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Anti-Mullerian Hormone: A Potential New Tool in Epidemiologic Studies of Female Fecundability

The objective of the present commentary is to suggest that epidemiologists explore the use of anti-Müllerian hormone (AMH) as a new measurement tool in fecundability studies. The authors briefly summarize the advantages and limitations of the 3 current approaches to studies of fecundability. All 3 approaches involve the collection of time-to-pregnancy or attempt-time data, and most are limited to participants who plan their pregnancies. AMH is produced by ovarian follicles during their early growth stages and is measured clinically to assess ovarian reserve (the number of remaining oocytes). Unlike time to pregnancy, serum AMH level can be assessed regardless of pregnancy-attempt status. Measurements are not significantly affected by phase of the menstrual cycle, oral contraceptive use, or early pregnancy. The authors suggest that AMH measurement can be a valuable addition to traditionally designed fecundability studies. In addition, this hormone should be investigated as an independent measure of fecundability in studies that focus on exposures hypothesized to target the ovary.

Bias in Observational Studies of Prevalent Users: Lessons for Comparative Effectiveness Research From a Meta-Analysis of Statins

Randomized clinical trials (RCTs) are usually the preferred strategy with which to generate evidence of comparative effectiveness, but conducting an RCT is not always feasible. Though observational studies and RCTs often provide comparable estimates, the questioning of observational analyses has recently intensified because of randomized-observational discrepancies regarding the effect of postmenopausal hormone replacement therapy on coronary heart disease. Reanalyses of observational data that excluded prevalent users of hormone replacement therapy led to attenuated discrepancies, which begs the question of whether exclusion of prevalent users should be generally recommended. In the current study, the authors evaluated the effect of excluding prevalent users of statins in a meta-analysis of observational studies of persons with cardiovascular disease. The pooled, multivariate-adjusted mortality hazard ratio for statin use was 0.77 (95% confidence interval (CI): 0.65, 0.91) in 4 studies that compared incident users with nonusers, 0.70 (95% CI: 0.64, 0.78) in 13 studies that compared a combination of prevalent and incident users with nonusers, and 0.54 (95% CI: 0.45, 0.66) in 13 studies that compared prevalent users with nonusers. The corresponding hazard ratio from 18 RCTs was 0.84 (95% CI: 0.77, 0.91). It appears that the greater the proportion of prevalent statin users in observational studies, the larger the discrepancy between observational and randomized estimates.

Environmental and Urinary Markers of Prenatal Exposure to Drinking Water Disinfection By-Products, Fetal Growth, and Duration of Gestation in the PELAGIE Birth Cohort (Brittany, France, 2002-2006)

Although prenatal exposure to water disinfection by-products does not appear to affect the duration of gestation, its impact on fetal growth remains an open question. The authors studied the associations between prenatal exposure to disinfection by-products and fetal growth restriction (FGR) and preterm birth in the PELAGIE cohort, a French birth cohort comprising 3,421 pregnant women recruited between 2002 and 2006. Exposure was assessed by estimating levels of trihalomethanes (THMs) in tap water during pregnancy and maternal water use and by measuring maternal urinary levels of trichloroacetic acid (TCAA) during early pregnancy in a nested case-control design that compared 174 FGR cases, 114 preterm births, and 399 controls. Higher uptake of THMs (especially brominated THMs) was associated with a higher risk of FGR. Women with TCAA detected in their urine (>0.01 mg/L) had a higher risk of FGR than those with TCAA levels below the detection limit (adjusted odds ratio = 1.8, 95% confidence interval: 0.9, 3.7) and had an odds ratio for preterm birth below 1 (adjusted odds ratio = 0.8, 95% confidence interval: 0.3, 2.6). Results from this prospective study, the first to use a biomarker of disinfection by-product exposure, suggest that prenatal exposure affects fetal growth, but the causal agent or agents remain to be identified.

Invited Commentary: Biomarkers of Exposure to Drinking Water Disinfection By-Products--Are We Ready Yet?

Studies of the relation between exposure to drinking water disinfection by-products and pregnancy outcomes have been limited by the complexity of the exposure itself (consisting of hundreds of different chemicals), the diverse pathways contributing to exposure, and the difficulty in assessing behavioral determinants of exposure. Therefore, exposure biomarkers offer great promise of enhancing exposure assessment, the limiting factor in the quality and conclusiveness of epidemiologic studies. However, there are significant conceptual and logistical challenges in developing biomarkers for the various constituents of concern that are sensitive to typical variation in exposure, reflective of the time periods of interest, not susceptible to interference from exposures other than water, not subject to reverse causality by correlates of adverse pregnancy outcomes, reflective of the chemicals of interest, and feasible for large-scale epidemiologic studies. Urinary trichloroacetic acid has been the leading candidate exposure biomarker for over a decade, and the first attempt to incorporate it into an epidemiologic study (Am J Epidemiol. 2012;175(4):263–275) is notable—the considerable limitations notwithstanding. In future efforts, investigators need to combine biomarker development with substantive epidemiologic studies to improve on this initial effort and prepare for more definitive research.

Is Childhood Asthma Associated With Educational Level and Longest-Held Occupation?

Children with asthma can experience chronic morbidity that may interfere with education and career progression. The authors investigated retrospectively whether a history of childhood asthma is associated with educational level and longest-held occupation, by gender. Cross-sectional analysis included a nationally representative sample of 10,452 adults aged ≥20 years who participated in the US National Health and Nutrition Examination Survey (2001–2004). Logistic regression was used to assess associations between a childhood-asthma history and educational level, employment, and longest-held occupation. An estimated 6.9% of men and 5.8% of women had a childhood-asthma history. Persons with a childhood-asthma history tended to have a higher educational level than those with no asthma history. Among those who ever worked, and after adjustment for age and race/ethnicity, men with a childhood-asthma history were more likely to work in health-diagnosing occupations, other professional occupations, and as cooks; women with a childhood-asthma history were more likely to work in management-related, entertainment-related, and health service occupations. Compared with those with no asthma history, persons with a childhood-asthma history tended to achieve a higher educational level and, if they worked, were more likely to work in particular occupations.

Passive Cigarette Smoke Exposure During Various Periods of Life, Genetic Variants, and Breast Cancer Risk Among Never Smokers

The association between passive cigarette smoke exposure and breast cancer risk is inconclusive and may be modified by genotype. The authors investigated lifetime passive cigarette smoke exposures, 36 variants in 12 carcinogen-metabolizing genes, and breast cancer risk among Ontario, Canada, women who had never smoked (2003–2004). DNA (saliva) was available for 920 breast cancer cases and 960 controls. Detailed information about passive smoke exposure was collected for multiple age periods (childhood, teenage years, and adulthood) and environments (home, work, and social). Adjusted odds ratios and 95% confidence intervals were estimated by multivariable logistic regression, and statistical interactions were assessed using the likelihood ratio test. Among postmenopausal women, most associations between passive smoke and breast cancer risk were null, whereas among premenopausal women, nonsignificant positive associations were observed. Significant interactions were observed between certain types of passive smoke exposure and genetic variants in CYP2E1, NAT2, and UGT1A7. While these interactions were statistically significant, the magnitudes of the effect estimates were not consistent or easily interpretable, suggesting that they were perhaps due to chance. Although the results of this study were largely null, it is possible that premenopausal women exposed to passive smoke or carrying certain genetic variants may be at higher risk of breast cancer.

Mortality Among Young Injection Drug Users in San Francisco: A 10-Year Follow-up of the UFO Study

This study examined associations between mortality and demographic and risk characteristics among young injection drug users in San Francisco, California, and compared the mortality rate with that of the population. A total of 644 young (<30 years) injection drug users completed a baseline interview and were enrolled in a prospective cohort study, known as the UFO ("U Find Out") Study, from November 1997 to December 2007. Using the National Death Index, the authors identified 38 deaths over 4,167 person-years of follow-up, yielding a mortality rate of 9.1 (95% confidence interval: 6.6, 12.5) per 1,000 person-years. This mortality rate was 10 times that of the general population. The leading causes of death were overdose (57.9%), self-inflicted injury (13.2%), trauma/accidents (10.5%), and injection drug user-related medical conditions (13.1%). Mortality incidence was significantly higher among those who reported injecting heroin most days in the past month (adjusted hazard ratio = 5.8, 95% confidence interval: 1.4, 24.3). The leading cause of death in this group was overdose, and primary use of heroin was the only significant risk factor for death observed in the study. These findings highlight the continued need for public health interventions that address the risk of overdose in this population in order to reduce premature deaths.

A Nationwide Cohort Study on the Incidence of Meningioma in Women Using Postmenopausal Hormone Therapy in Finland

The authors conducted a nationwide cohort study to evaluate the association between postmenopausal hormone therapy and meningioma incidence in Finland. All women who had used hormone therapy at least for 6 months at the age of 50 years or older during 1994–2009 were included. Women who had used postmenopausal hormone therapy were identified from the medical reimbursement register of the Social Insurance Institution (131,480 estradiol users and 131,248 estradiol-progestin users), and meningioma cases were identified from the Finnish Cancer Registry. During the average 9 years of follow-up, 289 estradiol users and 196 estradiol-progestin users were diagnosed with meningioma. Ever use of estradiol-only therapy was associated with an increased risk of meningioma (standardized incidence ratio = 1.29, 95% confidence interval: 1.15, 1.44). Among women who had been using estradiol-only therapy for at least 3 years, the incidence of meningioma was 1.40-fold higher (95% confidence interval: 1.18, 1.64; P < 0.001) than in the background population. In contrast, this risk was not increased in users of combination therapy (standardized incidence ratio = 0.93, 95% confidence interval: 0.80, 1.06). There was no difference in risk between continuous and sequential use of hormone therapy. Estradiol-only therapy was accompanied with a slightly increased risk of meningioma.

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and Design

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the study’s objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008–2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012–2013.

Regression Calibration When Foods (Measured With Error) Are the Variables of Interest: Markedly Non-Gaussian Data With Many Zeroes

Regression calibration has been described as a means of correcting effects of measurement error for normally distributed dietary variables. When foods are the items of interest, true distributions of intake are often positively skewed, may contain many zeroes, and are usually not described by well-known statistical distributions. The authors considered the validity of regression calibration assumptions where data are non-Gaussian. Such data (including many zeroes) were simulated, and use of the regression calibration algorithm was evaluated. An example used data from Adventist Health Study 2 (2002–2008). In this special situation, a linear calibration model does (as usual) at least approximately correct the parameter that captures the exposure-disease association in the "disease" model. Poor fit in the calibration model does not produce biased calibrated estimates when the "disease" model is linear, and it produces little bias in a nonlinear "disease" model if the model is approximately linear. Poor fit will adversely affect statistical power, but more complex linear calibration models can help here. The authors conclude that non-Gaussian data with many zeroes do not invalidate regression calibration. Irrespective of fit, linear regression calibration in this situation at least approximately corrects bias. More complex linear calibration equations that improve fit may increase power over that of uncalibrated regressions.

Credible Mendelian Randomization Studies: Approaches for Evaluating the Instrumental Variable Assumptions

As with other instrumental variable (IV) analyses, Mendelian randomization (MR) studies rest on strong assumptions. These assumptions are not routinely systematically evaluated in MR applications, although such evaluation could add to the credibility of MR analyses. In this article, the authors present several methods that are useful for evaluating the validity of an MR study. They apply these methods to a recent MR study that used fat mass and obesity-associated (FTO) genotype as an IV to estimate the effect of obesity on mental disorder. These approaches to evaluating assumptions for valid IV analyses are not fail-safe, in that there are situations where the approaches might either fail to identify a biased IV or inappropriately suggest that a valid IV is biased. Therefore, the authors describe the assumptions upon which the IV assessments rely. The methods they describe are relevant to any IV analysis, regardless of whether it is based on a genetic IV or other possible sources of exogenous variation. Methods that assess the IV assumptions are generally not conclusive, but routinely applying such methods is nonetheless likely to improve the scientific contributions of MR studies.

Taking Advantage of the Strengths of 2 Different Dietary Assessment Instruments to Improve Intake Estimates for Nutritional Epidemiology

With the advent of Internet-based 24-hour recall (24HR) instruments, it is now possible to envision their use in cohort studies investigating the relation between nutrition and disease. Understanding that all dietary assessment instruments are subject to measurement errors and correcting for them under the assumption that the 24HR is unbiased for usual intake, here the authors simultaneously address precision, power, and sample size under the following 3 conditions: 1) 1–12 24HRs; 2) a single calibrated food frequency questionnaire (FFQ); and 3) a combination of 24HR and FFQ data. Using data from the Eating at America’s Table Study (1997–1998), the authors found that 4–6 administrations of the 24HR is optimal for most nutrients and food groups and that combined use of multiple 24HR and FFQ data sometimes provides data superior to use of either method alone, especially for foods that are not regularly consumed. For all food groups but the most rarely consumed, use of 2–4 recalls alone, with or without additional FFQ data, was superior to use of FFQ data alone. Thus, if self-administered automated 24HRs are to be used in cohort studies, 4–6 administrations of the 24HR should be considered along with administration of an FFQ.

A Comparison of Self-Reported Analgesic Use and Detection of Urinary Ibuprofen and Acetaminophen Metabolites by Means of Metabonomics: The INTERMAP Study

Information on dietary supplements, medications, and other xenobiotics in epidemiologic surveys is usually obtained from questionnaires and is subject to recall and reporting biases. The authors used metabolite data obtained from hydrogen-1 (or proton) nuclear magnetic resonance (1H NMR) analysis of human urine specimens from the International Study of Macro-/Micro-Nutrients and Blood Pressure (INTERMAP Study) to validate self-reported analgesic use. Metabolic profiling of two 24-hour urine specimens per individual was carried out for 4,630 participants aged 40–59 years from 17 population samples in Japan, China, the United Kingdom, and the United States (data collection, 1996–1999). 1H NMR-detected acetaminophen and ibuprofen use was low (~4%) among East Asian population samples and higher (>16%) in Western population samples. In a comparison of self-reported acetaminophen and ibuprofen use with 1H NMR-detected acetaminophen and ibuprofen metabolites among 496 participants from Chicago, Illinois, and Belfast, Northern Ireland, the overall rate of concordance was 81%–84%; the rate of underreporting was 15%–17%; and the rate of underdetection was approximately 1%. Comparison of self-reported unspecified analgesic use with 1H NMR-detected acetaminophen and ibuprofen metabolites among 2,660 Western INTERMAP participants revealed similar levels of concordance and underreporting. Screening for urinary metabolites of acetaminophen and ibuprofen improved the accuracy of exposure information. This approach has the potential to reduce recall bias and other biases in epidemiologic studies for a range of substances, including pharmaceuticals, dietary supplements, and foods.

Re: "Socioeconomic Differences in Cardiometabolic Factors: Social Casusation or Health-Related Selection? Evidence from the Whitehall II Cohort Study, 1991-2004"

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Epidemiologic Approaches to Injury and Violence

This volume of Epidemiologic Reviews features 13 articles covering a variety of injury problems and research topics. In this commentary, the authors highlight the remarkable achievements in injury control and the important role the Haddon Matrix has played in understanding injury causation and developing preventive strategies; comment on the individual articles included in this volume in the broad categories of research methods, childhood injury, motor-vehicle-related injury, alcohol-related injury, intentional injury, and occupational injury; and outline research gaps and future directions in injury epidemiology and prevention.

Classifying External Causes of Injury: History, Current Approaches, and Future Directions

The International Classification of Diseases (ICD) is used to categorize diseases, injuries, and external causes of injury, and it is a key epidemiologic tool enabling storage and retrieval of data from health and vital records to produce core international mortality and morbidity statistics. The ICD is updated periodically to ensure the classification system remains current, and work is now under way to develop the next revision, ICD-11. It has been almost 20 years since the last ICD edition was published and over 60 years since the last substantial structural revision of the external causes chapter. Revision of such a critical tool requires transparency and documentation to ensure that changes made to the classification system are recorded comprehensively for future reference. In this paper, the authors provide a history of the development of external causes classification and outline the external cause structure. They discuss approaches to manage ICD-10 deficiencies and outline the ICD-11 revision approach regarding the development of, rationale for, and implications of proposed changes to the chapter. Through improved capture of external cause concepts in ICD-11, a stronger evidence base will be available to inform injury prevention, treatment, rehabilitation, and policy initiatives to ultimately contribute to a reduction in injury morbidity and mortality.

Measuring the Population Burden of Fatal and Nonfatal Injury

The value of measuring the population burden of fatal and nonfatal injury is well established. Population health metrics are important for assessing health status and health-related quality of life after injury and for integrating mortality, disability, and quality-of-life consequences. A frequently used population health metric is the disability-adjusted life-year. This metric was launched in 1996 in the original Global Burden of Disease and Injury study and has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. Apart from its obvious advantages and wide adherence, a number of challenges are encountered when the disability-adjusted life-year is applied to injuries. Validation of disability-adjusted life-year estimates for injury has been largely absent. This paper provides an overview of methods and existing knowledge regarding the population burden of injury measurement. The review of studies that measured burden of injury shows that estimates of the population burden remain uncertain because of a weak epidemiologic foundation; limited information on incidence, outcomes, and duration of disability; and a range of methodological problems, including definition and selection of incident and fatal cases, choices in selection of assessment instruments and timings of use for nonfatal injury outcomes, and the underlying concepts of valuation of disability. Recommendations are given for methodological refinements to improve the validity and comparability of future burden of injury studies.

Network Meta-analysis to Evaluate the Effectiveness of Interventions to Increase the Uptake of Smoke Alarms

This study is the first known to use network meta-analysis to simultaneously evaluate the effectiveness of interventions to increase the prevalence of functioning smoke alarms in households with children. The authors identified 24 primary studies from a systematic review of reviews and of more recently published primary studies, of which 23 (17 randomized controlled trials and 6 nonrandomized comparative studies) were included in 1 of the following 2 network meta-analyses: 1) possession of a functioning alarm: interventions that were more "intensive" (i.e., included components providing equipment (with or without fitting), home inspection, or both, in addition to education) generally were more effective. The intervention containing all of the aforementioned components was identified as being the most likely to be the most effective (probability (best) = 0.66), with an odds ratio versus usual care of 7.15 (95% credible interval: 2.40, 22.73); 2) type of battery-powered alarms: ionization alarms with lithium batteries were most likely to be the best type for increasing functioning possession (probability (best) = 0.69). Smoke alarm promotion programs should ensure they provide the combination of interventions most likely to be effective.

Roadway Characteristics and Pediatric Pedestrian Injury

Changing the built environment is a sound, but often underutilized approach to injury control. The authors reviewed the literature and conducted a meta-analysis to synthesize the evidence on the association of roadway characteristics with risk of pediatric pedestrian injury. To synthesize the data, they converted results to odds ratios based on direct results or abstracted outcomes and used Bayesian meta-analytic approaches by modeling outcomes as the logit of a normally distributed set of outcomes with vague prior distributions for the central measure of effect and its variance. On the basis of 10 studies of roadway features restricted exclusively to pediatric populations, the synthesized effect estimate for the association of roadway characteristics with pedestrian injury risk was 2.5 (95% credible interval: 1.8, 3.2). The probability of a new study showing an association between the built roadway and pediatric pedestrian injury was nearly 100%. The authors concluded that the built environment is directly related to the risk of pedestrian injury. This review and meta-analysis suggests that even modest interventions to the built roadway environment may result in meaningful reductions in the risk of pediatric pedestrian injury.

Interventions to Reduce Risks Associated With Vehicle Incompatibility

Occupants of smaller, lighter passenger cars are more likely to be killed or injured in collisions with larger, heavier sport utility vehicles and light trucks than in collisions with other cars. Interventions are needed to reduce this vehicle "incompatibility" and its consequences. The authors conducted a systematic literature review to identify evaluations of interventions to reduce incompatibility. They reviewed engineering, biomedical, and other technical literature. To be included, a study must have 1) evaluated an intervention to reduce vehicle incompatibility, or its consequences, in a crash; 2) reported new research; and 3) been published in English from 1990 to 2010. Seventeen studies met the inclusion criteria. Interventions were designed to reduce the aggressivity of larger vehicles or improve the crashworthiness of smaller vehicles. Effective interventions included 1) modified bumper heights, 2) improved side strength of smaller vehicles, 3) side-impact air bags, 4) changes to vehicle stiffness, and 5) modifications of other front-end structures. Some of the interventions shown to be effective are now in wide use. However, others have yet to be required by regulators or voluntarily agreed to by manufacturers. If larger, heavier vehicles remain on the nation's roads, countermeasures will be needed to reduce risks for occupants of other vehicles.

Marijuana Use and Motor Vehicle Crashes

Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected nonalcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.

Motor Vehicle Deaths Among American Indian and Alaska Native Populations

In the United States, the American Indian and Alaska Native (AI/AN) population has the highest motor vehicle death rate, which is significantly greater than that of any other race or ethnic group. To better understand why this significant disparity exists and how to eliminate it, the authors conducted a systematic review of the published scientific literature. Included studies were published between January 1, 1990, and January 31, 2011, and identified risk factors, or implemented and tested interventions, targeting motor vehicle deaths among the AI/AN population. Only 14 papers met the study’s inclusion criteria. Most of the epidemiologic studies explored alcohol use as a risk factor for deaths of both motor vehicle occupants and pedestrians; few studies addressed risk factors specifically for pedestrians. All of the intervention studies focused on mitigating risks for motor vehicle occupants. On the basis of the authors’ review, injury prevention interventions that are multifaceted and involve partnerships to change policy, the environment, and individual behavior can effectively mitigate motor-vehicle-related deaths among AI/ANs. Priority should be given to implementing interventions that address pedestrian safety and to sound investment in the states with the highest AI/AN motor vehicle death rates because reducing their burden can dramatically reduce the overall disparity.

The Role of Race/Ethnicity in Alcohol-attributable Injury in the United States

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.

Does the Alcohol Make Them Do It? Dating Violence Perpetration and Drinking Among Youth

Strong evidence links alcohol use to partner violence perpetration among adults, but the relation between youth alcohol use and dating violence perpetration (DVP) is not as well studied. The authors used meta-analytic procedures to evaluate current knowledge on the association between alcohol use and DVP among youth. The authors reviewed 28 studies published in 1985–2010; most (82%) were cross-sectional. Alcohol use was measured in 3 main ways: 1) frequency or quantity of use, 2) frequency of heavy episodic drinking, or 3) problem use. Collectively, results support the conclusion that higher levels of alcohol use are positively associated with youth DVP. With fixed-effects models, the combined odds ratios for DVP for frequency/quantity, heavy episodic drinking, and problem use were 1.23 (95% confidence interval (CI): 1.16, 1.31), 1.47 (95% CI: 1.17, 1.85), and 2.33 (95% CI: 1.94, 2.80), respectively. This association persisted even after accounting for heterogeneity and publication bias. No studies were designed to assess the immediate temporal association between drinking and DVP. Future research should assess whether there are acute or pharmacologic effects of alcohol use on youth DVP. Furthermore, few studies have been hypothesis driven, controlled for potential confounding, or examined potential effect measure modification. Studies designed to investigate the youth alcohol–DVP link specifically, and whether results vary by individuals’ gender, developmental stage, or culture, are needed.

Peer Victimization Among School-aged Children With Chronic Conditions

Peer victimization is a common problem among school-aged children, and those with chronic conditions are at an increased risk. A systematic review of the literature was carried out to explore the increased risk of peer victimization among children with chronic conditions compared with others, considering a variety of chronic conditions; and to assess intervention programs designed to reduce negative attitudes or peer victimization at school toward children with chronic conditions. Various data sources were used (PubMed, ERIC, PsycINFO, Web of Science), and 59 studies published between 1991 and 2011 and mainly carried out in North American and European countries were included in the review. A higher level of peer victimization among children with chronic conditions was shown for each type of condition explored in this review (psychiatric diagnoses, learning difficulties, physical and motor impairments, chronic illnesses, and overweight). Despite a substantial number of studies having shown a significant association between chronic conditions and peer victimization, intervention studies aiming to reduce bullying among these children were rarely evaluated. The findings of this review suggest a growing need to develop and implement specific interventions targeted at reducing peer victimization among children with chronic conditions.

Suicide in Asia: Opportunities and Challenges

Asian countries account for approximately 60% of the world’s suicides, but there is a great mismatch in the region between the scale of the problem and the resources available to tackle it. Despite certain commonalities, the continent itself is culturally, economically, and socially diverse. This paper reviews current epidemiologic patterns of suicide, including suicide trends, sociodemographic factors, urban/rural living, suicide methods, sociocultural religious influences, and risk and protective factors in Asia, as well as their implications. The observed epidemiologic distributions of suicides reflect complex interplays among the traditional value/culture system, rapid economic transitions under market globalization, availability/desirability of suicide methods, and sociocultural permission/prohibitions regarding suicides. In general, compared with Western countries, Asian countries still have a higher average suicide rate, lower male-to-female suicide gender ratio, and higher elderly-to-general-population suicide ratios. The role of mental illness in suicide is not as important as that in Western countries. In contrast, aggravated by access to lethal means in Asia (e.g., pesticide poisoning and jumping), acute life stress (e.g., family conflicts, job and financial security issues) plays a more important role than it does in Western countries. Some promising suicide prevention programs in Asia are illustrated. Considering the specific socioeconomic and cultural aspects of the region, community-based suicide intervention programs integrating multiple layers of intervention targets may be the most feasible and cost-effective strategy in Asia, with its populous areas and limited resources.

Humanitarian Relief Workers and Trauma-related Mental Illness

Humanitarian relief work is a growing field characterized by ongoing exposure to primary and secondary trauma, which has implications for workers’ occupational mental health. This paper reviews and summarizes research to date on mental health effects of relief work. Twelve studies on relief workers and 5 studies on organizations that employ relief workers are examined to determine whether relief work is a risk factor for trauma-related mental illness. Although studies are inconsistent regarding methods and outcomes documenting trauma-related mental illness among relief workers, it appears that relief workers, compared with the general population, experience elevated trauma rates and suffer from more posttraumatic stress disorder, depression, and anxiety. Organizations that employ relief workers have varying approaches to train for these risks, and more support in the field is needed.

An Aging Workforce and Injury in the Construction Industry

The relatively large birth cohort between 1946 and 1964, combined with the economic recession in the first decade of the 21st century, have led to an increase in the proportion of older workers in the US workplace. Understanding the health and safety needs of an aging workforce will be critical, especially in the construction industry, where physical job demands are high. This paper reviews the epidemiologic literature on the impact of age on injury among workers in the construction industry in terms of cause, type, and cost. PubMed was searched by using the following terms: older workers, construction, construction industry, injury, and age. The available studies reported that, among the construction industry workforce, older age at injury was related to higher injury costs but not to number of injuries. The higher injury costs associated with worker age are likely due in part to the severity of the injuries sustained by older workers. Identification of injury trends and subsequent analytical research efforts designed to ascertain factors associated with injury among older construction workers are needed for employers to effectively manage a health and safety program that addresses the needs of the aging worker.

Volume 140 Issue 03

Epidemiology Infection, Volume 140 Issue 03 Epidemiology Infection publishes original reports and reviews on all aspects of infection in humans and animals. Particular emphasis is given to the epidemiology, prevention and control of infectious diseases. The scope includes the zoonoses, tropical infections, food hygiene, vaccine studies, statistics and the clinical, social and public-health aspects of infectious disease. It has become the key international periodical in which to find the latest reports on recently discovered infections and new technology. For those concerned with policy and planning for the control of infections, the papers on mathematical modelling of epidemics caused by historical, current and emergent infections will be of particular value.

HYG volume 140 issue 3 Cover and Front matter

Miscellaneous Epidemiology & Infection, Volume 140 Issue 03, pp f1-f2Abstract

HYG volume 140 issue 3 Cover and Back matter

Miscellaneous Epidemiology & Infection, Volume 140 Issue 03, pp b1-b3Abstract

Livestock veterinarians at high risk of acquiring methicillin-resistant Staphylococcus aureus ST398

Review Articles C. GARCIA-GRAELLS, J. ANTOINE, J. LARSEN, B. CATRY, R. SKOV, O. DENIS, Epidemiology & Infection, Volume 140 Issue 03, pp 383-389Abstract

USA300 methicillin-resistant S. aureus (USA300 MRSA) colonization and the risk of MRSA infection in residents of extended-care facilities

Research Articles S. M. SHURLAND, O. C. STINE, R. A. VENEZIA, M. ZHAN, J. P. FURUNO, R. R. MILLER, M.-C. ROGHMANN, Epidemiology & Infection, Volume 140 Issue 03, pp 390-399Abstract

Clinical significance of methicillin-resistant Staphylococcus aureus colonization in residents in community long-term-care facilities in Spain

Research Articles A. MANZUR, E. RUIZ DE GOPEGUI, M. DOMINGUEZ, D. MARISCAL, L. GAVALDA, J. L. PEREZ, F. SEGURA, M. PUJOL, the Spanish Network for Research in Infectious Diseases null, Epidemiology & Infection, Volume 140 Issue 03, pp 400-406Abstract

Space–time pattern of hepatitis A in Spain, 1997–2007

Research Articles D. GOMEZ-BARROSO, C. VARELA, R. RAMIS, J. L. DEL BARRIO, F. SIMÓN, Epidemiology & Infection, Volume 140 Issue 03, pp 407-416Abstract

Determinants of anti-hepatitis A antibody seroprevalence in 2- to 19-year-olds in the USA using NHANES 2007–2008

Research Articles E. VELASCO-MONDRAGON, I. LINDONG, F. KAMANGAR, Epidemiology & Infection, Volume 140 Issue 03, pp 417-425Abstract

Changes in measles seroepidemiology of healthcare workers in southern Taiwan

Research Articles T. S. HO, S. M. WANG, L. R. WANG, C. C. LIU, Epidemiology & Infection, Volume 140 Issue 03, pp 426-431Abstract

Molecular and phylogenetic analysis of Greek measles 2010 strains

Research Articles A. MELIDOU, G. GIOULA, V. POGKA, M. EXINDARI, A. MOUTOUSSI, D. SGOURAS, K. PAPADAKOS, D. CHATZIDIMITRIOU, D. KARABAXOGLOU, A. MENTIS, N. MALISIOVAS, Epidemiology & Infection, Volume 140 Issue 03, pp 432-438Abstract

Mumps outbreak in Israel's highly vaccinated society: are two doses enough?

Research Articles E. ANIS, I. GROTTO, L. MOERMAN, B. WARSHAVSKY, P. E. SLATER, B. LEV, Epidemiology & Infection, Volume 140 Issue 03, pp 439-446Abstract

An outbreak of rubella in the Federation of Bosnia and Herzegovina between December 2009 and May 2010 indicates failure to vaccinate during wartime (1992–1995)

Research Articles M. HUKIC, J. M. HÜBSCHEN, M. SEREMET, I. SALIMOVIC-BESIC, M. MULAOMEROVIC, N. MEHINOVIC, S. KARAKAS, E. CHARPENTIER, C. P. MULLER, Epidemiology & Infection, Volume 140 Issue 03, pp 447-453Abstract

Infection and immunity for human parvovirus B19 in patients with febrile exanthema

Research Articles M. S. PEDRANTI, P. BARBERO, C. WOLFF, L. M. GHIETTO, M. ZAPATA, M. P. ADAMO, Epidemiology & Infection, Volume 140 Issue 03, pp 454-461Abstract

African horse sickness in The Gambia: circulation of a live-attenuated vaccine-derived strain

Brief Report C. A. L. OURA, P. A. S. IVENS, K. BACHANEK-BANKOWSKA, A. BIN-TARIF, D. B. JALLOW, C. SAILLEAU, S. MAAN, P. C. MERTENS, C. A. BATTEN, Epidemiology & Infection, Volume 140 Issue 03, pp 462-465Abstract

Age factor and implication of human papillomavirus type-specific prevalence in women with normal cervical cytology

Research Articles C. H. LAI, A. CHAO, C. J. CHANG, C. C. HUANG, L. C. WANG, S. HSUEH, C. T. LIN, T. I. WU, M. S. JAO, H. H. CHOU, Epidemiology & Infection, Volume 140 Issue 03, pp 466-473Abstract

The risk of airborne influenza transmission in passenger cars

Brief Report L. D. KNIBBS, L. MORAWSKA, S. C. BELL, Epidemiology & Infection, Volume 140 Issue 03, pp 474-478Abstract

Geographical gradient of mean age of dengue haemorrhagic fever patients in northern Thailand

Research Articles Y. NAGAO, A. TAWATSIN, S. THAMMAPALO, U. THAVARA, Epidemiology & Infection, Volume 140 Issue 03, pp 479-490Abstract

Under-recognition and reporting of dengue in Cambodia: a capture–recapture analysis of the National Dengue Surveillance System

Research Articles S. VONG, S. GOYET, S. LY, C. NGAN, R. HUY, V. DUONG, O. WICHMANN, G. W. LETSON, H. S. MARGOLIS, P. BUCHY, Epidemiology & Infection, Volume 140 Issue 03, pp 491-499Abstract

Costs of illness due to endemic cholera

Research Articles C. POULOS, A. RIEWPAIBOON, J. F. STEWART, J. CLEMENS, S. GUH, M. AGTINI, D. SUR, Z. ISLAM, M. LUCAS, D. WHITTINGTON, the DOMI Cholera COI Study Group null, Epidemiology & Infection, Volume 140 Issue 03, pp 500-509Abstract

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Anti-Mullerian Hormone: A Potential New Tool in Epidemiologic Studies of Female Fecundability

Bias in Observational Studies of Prevalent Users: Lessons for Comparative Effectiveness Research From a Meta-Analysis of Statins

Environmental and Urinary Markers of Prenatal Exposure to Drinking Water Disinfection By-Products, Fetal Growth, and Duration of Gestation in the PELAGIE Birth Cohort (Brittany, France, 2002-2006)

Invited Commentary: Biomarkers of Exposure to Drinking Water Disinfection By-Products--Are We Ready Yet?

Is Childhood Asthma Associated With Educational Level and Longest-Held Occupation?

Passive Cigarette Smoke Exposure During Various Periods of Life, Genetic Variants, and Breast Cancer Risk Among Never Smokers

Mortality Among Young Injection Drug Users in San Francisco: A 10-Year Follow-up of the UFO Study

A Nationwide Cohort Study on the Incidence of Meningioma in Women Using Postmenopausal Hormone Therapy in Finland

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and Design

Regression Calibration When Foods (Measured With Error) Are the Variables of Interest: Markedly Non-Gaussian Data With Many Zeroes

Credible Mendelian Randomization Studies: Approaches for Evaluating the Instrumental Variable Assumptions

Taking Advantage of the Strengths of 2 Different Dietary Assessment Instruments to Improve Intake Estimates for Nutritional Epidemiology

A Comparison of Self-Reported Analgesic Use and Detection of Urinary Ibuprofen and Acetaminophen Metabolites by Means of Metabonomics: The INTERMAP Study

Re: "Socioeconomic Differences in Cardiometabolic Factors: Social Casusation or Health-Related Selection? Evidence from the Whitehall II Cohort Study, 1991-2004"

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Epidemiologic Approaches to Injury and Violence

Classifying External Causes of Injury: History, Current Approaches, and Future Directions

Measuring the Population Burden of Fatal and Nonfatal Injury

Network Meta-analysis to Evaluate the Effectiveness of Interventions to Increase the Uptake of Smoke Alarms

Roadway Characteristics and Pediatric Pedestrian Injury

Interventions to Reduce Risks Associated With Vehicle Incompatibility

Marijuana Use and Motor Vehicle Crashes

Motor Vehicle Deaths Among American Indian and Alaska Native Populations

The Role of Race/Ethnicity in Alcohol-attributable Injury in the United States

Does the Alcohol Make Them Do It? Dating Violence Perpetration and Drinking Among Youth

Peer Victimization Among School-aged Children With Chronic Conditions

Suicide in Asia: Opportunities and Challenges

Humanitarian Relief Workers and Trauma-related Mental Illness

An Aging Workforce and Injury in the Construction Industry

Volume 140 Issue 03

HYG volume 140 issue 3 Cover and Front matter

HYG volume 140 issue 3 Cover and Back matter

Livestock veterinarians at high risk of acquiring methicillin-resistant Staphylococcus aureus ST398

USA300 methicillin-resistant S. aureus (USA300 MRSA) colonization and the risk of MRSA infection in residents of extended-care facilities

Clinical significance of methicillin-resistant Staphylococcus aureus colonization in residents in community long-term-care facilities in Spain

Space–time pattern of hepatitis A in Spain, 1997–2007

Determinants of anti-hepatitis A antibody seroprevalence in 2- to 19-year-olds in the USA using NHANES 2007–2008

Changes in measles seroepidemiology of healthcare workers in southern Taiwan

Molecular and phylogenetic analysis of Greek measles 2010 strains

Mumps outbreak in Israel's highly vaccinated society: are two doses enough?

An outbreak of rubella in the Federation of Bosnia and Herzegovina between December 2009 and May 2010 indicates failure to vaccinate during wartime (1992–1995)

Infection and immunity for human parvovirus B19 in patients with febrile exanthema

African horse sickness in The Gambia: circulation of a live-attenuated vaccine-derived strain

Age factor and implication of human papillomavirus type-specific prevalence in women with normal cervical cytology

The risk of airborne influenza transmission in passenger cars

Geographical gradient of mean age of dengue haemorrhagic fever patients in northern Thailand

Under-recognition and reporting of dengue in Cambodia: a capture–recapture analysis of the National Dengue Surveillance System

Costs of illness due to endemic cholera