exposures and autism spectrum disorder in metropolitan Cincinnati, Ohio

BackgroundEpidemiological studies report fairly consistent associations between various air pollution metrics and autism spectrum disorder (ASD), with some elevated risks reported for different prenatal and postnatal periods. ObjectivesTo examine associations between ASD and ambient fine particulate matter (PM2.5) and ozone concentrations during the prenatal period through the second year of life in a case-control study. MethodsASD cases (n = 428) diagnosed at Cincinnati Children's Hospital Medical Center were frequency matched (15:1) to 6420 controls from Ohio birth records. We assigned daily PM2.5 and ozone estimates for 2005–2012 from US EPA's Fused Air Quality Surface Using Downscaling model to each participant for each day based on the mother's census tract of residence at birth. We calculated adjusted odds ratios (aORs) using logistic regression across continuous and categorical exposure window averages (trimesters, first and second postnatal years, and cumulative measure), adjusting for maternal- and birth-related confounders, both air pollutants, and multiple temporal exposure windows. ResultsWe detected elevated aORs for PM2.5 during the 2nd trimester, 1st year of life, and a cumulative period from pregnancy through the 2nd year (aOR ranges across categories: 1.41–1.44, 1.54–1.84, and 1.41–1.52 respectively), and for ozone in the 2nd year of life (aOR range across categories: 1.29–1.42). Per each change in IQR, we observed elevated aORs for ozone in the 3rd trimester, 1st and 2nd years of life, and the cumulative period (aOR range: 1.19–1.27) and for PM2.5 in the 2nd trimester, 1st year of life, and the cumulative period (aOR range: 1.11–1.17). DiscussionWe saw limited evidence of linear exposure-response relationships for ASD with increasing air pollution, but the elevated aORs detected for PM2.5 in upper exposure categories and per IQR unit increases were similar in magnitude to those reported in previous studies, especially for postnatal exposures.

Trauma Exposure, DSM-5 Post-Traumatic Stress Disorder, and Sexual Risk Outcomes

The current study examined associations between DSM-5 post-traumatic stress disorder (PTSD) and three sexual risk outcomes: presence of a sexually transmitted disease/infection, frequency of condom use, and sex with a known user of injection drugs. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, analyzed 2017), a nationally representative survey of non-institutionalized U.S. adults aged ≥18 years. Sexual outcomes and trauma exposure were assessed via self-report, and PTSD was assessed using a validated structured interview. Logistic and multinomial regression analyses examined associations between PTSD, PTSD symptom clusters, trauma type, and each sexual outcome. Lifetime PTSD was associated with increased odds of having a past-year sexually transmitted disease/infection and sex with a known injection drug user (AOR=1.54 and 1.74, respectively); fewer intrusion symptoms were associated with sometimes/fairly often condom use relative to very often. Reporting of adult sexual assault, assaultive violence, and other trauma as one's worst event was associated with increased odds of a past-year sexually transmitted disease/infection (AOR range, 1.69-4.56), whereas child maltreatment was associated with using condoms never/almost never in the past 12 months (AOR=1.40). No other significant findings emerged. The current study demonstrates an association between certain trauma exposures, PTSD symptoms, and an increased likelihood of sexual risk outcomes. Clinicians working with individuals with PTSD symptoms, particularly those who have been exposed to interpersonal trauma, should screen for the presence of these sequelae.

Associations of risk factors of e-cigarette and cigarette use and susceptibility to use among baseline PATH study youth participants (2013–2014)

IntroductionImproved understanding of the distribution of traditional risk factors of cigarette smoking among youth who have ever used or are susceptible to e-cigarettes and cigarettes will inform future longitudinal studies examining transitions in use. MethodsMultiple logistic regression analysis was conducted using data from youth (ages 12–17 years) who had ever heard of e-cigarettes at baseline of the PATH Study (n = 12,460) to compare the distribution of risk factors for cigarette smoking among seven mutually exclusive groups based on ever cigarette/e-cigarette use and susceptibility status. ResultsCompared to committed never users, youth susceptible to e-cigarettes, cigarettes, or both had increasing odds of risk factors for cigarette smoking, with those susceptible to both products at highest risk, followed by cigarettes and e-cigarettes. Compared to e-cigarette only users, dual users had higher odds of nearly all risk factors (aOR range = 1.6–6.8) and cigarette only smokers had higher odds of other (non-e-cigarette) tobacco use (aOR range = 1.5–2.3), marijuana use (aOR = 1.9, 95%CI = 1.4–2.5), a high GAIN substance use score (aOR = 1.9, 95%CI = 1.1–3.4), low academic achievement (aOR range = 1.6–3.4), and exposure to smoking (aOR range = 1.8–2.1). No differences were observed for externalizing factors (depression, anxiety, etc.), sensation seeking, or household use of non-cigarette tobacco. ConclusionsAmong ever cigarette and e-cigarette users, dual users had higher odds of reporting traditional risk factors for smoking, followed by single product cigarette smokers and e-cigarette users. Understanding how e-cigarette and cigarette users differ may inform youth tobacco use prevention efforts and advise future studies assessing probability of progression of cigarette and e-cigarette use.

Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario.

Methadone maintenance therapy (MMT) is associated with improved outcomes for children exposed to maternal opioid dependence in utero. We examined Ontario's population of pregnant women on MMT and determined the impact of timing of MMT initiation on perinatal outcomes. Cohort study. Ontario, Canada. Women eligible for public drug benefits and on MMT during pregnancy between 2005 and 2015. We stratified women based on their timing of MMT initiation: (1) stabilized prior to conception, (2) newly initiated prior to conception, (3) initiation in trimester 1, (4) initiation in trimester 2 or (5) initiation in trimester 3. The primary outcomes in the multivariable logistic regression analysis were key perinatal health indicators: small for gestational age, preterm birth, congenital anomalies, severe maternal morbidity, caesarean section and induced labor. Secondary outcomes were specific to maternal opioid dependence: neonatal abstinence syndrome (NAS), admission to a neonatal intensive care unit (NICU), NAS treatment, removal from mother's custody at hospital discharge and neonatal death. Among 1842 women on MMT during pregnancy, 87.6% (n=1614) initiated MMT before conception. Almost a quarter of their infants (22.2%; n=408) were born small for gestational age, 17.5% (n=323) were preterm and 5.9% (n=109) were born with a congenital anomaly. The odds of primary outcomes occurring did not differ based on timing of methadone initiation; however, infants of mothers who initiated methadone during pregnancy had up to a fourfold increase in the odds of social services removal at the hospital [adjusted odds ratio (aOR) range=3.70-4.19] compared with those whose mothers were stabilized on MMT prior to conception. Later initiation of methadone maintenance therapy among pregnant women in Ontario, Canada has not been found to be clearly related to most key perinatal adverse health outcomes.

Chronic Health Conditions Among US Veterans Discharged From Military Service for Misconduct.

Veterans who are discharged from military service due to misconduct are vulnerable to negative health-related outcomes, including homelessness, incarceration, and suicide. We used national data from the Veterans Health Administration for 218,608 veterans of conflicts in Iraq and Afghanistan that took place after the events of September 11, 2001, to compare clinical diagnoses between routinely-discharged (n = 203,174) and misconduct-discharged (n = 15,433) veterans. Misconduct-discharged veterans had significantly higher risk for all mental health conditions (adjusted odds ratio [AOR] range, 2.5–8.0) and several behaviorally linked chronic health conditions (AOR range, 1.2–5.9). Misconduct-discharged veterans have serious and complex health care needs; prevention efforts should focus on behavioral risk factors to prevent the development and exacerbation of chronic health conditions among this vulnerable population.

Health of Infants After ART-Treated, Subfertile, and Fertile Deliveries.

To assess the risk of adverse health outcomes for infants after assisted reproductive technology (ART)-treated and subfertile as compared with fertile deliveries. Live-born singleton infants ≥23 weeks' gestational age (GA) born in Massachusetts between July 1, 2004, and December 31, 2010, were analyzed by linking a clinical ART database with state vital records. χ2 tests were used to compare the outcomes of fertile (those without ART treatment or other indicators of infertility), subfertile (indicators of infertility, no ART), and ART-treated (linked to ART deliveries) mothers, stratified by GA. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated by using multivariate logistic regression within each GA stratum, controlling for maternal sociodemographic and health characteristics. Compared with infants of fertile mothers (n = 336 705), infants born to subfertile (n = 5043) or ART-treated (n = 8375) mothers were more likely to be preterm (aOR 1.39 [95% CI 1.26-1.54] and aOR 1.72 [95% CI 1.60-1.85], respectively) and have respiratory and gastrointestinal and/or nutritional conditions (aOR range: 1.12-1.18). When stratified by GA, infants of subfertile or ART-treated mothers were at greater risk for congenital malformations and infectious diseases as well as cardiovascular and respiratory conditions (aOR range: 1.30-2.61; 95% CI range: 1.02-4.59). Compared with infants born to subfertile mothers, infants born to ART-treated mothers were at lower risk for being small for GA and having congenital malformations and cardiovascular conditions and at higher risk for infectious disease conditions. Compared with infants born to fertile mothers, infants of subfertile and ART-treated mothers are at greater risk for adverse health outcomes at birth beyond prematurity. The occurrence and magnitude of these risks vary by GA and organ systems.

Exposure to disinfectant by-products and the risk of stillbirth in Massachusetts

ObjectivesWe examined stillbirths in relation to disinfection by-product (DBP) exposures including chloroform, bromodichloromethane (BDCM), dibromochloromethane, bromoform, trichloroacetic acid, dichloroacetic acid (DCAA), monobromoacetic acid and summary DBP measures (trihalomethanes (THM4), haloacetic...

Implications of false-positive results for future cancer screenings.

False-positive cancer screening results may affect a patient's willingness to obtain future screening. The authors conducted logistic regression analysis of 450,484 person-years of electronic medical records (2006-2015) in 92,405 individuals aged 50 to 75 years. Exposures were false-positive breast, prostate, or colorectal cancer screening test results (repeat breast imaging or negative breast biopsy ≤3 months after screening mammography, repeat prostate-specific antigen [PSA] test ≤3 months after PSA test result ≥4.0 ng/mL or negative prostate biopsy ≤3 months after any PSA result, or negative colonoscopy [without biopsy/polypectomy] ≤6 months after a positive fecal occult blood test). Outcomes were up-to-date status with breast or colorectal cancer screening. Covariates included prior screening history, clinical information (eg, family history, obesity, and smoking status), comorbidity, and demographics. Women were more likely to be up to date with breast cancer screening if they previously had false-positive mammography findings (adjusted odds ratio [AOR], 1.43 [95% confidence interval, 1.34-1.51] without breast biopsy and AOR, 2.02 [95% confidence interval, 1.56-2.62] with breast biopsy; both P<.001). The same women were more likely to be up to date with colorectal cancer screening (AOR range, 1.25-1.47 depending on breast biopsy; both P<.001). Men who previously had false-positive PSA testing were more likely to be up to date with colorectal cancer screening (AOR, 1.22 [P = .039] without prostate imaging/biopsy and AOR, 1.60 [P = .028] with imaging/biopsy). Results were stronger for individuals with more false-positive results (all P≤.005). However, women with previous false-positive colorectal cancer fecal occult blood test screening results were found to be less likely to be up to date with breast cancer screening (AOR, 0.73; P<.001). Patients who previously had a false-positive breast or prostate cancer screening test were more likely to engage in future screening. Cancer 2018;124:2390-8. © 2018 American Cancer Society.

Intrastate Variation in Treatment and Outcomes of Out-of-Hospital Cardiac Arrest

Objective: Our objective was to analyze and compare out-of-hospital cardiac arrest (OHCA) system of care performance and outcomes at the Medical Control Authority (MCA) level in the state of Michigan. We hypothesized that clinically and statistically significant variations in treatment and outcomes of OHCA exists within a single U.S. state. Methods: We performed a retrospective, observational study of all non-traumatic EMS-treated OHCA from the state of Michigan CARES registry for 2014–2015. Geocoding of the OHCA incident address was used to assign records to individual MCAs. MCA-based demographics, arrest characteristics, system of care performance and outcomes were quantified and compared. Associations between demographics, system of care parameters, and outcomes were examined at the MCA level. Results: A total of 8,115 records with complete data were available for analysis. Eleven MCAs met study inclusion criteria of >100 cases, producing a final sample size of 7,788 records (96%). Statistically significant variations in survival to hospital discharge ranged from 4.5% to 15% (p < 0.001) (Adjusted odds ratio [AOR] range 0.6–2.0) and survival with good neurologic outcome 2.7–12.5% (p < 0.001; AOR range 0.5–2.2,) were observed across MCAs. Bystander CPR ranged from 32% to 53% (p < 0.001) and bystander AED application ranged from 3.5% 11.5% (p < 0.05). Of patients admitted to the hospital alive, 29–68% received targeted temperature management. In hospital mortality ranged from 53.1% to 73.9% (p < 0.05). Conclusion: Significant intrastate variability in OHCA system of care performance and outcomes currently exist and are similar to what has been previously reported across North America almost a decade ago. This degree of variability highlights the opportunity to optimize modifiable factors within local systems of care to improve OHCA outcomes.

Prevalence of Mental Disorder and Service Use by Immigrant Generation and Race/Ethnicity Among U.S. Adolescents

To examine differences in lifetime prevalence of mental disorder and service use among U.S. adolescents by both immigrant generation and race/ethnicity. A total of 6,250 adolescents aged 13 to 18 years in the National Comorbidity Survey Replication Adolescent Supplement were assessed for lifetime prevalence of mood and/or anxiety disorders, behavior disorders, and mental health service use. Twelve groups defined by self-identified race/ethnicity (non-Hispanic white, Hispanic, non-Hispanic black, Asian) and immigrant generation (first, second, third, or more) were compared. Differences in prevalence of lifetime mental disorder were most apparent when immigrant generation and race/ethnicity were considered jointly. Compared to third+generation non-Hispanic white adolescents, the odds of mood/anxiety disorder were increased among second-generation Asian (adjusted odds ratio [AOR]= 2.51; 95% CI= 1.22-5.17) and third+generation Hispanic (AOR= 1.28; 95% CI= 1.00-1.63) but reduced among first-generation Asian (AOR= 0.27; 95% CI= 0.10-0.71) and second-generation non-Hispanic white adolescents (AOR= 0.50; 95% CI= 0.30-0.81). The odds of behavior disorder were lower among first-generation Asian (AOR= 0.26; 95% CI= 0.09-0.71) and all generations of non-Hispanic black adolescents (AOR range 0.43-0.55). Adjusting for lifetime disorder, first-generation Hispanic and non-Hispanic white adolescents and all generations of non-Hispanic black adolescents were less likely to receive mental health services (AOR range 0.24-0.55). Variation in risk of disorder by immigrant generation and race/ethnicity underscores the importance of considering social, economic, and cultural influences in etiologic and treatment studies of adolescent psychopathology. Lower rates of service use, particularly among first-generation immigrant adolescents, highlight the need to identify and address barriers to recognition and treatment of mental disorders among adolescents from immigrant and racial/ethnic minority backgrounds.

Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project

College entrance may be a strategically well-placed "point of capture" for detecting late adolescents with suicidal thoughts and behaviors (STB). However, a clear epidemiological picture of STB among incoming college students is lacking. We present the first cross-national data on prevalence as well as socio-demographic and college-related correlates for STB among first-year college students. Web-based self-report surveys were obtained from 13,984 first-year students (response rate 45.5%) across 19 colleges in 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States). Lifetime prevalence of suicidal ideation, plans, and attempts was 32.7%, 17.5%, and 4.3%, respectively. The 12-month prevalence was 17.2%, 8.8%, and 1.0%, respectively. About three-fourths of STB cases had onset before the age of 16 years (Q3= 15.8), with persistence figures in the range of 41% to 53%. About one-half (53.4%) of lifetime ideators transitioned to a suicide plan; 22.1% of lifetime planners transitioned to an attempt. Attempts among lifetime ideators without plan were less frequent (3.1%). Significant correlates of lifetime STB were cross-nationally consistent and generally modest in effect size (median adjusted odds ratio [aOR]= 1.7). Nonheterosexual orientation (aOR range 3.3-7.9) and heterosexual orientation with some same-sex attraction (aOR range 1.9-2.3) were the strongest correlates of STB, and of transitioning from ideation to plans and/or attempts (aOR range 1.6-6.1). The distribution of STB in first-year students is widespread, and relatively independent of socio-demographic risk profile. Multivariate risk algorithms based on a high number of risk factors are indicated to efficiently link high-risk status with effective preventive interventions.

Determinants of site of tuberculosis disease: An analysis of European surveillance data from 2003 to 2014.

BackgroundWe explored host-related factors associated with the site of tuberculosis (TB) disease using variables routinely collected by the 31 EU/EEA countries for national surveillance.MethodsLogistic regression models were fitted to case-based surveillance data reported to the European Centre for Disease Prevention and Control for TB cases notified from 2003 to 2014. Missing data on HIV infection and on susceptibility to isoniazid and rifampicin for many patients precluded the inclusion of these variables in the analysis. Records from Finland, Lithuania, Spain and the United Kingdom were excluded for lack of exact details of disease localisation; other records without one or more variable (e.g. previous treatment history, geographical origin) or who had mixed pulmonary and extrapulmonary disease or more than one form of extrapulmonary disease were also removed (total exclusion = 38% of 913,637 notifications).Results564,916 TB cases reported by 27 EU/EEA countries had exclusive pulmonary (PTB; 83%) or extrapulmonary (EPTB; 17%) disease. EPTB was associated with age <15 years (aOR: 5.50), female sex (aOR: 1.60), no previous TB treatment (aOR: 3.10), and geographic origin (aOR range: 0.52–3.74). Origin from the Indian subcontinent or Africa was most strongly associated with lymphatic, osteo-articular and peritoneal/digestive localization (aOR>3.7), and age <15 years with lymphatic (aOR: 17.96) and central nervous system disease (aOR: 11.41).ConclusionsAwareness of host-related determinants of site of TB is useful for diagnosis. The predilection for EPTB among patients originating from countries outside Europe may reflect strain preferences for disease localization, geographic/ethnic differences in disease manifestation and other factors, like HIV.

Maternal Substance Use Disorders and Infant Outcomes in the First Year of Life among Massachusetts Singletons, 2003-2010

To determine the association of maternal substance use disorders (SUDs) during pregnancy with adverse neonatal outcomes and infant hospital re-admissions, observational stays, and emergency department utilization in the first year of life. We analyzed 2 linked statewide datasets from 2002 to 2010: the Massachusetts Pregnancy to Early Life Longitudinal data system and the Massachusetts Bureau of Substance Abuse Services Management Information System. Generalized estimating equations were used to assess the association of maternal SUDs and neonatal outcomes and infant hospital-based care in the first year of life, controlling for maternal and infant characteristics. Maternal SUDs increased from 19.4 per 1000 live births in 2003 to 31.1 per 1000 live births in 2009. In the adjusted analysis, exposed neonates were more likely to be born preterm (aOR 1.85; 95% CI 1.75-1.96) and low birthweight (aOR 1.94; 95% CI 1.80-2.09). After controlling for maternal characteristics and preterm birth, SUD-exposed neonates were more likely to have intrauterine growth restriction, cardiac, respiratory, neurologic, infectious, hematologic, and feeding/nutrition problems, prolonged hospital stay, and higher mortality (aOR range 1.26-3.80). Exposed infants were more likely to be rehospitalized (aOR 1.10; 95% CI 1.04-1.17) but less likely to have an observational stay (aOR 0.90; 95% CI 0.82-0.99) or use the emergency department (aOR 0.87; 95% CI 0.83-0.90) in the first year of life. Infants born to mothers with SUD are at higher risk for adverse health outcomes in the perinatal period and are also more likely to be rehospitalized in the first year of life.

Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997–2011

PurposeTo compare the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or opioids to the use of acetaminophen without NSAIDs or opioids with respect to associations with birth defects. MethodsWe used data from the National Birth Defects Prevention Study (1997–2011). Exposure was self-reported maternal analgesic use from the month before through the third month of pregnancy (periconceptional). Adjusted odds ratios (aORs) were calculated to examine associations with 16 birth defects. ResultsCompared to acetaminophen, mothers reporting NSAIDs were significantly more likely to have offspring with gastroschisis, hypospadias, cleft palate, cleft lip with cleft palate, cleft lip without cleft palate, anencephaly, spina bifida, hypoplastic left heart syndrome, pulmonary valve stenosis, and tetralogy of Fallot (aOR range, 1.2–1.6). Opioids were associated with tetralogy of Fallot, perimembranous ventricular septal defect, and ventricular septal defect with atrial septal defect (aOR range, 1.8–2.3), whereas use of both opioids and NSAIDs was associated with gastroschisis, cleft palate, spina bifida, hypoplastic left heart syndrome, and pulmonary valve stenosis (aOR range, 2.0–2.9). ConclusionsCompared to periconceptional use of acetaminophen, selected birth defects occurred more frequently among infants of women using NSAIDs and/or opioids. However, we could not definitely determine whether these risks relate to the drugs or to indications for treatment.

Self-reported cognitive scales in a US National Survey: reliability, validity, and preliminary evidence for associations with alcohol and drug use.

To evaluate relationships between measures of cognitive functioning and alcohol or drug use among adults (≥18years) in the US general population. Two cognitive scales were created based on dimensionality and reliability of self-reported Executive Function Index items. Relationships between the two scales and validators were evaluated. Associations between the cognitive scales and past-year frequency of alcohol or drug use were estimated with adjusted odds ratios (aOR). United States, using the 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative adult sample selected by multi-stage probability sampling. 36 085 respondents. Past-year substance use outcome variables categorized binge drinking, marijuana, cocaine, opioid, sedative/tranquilizer and stimulant use as frequent (at least weekly to daily), infrequent (any to two to three times/month) or no use, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Key predictors were the two cognitive scales. Construct validators included education and functional impairment. Covariates included age, gender, income and race/ethnicity. Nine cognitive items fitted a two-factor model (comparative fit index=0.973): attention (five items) and executive functioning (four items). Both scales were associated positively with higher education (Ps<0.001) and negatively with functional impairment (Ps<0.001), demonstrating construct validity. Poorer attention was associated with frequent and infrequent binge drinking and use of drugs [aOR range=1.07 (binge drinking) to 1.72 (stimulants), Ps≤0.01]. Poorer executive functioning was associated with frequent binge drinking and use of drugs [aOR range=1.22 (binge drinking) to 2.03 (cocaine), Ps<0.001] and infrequent use of all drugs [aOR range=1.19 (marijuana) to 1.63 (cocaine), Ps<0.001]. Impairments in attention and executive functioning are positively associated with substance use in the US general population.

The impact of parental offending on offspring aggression in early childhood: a population-based record linkage study.

To examine the impact of parental criminal offending, both paternal and maternal, on offspring aggression at age 5 years, while also considering key risk factors, including parental mental illness, child's sex, and socioeconomic disadvantage. The sample comprised 69,116 children, with linked parental information, from the New South Wales Child Development Study, a population-based multi-agency, multi-generational record linkage study that combines information from a teacher-reported cross-sectional survey of early childhood development at age 5 years (the 2009 Australian Early Development Census; AEDC) with data obtained via administrative records from multiple sources (e.g., health, crime, education, and welfare). Hierarchical logistic regression analyses were conducted to determine the effects of maternal and paternal criminal court appearances (frequency and type of offending), and mental health service contacts, on offspring aggression measured in the AEDC. Having a parent with a history of offending was significantly associated with high levels of offspring aggression in early childhood. The strength of association was greatest when parents were involved in frequent (≥6 offences: adjusted odds ratio [aOR] range = 1.55-1.73) and violent (aOR range = 1.49-1.63) offending. Both maternal and paternal offending remained significant predictors of offspring aggression after accounting for parental mental illness, and associations were similar in magnitude for maternal and paternal offending histories. Parental history of severe criminal offending increased the risk of high levels of aggression in offspring during early childhood, highlighting the need for intervention with families during this key developmental period.

Cancer-related hospitalisations and ‘unknown’ stage prostate cancer: a population-based record linkage study

ObjectivesTo identify reasons for prostate cancer stage being recorded as ‘unknown’ in Australia's largest population-based cancer registry.DesignProspective population-based cohort.SettingNew South Wales (NSW) is the most populous state in Australia, with...