Marni B. Jacobs

Childhood adiposity and fertility difficulties: the Bogalusa Heart Study

Adult obesity is associated with infertility; however, childhood obesity has received little consideration.

When is exposure to a natural disaster traumatic? Comparison of a trauma questionnaire and disaster exposure inventory

Few studies have compared the sensitivity of trauma questionnaires to disaster inventories for assessing the prevalence of exposure to natural disaster or associated risk for post-disaster psychopathology. The objective of this analysis was to compare reporting of disaster exposure on a trauma questionnaire (Brief Trauma Questionnaire [BTQ]) to an inventory of disaster experience. Between 2011 and 2014, a sample of 841 reproductive-aged southern Louisiana women were interviewed using the BTQ and completed a detailed inventory about exposure to hurricanes and flooding. Post-traumatic stress disorder (PTSD) symptomology was measured with the Post-Traumatic Stress Checklist, and depression with the Edinburgh Depression Scale. The single question addressing disaster exposure on the BTQ had a sensitivity of between 65% and 70% relative to the more detailed questions. Reporting disaster exposure on the BTQ was more likely for those who reported illness/injury due to a hurricane or flood (74%-77%) or danger (77-79%), compared to those who reported damage (69-71%) or evacuation (64-68%). Reporting disaster exposure on the BTQ was associated with depression (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.43-3.68). A single question is unlikely to be useful for assessing the degree of exposure to disaster across a broad population, and varies in utility depending on the mental health outcome of interest: the single trauma question is useful for assessing depression risk.

Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics

Abstract Introduction: Increased childhood adversity may be affect adult fertility, however, the mechanism through which this occurs is unclear. Menstrual cycle abnormalities are predictive of fertility difficulties, and stress influences menstrual cycle characteristics. Here, we assess whether adverse childhood experiences (ACEs) are associated with fertility difficulties and menstrual cycle dysregulation, offering a plausible mechanism for the link between lifetime stress and fertility. Methods: From April 2012 to February 2014, 742 pregnant and non-pregnant women aged 18–45 years residing in southeastern Louisiana provided information on childhood adversity and reproductive history. Associations between ACEs and fertility difficulties and menstrual cycle patterns were evaluated. Results: As the number of ACEs increased, risk of fertility difficulties and amenorrhea increased (RR = 1.09, 95% CI 1.05–1.13 and RR = 1.07, 95% CI 1.04–1.10, respectively), while fecundability decreased [fecundability ratio (FR) = 0.97, 95% CI 0.95–1.00]. Compared to women with no adversity, women in the high adversity group were more likely to experience both infertility and amenorrhea (RR = 2.75, 95% CI 1.45–5.21 and RR = 2.54, 95% CI 1.52–4.25, respectively), and reduced fecundability (FR = 0.75, 95% CI 0.56–1.00). Although similar patterns were seen for menstrual cycle irregularity, associations were diminished. Associations did not materially change following adjustment for age, body mass index, race, education, smoking and income. Results are constrained by the self-report nature of the study and the limited generalizability of the study population. Discussion: To our knowledge, this is the first study to present evidence of a link between childhood stressors, menstrual cycle disruption and fertility difficulties. The effect of childhood stress on fertility may be mediated through altered functioning of the HPA axis, acting to suppress fertility in response to less than optimal reproductive circumstances.

Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis

Objectives Sexually transmitted infection (STI) prevalence and risk behaviour may differ at different phases of deployment. We examined STI prevalence and sexual behaviour in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. Methods Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. Results Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). Conclusions Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions.

IMPACT OF A COMMUNITY POPULAR OPINION LEADER INTERVENTION AMONG AFRICAN AMERICAN ADULTS IN A SOUTHEASTERN UNITED STATES COMMUNITY

We examine the impact of an adapted community popular opinion leader (C-POL) intervention targeting alcohol-using social networks in Southeast Louisiana. A pre-post C-POL was conducted between October 2009 and April 2013, targeting alcohol users. A total of 65 popular opinion leaders were recruited, trained, and deployed into their social networks to diffuse intervention messages. Anonymous community surveys conducted within the venues among 99 male and female participants at baseline and 197 at 6 months to 1 year later revealed significant behavioral and knowledge changes. Average sexual risk score based on 7 sexual risk items declined from 15.3 to 11.9 (p<0.001); the number of vaginal and anal sex partners in the last year decreased from 11.3 to 7.7 and 3.9 to 2.3, respectively (p<0.01); and HIV knowledge score (based on % correct) increased from 67.2 to 76.8% (p<0.001). Findings add to the evidence base surrounding peer interventions.

Multigenerational Cardiometabolic Risk as a Predictor of Birth Outcomes: The Bogalusa Heart Study.

Objective To examine the relationship between generation 1 (grandmaternal) cardiometabolic risk factors and generation 3 (grandchilds) birthweight and gestational age. Study Design Mother‐daughter pairs in the Bogalusa Heart Study (1973‐present) were linked to their childrens birth certificates; women were also interviewed about their reproductive histories, creating a 3‐generation linkage including 177 generation 1 (grandmothers), 210 generation 2 (mothers), and 424 generation 3 (children). Prepregnancy cardiometabolic risk factors (body mass index [BMI], lipids, glucose) or generation 1 (mean age 16.2 years) and 2 (mean age 11.1 years) were examined as predictors of generation 3 birthweight and gestational age using linear and logistic regression with adjustment for age, race, parity, and other confounders. Results Generation 2 higher BMI was associated with higher birthweight (28 g per 1 unit, 95% CI 12‐44) and gestational age (0.08 weeks, 95% CI 0.02‐0.14) in generation 3, and generation 1 higher BMI was associated with higher birthweight (52 g, 95% CI 34‐70) in the generation 2. Generation 1s higher glucose levels were associated with higher birthweight in generation 3 (adjusted beta 111 g, 95% CI 33‐189), and triglycerides (adjusted beta −21, 95% CI −43‐0) and low‐density lipoprotein (adjusted beta −24, 95% CI −48‐0) were associated with lower birthweight. Conclusions These results suggest the possibility of multigenerational developmental programming of birth outcomes, although mechanisms (whether biological or environmental) are undetermined.

Feasibility of Linking Long-Term Cardiovascular Cohort Data to Offspring Birth Records: The Bogalusa Heart Study

Introduction Researchers in perinatal health, as well as other areas, may be interested in linking existing datasets to vital records data when the existence or timing of births is unknown. Methods 5914 women who participated in the Bogalusa Heart Study (1973–2009), a long-running study of cardiovascular health in childhood, adolescence, and adulthood, were linked to vital statistics birth data from Louisiana, Mississippi, and Texas (1982–2010). Deterministic and probabilistic linkages based on social security number, race, maternal date of birth, first name, last name, and Soundex codes for name were conducted. Characteristics of the linked and unlinked women were compared using t-tests, Chi square tests, and multiple regression with adjustment for age and year of examinations. Results The Louisiana linkage linked 4876 births for 2770 women; Mississippi linked 791 births to 487 women; Texas linked 223 births to 153 women; After removal of duplicates and implausible dates, this left a total of 5922 births to 3260 women. This represents a successful linkage of 55% of all women ever seen in the larger study, and an estimated 65% of all women expected to have given birth. Those linked had more study visits, were more likely to be black, and had statistically lower BMIs than unlinked participants. Discussion Linking unrelated study data to vital records data was feasible to a degree. The linked group had a somewhat more favorable health profile and was less mobile than the overall study population.

Self-Reported HIV-Positive Status But Subsequent HIV-Negative Test Result Using Rapid Diagnostic Testing Algorithms Among Seven Sub-Saharan African Military Populations

HIV rapid diagnostic tests (RDTs) combined in an algorithm are the current standard for HIV diagnosis in many sub-Saharan African countries, and extensive laboratory testing has confirmed HIV RDTs have excellent sensitivity and specificity. However, false-positive RDT algorithm results have been reported due to a variety of factors, such as suboptimal quality assurance procedures and inaccurate interpretation of results. We conducted HIV serosurveys in seven sub-Saharan African military populations and recorded the frequency of personnel self-reporting HIV positivity, but subsequently testing HIV-negative during the serosurvey. The frequency of individuals who reported they were HIV-positive but subsequently tested HIV-negative using RDT algorithms ranged from 3.3 to 91.1%, suggesting significant rates of prior false-positive HIV RDT algorithm results, which should be confirmed using biological testing across time in future studies. Simple measures could substantially reduce false-positive results, such as greater adherence to quality assurance guidelines and prevalence-specific HIV testing algorithms as described in the World Health Organization’s HIV testing guidelines. Other measures to improve RDT algorithm specificity include classifying individuals with weakly positive test lines as HIV indeterminate and retesting. While expansion of HIV testing in resource-limited countries is critical to identifying HIV-infected individuals for appropriate care and treatment, careful attention to potential causes of false HIV-positive results are needed to prevent the significant medical, psychological, and fiscal costs resulting from individuals receiving a false-positive HIV diagnosis.

Maternal apolipoprotein E genotype as a potential risk factor for poor birth outcomes: The Bogalusa Heart Study

Objective:The objective of this study was to assess the association between apolipoprotein E (apoE) genotype and preterm birth (PTB) and small for gestational age (SGA).Study Design:ApoE phenotyping was performed on 680 women linked to 1065 births. Allele frequencies were compared and PTB and SGA risk was estimated using log-binomial regression.Results:The ɛ2 allele was more common in SGA births (P<0.01). SGA risk was increased among ɛ2 carriers compared with genotype ɛ3/ɛ3, though associations were attenuated following adjustment for maternal age, education, race, smoking and prenatal visits. Stronger associations were observed for term SGA (first birth: adjusted relative risk (aRR)=1.78, 95% confidence interval (CI) 1.06 to 2.98; any birth: aRR=1.52, 95% CI 0.96 to 2.40) and among whites specifically (first: aRR=2.88, 95% CI 1.45 to 5.69; any: aRR=2.75, 95% CI 1.46 to 5.22).Conclusions:Associations between maternal apoE genotype and SGA may represent decreased fetal growth in women with lower circulating cholesterol levels.