Carmen Messerlian

An Empirical Study Examining the Impact of Gambling Advertisements on Adolescent Gambling Attitudes and Behaviors

Based upon a previous qualitative study a questionnaire ascertaining adolescents’ awareness of gambling advertisements and their impact upon their behavior was developed and administered to 1,147 youth between the ages of 12 and 19. The findings suggest that almost all youth report being exposed to advertising with many individuals indicating being bombarded with messages, especially through pop-up ads viewed on the Internet. Sixty-one percent of youth reported receiving spam gambling advertisements by e-mail and 96% had seen TV advertisements for gambling. The underlying perceived message is that winning is easy, the chance of winning is high and that gambling is an easy way to become wealthy. While most youth are dismissive of the messages and are aware of the risks associated with gambling, a large percentage of youth report that these messages prompt them to gamble. Rather than inciting non-gamblers to begin gambling, advertisements appear to serve the function of maintaining established gambling habits and were particularly problematic to youth with gambling problems. Gender and developmental trends were noted.

Infertility and the risk of adverse pregnancy outcomes: a systematic review and meta-analysis

STUDY QUESTION Do women who conceive without treatment after a long time to pregnancy (TTP) have an increased risk of preterm birth compared with women in the general obstetric population? SUMMARY ANSWER Based on this meta-analyses of 14 studies, women with a long TTP are at an increased risk of preterm birth: pooled crude odds ratio (OR): 1.38 (95% CI: 1.25-1.54). WHAT IS KNOWN ALREADY Several studies have shown that women who conceive without treatment after >12 months of trying have an elevated risk of poor pregnancy outcomes. To date, no systematic review or meta-analysis of this evidence has been published. STUDY DESIGN, SIZE, DURATION This systematic review identified literature from Embase, Medline and Popline published between January 1974 and October 2011, on the association between infertility in a non-treated population and the risk of preterm birth, low birthweight (LBW), small-for-gestational age and birthweight deficits. PARTICIPANTS/MATERIALS, SETTING, METHODS Two authors independently conducted the searches, selected the studies and abstracted the data. A total of 89 full-text articles were assessed for eligibility and 17 met the inclusion criteria. The pooled analysis of the primary outcome led to a total sample size of 1 269 758 births: 19 983 in the exposed/infertile group and 1 249 775 in the unexposed/fertile group. There were a total 68 885 preterm births in the overall sample: 1644 (8.2%) and 67 241 (5.4%) among the infertile and reference groups, respectively. MAIN RESULTS AND THE ROLE OF CHANCE A moderate increase in the risk of preterm birth persisted irrespective of the type of pooling. The common OR of the pooled crude preterm birth data compared with the pooled regression-adjusted analysis was modestly attenuated: from 1.38 (95% CI: 1.25, 1.54) to 1.31 (95% CI: 1.21, 1.42), with I² decreasing from 53.2 to 3.9% in the crude to adjusted results, respectively. An association of a similar magnitude was seen between infertility and LBW, due in part to overlapping of outcomes. LIMITATIONS, REASONS FOR CAUTION Consistency of the estimates across various types of pooling, including the more restricted sensitivity analyses of higher quality studies, is reassuring. While it is possible that systematic error may have been present through misclassification of exposure and confounding, these findings suggest that it would need to be of the same magnitude across diverse studies, which seems unlikely. WIDER IMPLICATIONS OF THE FINDINGS A long TTP is only a symptom, research is needed to assess whether specific groups of infertile couples are at increased risk of adverse outcome, or whether the increased risk is due to characteristics common to most infertile couples. As long as the contribution of infertility is not clarified, the risks due to assisted reproductive technologies cannot be properly assessed. STUDY FUNDING/COMPETING INTEREST(S) C.M. was supported by a Canadian Institutes of Health Research doctoral research award at the time of this study. No competing interests are declared.

Social Marketing Campaigns for Youth Gambling Prevention: Lessons Learned from Youth

Youth gambling is an important, although often overlooked adolescent health issue. Media-based prevention programs have long been employed as tools to address high risk behaviours, namely drug, alcohol and tobacco use, as well as sexual health. However, social marketing has yet to be drawn upon as a strategy to address problem gambling among adolescents. This strategy would appear to be especially relevant given the recent rise in the portrayal of gambling in the mass media, often glamorizing and normalizing games and practices. The authors aimed to examine the use of social marketing as a strategy for gambling prevention among adolescent. A qualitative study using focus groups was conducted to explore adolescents’ exposure to existing prevention campaigns and their message content and communication preferences for a youth gambling social marketing campaign. Social marketing advertisements, depicting real-life stories with an emotional appeal, that portrayed the negative consequences associated with a gambling problem were highly endorsed by participants. Participants further recommended illustrating the basic facts of gambling using simple messages that raise awareness in a non-judgmental manner. Adolescents are critical of the “don’t do it” message as this approach does not reflect the current youth gambling culture. It is expected that this study serve as a source for the development of future social marketing campaigns on youth gambling. Targeting variable and campaign strategies recommended herein should be considered in the early stages and tested along the way.

Urinary phthalate metabolites and ovarian reserve among women seeking infertility care

STUDY QUESTION Are urinary phthalate metabolites associated with reduced antral follicle growth among women in an infertility setting? SUMMARY ANSWER Higher urinary concentrations of di(2-ethylhexyl) phthalate (DEHP) metabolites were associated with significant decreases in antral follicle count (AFC) among women seeking infertility care. WHAT IS KNOWN ALREADY Experimental animal studies show that DEHP accelerates primordial follicle recruitment and inhibits antral follicle growth. Whether phthalates also reduce the growing antral follicle pool in humans remains unknown. STUDY DESIGN, SIZE, DURATION We examined the association between urinary phthalate metabolites and AFC using prospective data from 215 females recruited between 2004 and 2012 in the Environment and Reproductive Health (EARTH) study. PARTICIPANTS/MATERIALS, SETTING, METHODS We quantified the urinary concentrations of 11 phthalate metabolites. We estimated the geometric mean for all urine samples provided prior to unstimulated day 3 AFC assessment for each woman. We evaluated the association of AFC with ∑DEHP (molar sum of four DEHP metabolites) and individual phthalate metabolites using Poisson regression, adjusting for age, BMI and smoking. MAIN RESULTS AND THE ROLE OF CHANCE We observed significant decreases in mean AFC for all higher quartiles of ∑DEHP as compared with the lowest quartile. Compared with women in the first quartile of ∑DEHP, women in the second, third and fourth quartiles had a -24% (95% confidence interval (CI): -32%, -16%), -19% (95% CI: -27%, -9%), and -14% (95% CI: -23%, -5%) decrease in mean AFC. The absolute mean AFC in the first quartile was 14.2 follicles (95% CI: 13.2, 15.2) compared with 10.7 follicles (95% CI: 9.9, 11.6) in the second quartile. We observed similar trends among the four individual DEHP metabolites. There was no consistent change in AFC among the remaining phthalate metabolite concentrations evaluated. LIMITATIONS, REASONS FOR CAUTION We demonstrated a negative association between DEHP and a well-established marker of ovarian reserve among a subfertile population. However these findings may not be generalizable to women without fertility concerns, and we cannot rule out co-exposure to other chemicals. WIDER IMPLICATIONS OF THE FINDINGS Environmental chemicals that inhibit the size of the growing antral follicle pool can impair fertility and reduce fecundity. This study suggests evidence in need of further investigation on the impact of phthalates on the human oocyte and follicular development. STUDY FUNDING/COMPETING INTERESTS Work supported by grants ES009718, ES022955, ES000002, and T32ES007069 from the National Institute of Environmental Health Sciences (NIEHS) and grant T32 DK007703-16 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). C.M. was supported by a post-doctoral training award from the Canadian Institutes of Health Research. There are no competing interests to declare.

A public health perspective for youth gambling

The recent emergence of gambling problems among youth around the world is alarming. For those most vulnerable in our society, children and adolescents, problem gambling presents a serious public health concern. Our current knowledge and understanding of the magnitude of the problem and its considerable impact upon the well-being of youth compels us to respond in a timely and effective manner. A general public health paradigm to gambling, originally articulated by Wynne (1997) and Korn and Shaffer (1999), highlights the importance of such an approach. However, a conceptual model and framework to understand and specifically address youth problem gambling within a public health framework is needed. This article articulates a theoretical framework and model that will help facilitate the development, implementation and evaluation of a comprehensive, multi-level health promotion and prevention strategy for youth problem gambling.

Fathers Matter: Why It’s Time to Consider the Impact of Paternal Environmental Exposures on Children’s Health

PurposeDespite accumulating evidence from experimental animal studies showing that paternal environmental exposures induce genetic and epigenetic alterations in sperm which in turn increase the risk of adverse health outcomes in offspring, there is limited epidemiological data on the effects of human paternal preconception exposures on children’s health. We summarize animal and human studies showing that paternal preconception environmental exposures influence offspring health. We discuss specific approaches and designs for human studies to investigate the health effects of paternal preconception exposures, the specific challenges these studies may face, and how we might address them.Recent FindingsIn animal studies, paternal preconception diet, stress, and chemical exposures have been associated with offspring health and these effects are mediated by epigenetic modifications transmitted through sperm DNA, histones, and RNA. Most epidemiological studies have examined paternal preconception occupational exposures and their effect on the risk of birth defects and childhood cancer; few have examined the effects of low-level general population exposure to environmental toxicants. While the design and execution of epidemiological studies of paternal preconception exposures face challenges, particularly with regard to selection bias and recruitment, we believe these are tractable and that preconception studies are feasible.SummaryNew or augmented prospective cohort studies would be the optimal method to address the critical knowledge gaps on the effect of paternal preconception exposures on prevalent childhood health outcomes. Determining if this period of life represents a window of heightened vulnerability would improve our understanding of modifiable risk factors for children’s health and wellbeing.

Low-technology assisted reproduction and the risk of preterm birth in a hospital-based cohort.

OBJECTIVE To estimate the risk of preterm birth in singleton infants conceived through low-technology assisted reproduction (intrauterine insemination and/or ovulation induction/stimulation). DESIGN Hospital-based cohort study. SETTING University-affiliated hospital. PATIENT(S) Singleton babies born between 2001 and 2007 to 16,712 couples with no reported infertility (reference category), 378 babies conceived with low-technology treatment; 437 conceived with high-technology treatment; and 620 conceived naturally after a period of infertility. INTERVENTION(S) None. Treatment data were obtained from couples undergoing standard infertility investigation and care. MAIN OUTCOME MEASURE(S) Preterm birth, defined at three clinical endpoints: <37, <35, and <32 weeks of completed gestation. RESULT(S) After adjustment for age, parity, education, smoking, alcohol/drug use, and body mass index, the risk ratios and 95% confidence intervals (CI) of preterm birth for low technology were: 1.49 (CI: 1.12-2.00); 2.02 (CI: 1.30-3.13); and 2.93 (CI: 1.63-5.26) at <37, <35, and <32 weeks gestation, respectively, not dissimilar from the estimates for in vitro fertilization. Restricting the analysis to primiparas strengthened the association between treatment and preterm birth at the lower gestational endpoints. The increased risk persisted when the untreated group was used as the reference category, although the estimates were attenuated. CONCLUSION(S) In this large hospital-based cohort study, low-technology assisted reproduction appeared to be a moderately strong predictor of preterm birth, with similar associations observed in the high-technology treatment group. After adjusting for confounders, as well as the shared characteristics of infertile couples, associations were attenuated but remained significant, suggesting that part of the risk is likely attributable to the treatment.

Urinary Concentrations of Phthalate Metabolites and Pregnancy Loss Among Women Conceiving with Medically Assisted Reproduction

Background: Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent. Methods: We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified 11 phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (&Sgr;DEHP). We estimated risk ratios (RRs) and 95% confidence intervals for biochemical loss and total pregnancy loss (<20 weeks’ gestation) across quartiles using repeated measures log-binomial models, adjusted for age, body mass index, smoking and infertility diagnosis. Results: Of the 303 pregnancies, 83 (27%) ended in loss less than 20 weeks’ gestation and among these, 31 (10%) ended in biochemical loss. Although imprecise, the RRs for biochemical loss increased across quartiles of &Sgr;DEHP and three individual DEHP metabolites. For &Sgr;DEHP, the RRs (confidence intervals) were 2.3 (0.63, 8.5), 2.0 (0.58, 7.2), and 3.4 (0.97, 11.7) for quartiles two, three, and four, compared with one, respectively (P trend = 0.04). RRs for total pregnancy loss were elevated in the highest quartiles of &Sgr;DEHP and three DEHP metabolites. The remaining seven phthalate metabolite concentrations evaluated were not associated with either outcome. Conclusions: We found a suggestive pattern of association between conception cycle-specific urinary concentrations of DEHP metabolites and biochemical and total pregnancy loss among women undergoing medically assisted reproduction.

Variation in cerebral palsy profile by socio‐economic status

Socio‐economic differences in maternal and child health are well recognized, but the role of individual‐level and area‐level determinants in cerebral palsy (CP) phenotypes is debated. We set out to examine (1) the association between area‐level and individual‐level measures of socio‐economic deprivation and CP phenotype among children, including subtype, severity, and comorbidities; and (2) the direct effect of area‐level deprivation not mediated through individual‐level deprivation.

Combined impact of high body mass index and in vitro fertilization on preeclampsia risk: A hospital‐based cohort study

Overweight and obese women may be heavy users of in vitro fertilization (IVF) owing to obesity‐related oligo‐anovulation. The higher doses of gonadotropins required to achieve pregnancy in obese women may contribute to impaired placentation and the development of preeclampsia. This study was designed to assess the combined effect of high maternal body mass index (BMI) and IVF on risk of preeclampsia and to evaluate for an interaction between the two factors.