Previous studies suggest that prenatal immune challenges may elevate the risk of schizophrenia and related psychoses in offspring, yet there has been limited research focused on maternal bacterial ...infection. The authors hypothesized that maternal bacterial infection during pregnancy increases offspring risk of psychotic disorders in adulthood, and that the magnitude of this association varies as a function of severity of infectious exposure and offspring sex.
The authors analyzed prospectively collected data from 15,421 pregnancies among women enrolled between 1959 and 1966 at two study sites through the Collaborative Perinatal Project. The sample included 116 offspring with confirmed psychotic disorders. The authors estimated associations between maternal bacterial infection during pregnancy and psychosis risk over the subsequent 40 years, stratified by offspring sex and presence of reported parental mental illness, with adjustment for covariates.
Maternal bacterial infection during pregnancy was strongly associated with psychosis in offspring (adjusted odds ratio=1.8, 95% CI=1.2-2.7) and varied by severity of infection and offspring sex. The effect of multisystemic bacterial infection (adjusted odds ratio=2.9, 95% CI=1.3-5.9) was nearly twice that of less severe localized bacterial infection (adjusted odds ratio=1.6, 95% CI=1.1-2.3). Males were significantly more likely than females to develop psychosis after maternal exposure to any bacterial infection during pregnancy.
The study findings suggest that maternal bacterial infection during pregnancy is associated with an elevated risk for psychotic disorders in offspring and that the association varies by infection severity and offspring sex. These findings call for additional investigation and, if the findings are replicated, public health and clinical efforts that focus on preventing and managing bacterial infection in pregnant women.
•Gestational and childhood phthalate exposures may be associated with behaviors.•Childhood exposure to phthalate mixtures may be associated with behaviors.•MCNP, MEP, and MBzP were the most important ...components of this mixture.•Measurement error was accounted for in urinary phthalate metabolite concentrations.
Early-life phthalate exposures may adversely influence neurodevelopment by disrupting thyroid hormone homeostasis, altering brain lipid metabolism, or reducing gonadal hormone concentrations. Previous literature examining gestational phthalate exposure and child behavior were inconclusive and few prospective studies have examined childhood phthalate exposure, particularly phthalate mixtures. We investigated whether gestational and childhood phthalate exposures were associated with child behavior.
We used data from 314 mother–child pairs in the HOME Study, a longitudinal pregnancy and birth cohort that enrolled pregnant women from Cincinnati, Ohio. We quantified urinary concentrations of 11 phthalate metabolites in samples collected twice during gestation from women and six times from their children when they were ages 1, 2, 3, 4, 5, and 8 years. We assessed children’s behavior at ages 2, 3, 4, 5, and 8 years using the Behavioral Assessment System for Children-2. Using linear mixed models, we estimated covariate-adjusted associations of measurement-error-corrected gestational and childhood phthalate metabolite concentrations (per interquartile range increase) with repeated child behavior assessments. We used Weighted Quantile Sum (WQS) regression to estimate the association of phthalate mixtures with child behavior.
Gestational mono(3-carboxypropyl) phthalate (MCPP) concentrations were associated with more problem behaviors (internalizing: β = 0.9, 95% confidence interval CI = -0.1, 1.9; externalizing: β = 1.0, 95%CI = -0.1, 2.0; behavioral symptoms index BSI: β = 1.1, 95%CI = 0.1, 2.1). Higher childhood monobenzyl phthalate (MBzP) (β = 1.4; 95%CI = 0.0, 2.7), monocarboxynonyl phthalate (MCNP) (β = 3.2; 95%CI = 1.6, 4.8), monocarboxyoctyl phthalate (MCOP) (β = 0.9; 95%CI = 0.0, 1.7), MCPP (β = 1.8; 95%CI = 0.2, 3.5), and monoethyl phthalate (MEP) (β = 1.6; 95%CI = 0.1, 3.1) concentrations were associated with higher BSI composite scores. Consistent with this, the weighted childhood phthalate index was associated with more problem behaviors (internalizing: β = 1.5, 95%CI = −0.2, 3.1; externalizing: β = 1.7, 95%CI = 0.1, 3.5; BSI: β = 1.7, 95%CI = 0.2, 3.2); MBzP, MCNP, and MEP largely contributed to these associations.
Our findings suggest that childhood exposure to phthalate mixtures may be associated with children’s problem behaviors.
e-Cigarettes are the most commonly used tobacco product among young adults (YAs). Despite the harms of nicotine exposure among YAs, there are few, if any, empirically tested vaping cessation ...interventions available.
To determine the effectiveness of a text message program for vaping cessation among YAs vs assessment-only control.
A parallel, 2-group, double-blind, individually randomized clinical trial was conducted from December 2019 to November 2020 among YA e-cigarette users. Eligible individuals were US residents aged 18 to 24 years who owned a mobile phone with an active text message plan, reported past 30-day e-cigarette use, and were interested in quitting in the next 30 days. Participants were recruited via social media ads, the intervention was delivered via text message, and assessments were completed via website or mobile phone. Follow-up was conducted at 1 and 7 months postrandomization; follow-up data collection began January 2020 and ended in November 2020. The study was prespecified in the trial protocol.
All participants received monthly assessments via text message about e-cigarette use. The assessment-only control arm (n = 1284) received no additional intervention. The active intervention arm (n = 1304) also received This is Quitting, a fully automated text message program for vaping cessation that delivers social support and cognitive and behavioral coping skills training.
The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 7 months analyzed under intention-to-treat analysis, which counted nonresponders as vaping. Secondary outcomes were 7-day ppa under intention-to-treat analysis and retention weighted complete case analysis of 30-day and 7-day ppa.
Of the 2588 YA e-cigarette users included in the trial, the mean (SD) age was 20.4 (1.7) years, 1253 (48.4%) were male, 2159 (83.4%) were White, 275 (10.6%) were Hispanic, and 493 (19.0%) were a sexual minority. Most participants (n = 2129; 82.3%) vaped within 30 minutes of waking. The 7-month follow-up rate was 76.0% (n = 1967), with no differential attrition. Abstinence rates were 24.1% (95% CI, 21.8%-26.5%) among intervention participants and 18.6% (95% CI, 16.7%-20.8%) among control participants (odds ratio, 1.39; 95% CI, 1.15-1.68; P < .001). No baseline variables moderated the treatment-outcome relationship, including nicotine dependence.
Results of this randomized clinical trial demonstrated that a tailored and interactive text message intervention was effective in promoting vaping cessation among YAs. These results establish a benchmark of intervention effectiveness.
ClinicalTrials.gov Identifier: NCT04251273.
Triclosan exposure may decrease circulating thyroxine levels or cause neuron apoptosis, which in turn may adversely affect neurodevelopment. However, few studies have examined the association of ...early life triclosan exposure with child behavior.
To quantify the association between early-life triclosan exposure and child behavior at age 8-years in 202 mother-child pairs from the HOME study (Cincinnati, OH; enrolled: 2003–2006).
We quantified urinary triclosan concentrations up to 3 times in mothers (16-weeks, 26-weeks, and delivery) and up to 6 times in children (1, 2, 3, 4, 5, and 8 years). Parents rated children's problem behaviors at age 8-years using the Behavioral Assessment System for Children-2 (BASC-2). Adjusting for covariates and accounting for exposure measurement error, we estimated changes in behavior problem scores per 10-fold increase in mean gestational and childhood triclosan concentrations. In addition, we estimated sex-specific associations.
Child sex modified the association of gestational and childhood triclosan with several BASC-2 scales (sex × triclosan p-values < 0.2). In boys, increasing gestational triclosan was associated with higher behavioral symptom index (β: 4.5; 95% CI: 1.0, 8.1), externalizing problems (β: 5.0; 95% CI: 1.2, 9.0), attention problem (β: 6.6; 95% CI: 2.4, 11), hyperactivity (β: 6.4; 95% CI: 2.1, 11), and somatization (β: 3.8; 95% CI: 0.3, 7.3) scores. In contrast, triclosan-BASC-2 associations in girls were generally null and not statistically significant. We observed similar patterns of associations between childhood triclosan and these same behavioral scores; however, their magnitude decreased substantially after adjusting for gestational triclosan and associations were not statistically significant.
In this cohort, increasing gestational and childhood urinary triclosan concentrations were associated with higher behavior problem scores in 8-year old boys, but not girls.
•We measured urinary triclosan concentrations up to nine times between the 2nd trimester of pregnancy and age 8-years.•We assessed parent-reported child problem behaviors at age 8 years.•We used a regression-calibration approach to account for triclosan exposure measurement error.•Urinary triclosan concentrations were associated with externalizing problem, attention, and hyperactivity scores in boys, but not girls.
Objective:
Physical activity (PA) has been shown to provide health benefits for breast cancer patients. The effects of augmenting oncology health care provider (HCP) advice for PA with 3 months of ...telephone counseling versus contact control were evaluated in a randomized trial.
Methods:
After receiving brief HCP advice to become physically active, 192 women (age in years:
M
= 60.0,
SD
= 9.9) who had completed treatment for Stage 0-IV breast cancer were randomized to telephone counseling to support PA (
n
= 106) or contact control (
n
= 86). Their PA, motivational readiness, fatigue, and physical functioning were assessed at baseline (before receiving HCP advice), 3, 6, and 12 months.
Results:
Telephone counseling produced significant effects on the primary outcome of moderate-intensity PA of about 30 min/week at both 3 months (95% CI = 0.44, 57.32) and 6 months (95% CI = 3.06, 61.26). Intervention participants were also more than twice as likely as control participants to report improvements in achieving PA guidelines of at least 150 min/week at 3 (OR = 2.43, 95% CI = 1.18, 4.98) and 6 months (OR = 2.11, 95% CI = 1.00-4.48). Telephone counseling was significantly more effective than contact control in increasing motivational readiness for PA at all follow-ups (ORs = 3.93-6.28, all
p
s <.003). No between-groups differences were found for fatigue, while differential improvements in physical functioning did not remain significant past 3 months (
p
= .01).
Conclusion:
HCP advice plus telephone counseling improved PA among breast cancer patients at 3 and 6 months and also differentially improved patients' motivational readiness at all follow-ups, suggesting the potential for exercise promotion in cancer follow-up care.
•Gestational PFOA exposure was associated with unfavorable cardiometabolic risk.•Gestational PFHxS exposure was associated with unfavorable cardiometabolic risk.•A novel risk score was used to assess ...adolescents’ cardiometabolic risk.
Per- and polyfluoroalkyl substances (PFAS) may adversely influence cardiometabolic risk. However, few studies have examined if the timing of early life PFAS exposure modifies their relation to cardiometabolic risk. We examined the influence of gestational and childhood PFAS exposure on adolescents’ cardiometabolic risk.
We quantified concentrations of four PFAS (perfluorooctanoate PFOA, perfluorooctane sulfonate PFOS, perfluorononanoate PFNA, and perfluorohexane sulfonate PFHxS) in sera collected during pregnancy, at birth, and at ages 3, 8, and 12 years from 221 mother–child pairs in the HOME Study (enrolled 2003–06, Cincinnati, Ohio). We measured cardiometabolic risk factors using physical examinations, fasting serum biomarkers, and dual-energy X-ray absorptiometry scans at age 12 years. Cardiometabolic risk summary scores were calculated by summing age- and sex-standardized z-scores for individual cardiometabolic risk factors. We used multiple informant models to estimate covariate-adjusted associations of serum PFAS concentrations (log2-transformed) at each visit with cardiometabolic risk scores and their individual components, and tested for differences in associations across visits.
The associations of serum PFOA concentrations with cardiometabolic risk scores differed across visits (P for heterogeneity = 0.03). Gestational and cord serum PFOA concentrations were positively associated with cardiometabolic risk scores (βs and 95% confidence intervals 95% CIs: gestational 0.8 0.0, 1.6; cord 0.9 -0.1, 1.9 per interquartile range increase). These positive associations were primarily driven by homeostatic model assessment for insulin resistance index (β = 0.3 0.1, 0.5) and adiponectin to leptin ratio (β = -0.5 -1.0, 0.0). Other individual cardiometabolic risk factors associated with gestational PFOA included insulin and waist circumference. Gestational and cord PFHxS were also associated with higher cardiometabolic risk scores (βs: gestational 0.9 0.2, 1.6; cord 0.9 0.1, 1.7).
In this cohort of children with higher gestational PFOA exposure, fetal exposure to PFOA and PFHxS was associated with unfavorable cardiometabolic risk in adolescence.
Use of online social networks for smoking cessation has been associated with abstinence. Little is known about the mechanisms through which the formation of social ties in an online network may ...influence smoking behavior. Using dynamic social network analysis, we investigated how temporal changes of an individual's number of social network ties are prospectively related to abstinence in an online social network for cessation. In a network where quitting is normative and is the focus of communications among members, we predicted that an increasing number of ties would be positively associated with abstinence.
Participants were N = 2,657 adult smokers recruited to a randomized cessation treatment trial following enrollment on BecomeAnEX.org, a longstanding Internet cessation program with a large and mature online social network. At 3-months post-randomization, 30-day point prevalence abstinence was assessed and website engagement metrics were extracted. The social network was constructed with clickstream data to capture the flow of information among members. Two network centrality metrics were calculated at weekly intervals over 3 months: 1) in-degree, defined as the number of members whose posts a participant read; and 2) out-degree-aware, defined as the number of members who read a participant's post and commented, which was subsequently viewed by the participant. Three groups of users were identified based on social network engagement patterns: non-users (N = 1,362), passive users (N = 812), and active users (N = 483). Logistic regression modeled 3-month abstinence by group as a function of baseline variables, website utilization, and network centrality metrics.
Abstinence rates varied by group (non-users = 7.7%, passive users = 10.7%, active users = 20.7%). Significant baseline predictors of abstinence were age, nicotine dependence, confidence to quit, and smoking temptations in social situations among passive users (ps < .05); age and confidence to quit among active users. Among centrality metrics, positive associations with abstinence were observed for in-degree increases from Week 2 to Week 12 among passive and active users, and for out-degree-aware increases from Week 2 to Week 12 among active users (ps < .05).
This study is the first to demonstrate that increased tie formation among members of an online social network for smoking cessation is prospectively associated with abstinence. It also highlights the value of using individuals' activities in online social networks to predict their offline health behaviors.
Objectives
To assess the clinical utility of the Trail‐Making Tests (TMTs) as screens for impaired road‐test performance.
Design
Secondary analyses of three data sets from previously published ...studies of impaired driving in older adults using comparable road test designs and outcome measures.
Setting
Two academic driving specialty clinics.
Participants
Older drivers (N = 392; 303 with cognitive impairment, 89 controls) from Rhode Island and Missouri.
Measurements
Standard operating characteristics were evaluated for the TMT Part A (TMT‐A) and Part B (TMT‐B), as well as optimal upper and lower test cut‐points that could be useful in defining groups of drivers with indeterminate likelihood of impaired driving who would most benefit from further screening or on‐road testing.
Results
Discrimination remained high (>70%) when cut‐points for the TMTs derived from Rhode Island data were applied to Missouri data, but calibration was poor (all P < .01). TMT‐A provided the best utility for determining a range of scores (68–90 seconds) for which additional road testing would be indicated in general practice settings. A high frequency of cognitively impaired participants unable to perform the TMT‐B test within the allotted time limited the utility of the test (>25%). Mere inability to complete the test in a reasonable time frame (e.g., TMT‐A > 48 seconds or TMT‐B > 108 seconds) may still be a useful tool in separating unsafe from safe or marginal drivers in such samples.
Conclusion
The TMTs (particularly TMT‐A) may be useful as screens for driving impairment in older drivers in general practice settings, where most people are still safe drivers, but more‐precise screening measures need to be analyzed critically in a variety of clinical settings for testing cognitively impaired older drivers.
Objective
This study aimed to determine whether weight losses from a primarily smartphone‐based behavioral obesity treatment (SMART) differed from those of a more intensive group‐based behavioral ...obesity treatment (GROUP) and a control condition (CONTROL).
Methods
A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP‐based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self‐monitoring via paper diaries with written feedback; SMART‐based treatment with online lessons, self‐monitoring, and feedback plus monthly weigh‐ins; or a CONTROL condition with self‐monitoring via paper diaries with written feedback and monthly weigh‐ins.
Results
Among the 276 participants (17% men; 7.2% minority; mean SD age: 55.1 9.9 years; weight: 95.9 17.0 kg; BMI: 35.2 5.0 kg/m2), 18‐month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5‐7.4) in GROUP, 5.5 kg (95% CI: 3.9‐7.1) in SMART, and 6.4 kg (95% CI: 3.7‐9.2) in CONTROL.
Conclusions
Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group‐based approach.
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