Shallow Meritocracy

Pregnant people who smoke constitute a uniquely vulnerable population likely to be impacted by a menthol cigarette (MC) ban. However, there are no published reports of the prevalence of prenatal MC use in a nationally representative US sample including racial andethnic disparities and associated characteristics. Participants were 1245 US pregnant people who smoked MC or non-MC (NMC) in the past 30 days from the 2010-2019 National Survey on Drug Use and Health. Prevalence of past 30-day MC use was determined; weighted sociodemographic characteristics, tobacco use, and substance co-use were compared across MC and NMC groups and in multivariable analyses. The prevalence of MC use among pregnant people who smoked was 52.29% (95% CI: 48.17, 56.41) overall and 92.23% (95% CI: 87.74 to 96.73) among non-Hispanic Black pregnant people who smoked. A greater proportion of pregnant people who used MCs (vs NMCs) were non-Hispanic Black or Hispanic, unmarried, sexual minorities, from a large metropolitan area, smoked fewer cigarettes per day and reported later age of initiation. In multivariable analyses, only non-Hispanic Black race remained a significant predictor of MC use; non-Hispanic Black (vs non-Hispanic White) pregnant people who smoked showed 13.88 times (95% CI: 6.30 to 30.58) greater odds of MC use (p < .01). This is the first study to determine the prevalence and correlates of prenatal MC use in a nationally representative US sample. Given the known causal impacts of prenatal smoking on maternal and infant morbidity, results suggest that the planned menthol ban offers opportunities for improving maternal and infant health. Using a nationally representative US sample, this study highlights that more than half of pregnant people who smoke and nearly all of Black pregnant people who smoke in the US use menthol cigarettes. Given high rates of menthol cigarette use and causal links between prenatal cigarette use and maternal and infant morbidity, the menthol cigarette ban proposed by the Food and Drug Administration (FDA) offers a potential opportunity to develop tailored education and intervention strategies to improve perinatal and infant health.

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently occur together, but sociodemographic, behavioral, and diagnostic correlates of this comorbidity have not been comprehensively studied. Data from the nationally representative US sample surveyed in the National Epidemiologic Survey on Alcohol and Related Conditions-III ( N = 36,309) were used to define three groups, individuals with a) both past-year GAD and MDD ( n = 909, 16.9%), b) GAD only ( n = 999, 18.6%), and c) MDD only ( n = 3471, 64.5%). The comorbid group was compared with each single-diagnosis group on sociodemographic, behavioral, and diagnostic characteristics based on effect sizes (risk ratios and Cohen's d ) rather than p values because of the large sample sizes. Multivariable-adjusted logistic regression analyses were used to identify factors independently associated with the comorbid group. Bivariate analysis showed that the comorbid group had more parental and childhood adversities, additional psychiatric disorders, and poorer mental health quality of life than both single-disorder groups. Multivariable-adjusted logistic regression of the comorbid group showed that on two of five factors, additional psychiatric diagnoses were significantly more frequent than in the GAD-only group, and that on three of six factors, additional psychiatric diagnoses were significantly more frequent than in the MDD-only group. There is a significantly higher burden of social adjustment problems, comorbid psychiatric disorders, and poorer mental health-related quality of life among individuals with comorbid GAD-MDD than those with single disorders. The adversities associated with this non-SUD psychiatric comorbidity are comparable to those associated with the more extensively studied comorbidity of psychiatric and substance use disorders and deserve further research and treatment.

Associations between childhood maltreatment and risk of myocardial infarction in adulthood: Results from the National Epidemiologic Survey on alcohol and Related Conditions

PurposeTo evaluate cardiovascular and psychiatric morbidity in patient visits with obstructive sleep apnea (OSA) with insomnia (OSA+Insomnia) versus OSA without insomnia (OSA-Insomnia) in a nationally representative US sample.MethodsA retrospective case-control study of epidemiologic databases (National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey) representing an estimated ± standard error (SE) 62,253,910±5,274,747 (unweighted count = 7234) patient visits with diagnosis of OSA from 1995–2010, was conducted. An estimated 3,994,104±791,386 (unweighted count = 658) were classified as OSA+Insomnia and an estimated 58,259,806±4,849,800 (unweighted count = 6576) as OSA-Insomnia. Logistic regression analysis was carried out using OSA+Insomnia versus OSA-Insomnia as the dependent variable, and age (>50 years versus ≤50 years), sex, race (‘White’ versus ‘non-White’), essential hypertension, heart failure, ischemic heart disease, cardiac dysrhythmia, cerebrovascular disease, diabetes, obesity, hyperlipidemia, depressive, anxiety, and adjustment disorders (includes PTSD), hypersomnia and all medications used as independent variables. All comorbidities were physician diagnosed using the ICD9-CM.ResultsAmong patient visits with OSA, an estimated 6.4%±0.9% also had insomnia. Logistic regression analysis revealed that the OSA+Insomnia group was significantly more likely to have essential hypertension (all ICD9-CM codes 401) (OR = 1.83, 95% CI 1.27–2.65) and provisionally more likely to have cerebrovascular disease (ICD9-CM codes 430–438) (OR = 6.58, 95% CI 1.66–26.08). The significant OR for cerebrovascular disease was considered provisional because the unweighted count was <30.ConclusionsIn a nationally representative sample, OSA+Insomnia was associated significantly more frequently with essential hypertension than OSA-Insomnia, a finding that has not been previously reported. In contrast to studies that have considered patient self-reports of psychological morbidity, the absence of a significant association with psychiatric disorders in our study may be indicative of the fact that we considered only physician-rated psychiatric syndromes meeting ICD9-CM criteria. Our findings among the OSA+Insomnia group are therefore most likely conservative.

To examine the association between a history of 5 types of childhood maltreatment (that is, physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several substance use disorders (SUDs), including alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine, in a nationally representative US adult sex-stratified sample. Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative US sample of adults aged 20 years and older (n = 34 653). Logistic regression models were conducted to understand the relations between 5 types of childhood maltreatment and SUDs separately among men and women after adjusting for sociodemographic variables and Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I and II mental disorders. All 5 types of childhood maltreatment were associated with increased odds of all individual SUDs among men and women after adjusting for sociodemographic variables, with the exception of physical neglect and heroin abuse or dependence, emotional neglect, and amphetamines and cocaine abuse or dependence among men (adjusted odds ratio range 1.3 to 4.7). After further adjustment for other DSM Axis I and II mental disorders, the relations between childhood maltreatment and SUDs were attenuated, but many remained statistically significant. Differences in the patterns of findings were noted for men and women for sexual abuse and emotional neglect. This research provides evidence of the robust nature of the relations between many types of childhood maltreatment and many individual SUDs. The prevention of childhood maltreatment may help to reduce SUDs in the general population.

BackgroundThis paper reviews nationally representative public opinion surveys on artificial intelligence (AI) in the United States, with a focus on areas related to health care. The potential health applications of AI continue to gain attention owing to their promise as well as challenges. For AI to fulfill its potential, it must not only be adopted by physicians and health providers but also by patients and other members of the public.ObjectiveThis study reviews the existing survey research on the United States’ public attitudes toward AI in health care and reveals the challenges and opportunities for more effective and inclusive engagement on the use of AI in health settings.MethodsWe conducted a systematic review of public opinion surveys, reports, and peer-reviewed journal articles published on Web of Science, PubMed, and Roper iPoll between January 2010 and January 2022. We include studies that are nationally representative US public opinion surveys and include at least one or more questions about attitudes toward AI in health care contexts. Two members of the research team independently screened the included studies. The reviewers screened study titles, abstracts, and methods for Web of Science and PubMed search results. For the Roper iPoll search results, individual survey items were assessed for relevance to the AI health focus, and survey details were screened to determine a nationally representative US sample. We reported the descriptive statistics available for the relevant survey questions. In addition, we performed secondary analyses on 4 data sets to further explore the findings on attitudes across different demographic groups.ResultsThis review includes 11 nationally representative surveys. The search identified 175 records, 39 of which were assessed for inclusion. Surveys include questions related to familiarity and experience with AI; applications, benefits, and risks of AI in health care settings; the use of AI in disease diagnosis, treatment, and robotic caregiving; and related issues of data privacy and surveillance. Although most Americans have heard of AI, they are less aware of its specific health applications. Americans anticipate that medicine is likely to benefit from advances in AI; however, the anticipated benefits vary depending on the type of application. Specific application goals, such as disease prediction, diagnosis, and treatment, matter for the attitudes toward AI in health care among Americans. Most Americans reported wanting control over their personal health data. The willingness to share personal health information largely depends on the institutional actor collecting the data and the intended use.ConclusionsAmericans in general report seeing health care as an area in which AI applications could be particularly beneficial. However, they have substantial levels of concern regarding specific applications, especially those in which AI is involved in decision-making and regarding the privacy of health information.

Selenium, an essential trace element involved in defense against oxidative stress, may prevent cancer and cardiovascular disease. We evaluated the association between selenium levels and all-cause and cause-specific mortality in a representative sample of US adults. Serum selenium levels were measured in 13,887 adult participants in the Third National Health and Nutrition Examination Survey. Study participants were recruited from 1988 to 1994 and followed up for mortality for up to 12 years. The mean serum selenium level was 125.6 ng/mL. The multivariate adjusted hazard ratios comparing the highest (> or = 130.39 ng/mL) with the lowest (< 117.31 ng/mL) serum selenium level tertile were 0.83 (95% confidence interval [CI], 0.72-0.96) for all-cause mortality, 0.69 (95% CI, 0.53-0.90) for cancer mortality, and 0.94 (95% CI, 0.77-1.16) for cardiovascular mortality. However, based on spline regression models, the association between serum selenium levels and all-cause and cancer mortality was nonlinear, with an inverse association at low selenium levels (< 130 ng/mL) and a modest increase in mortality at high selenium levels (> 150 ng/mL). There was no association between serum selenium levels and cardiovascular mortality. In a representative sample of the US population, we found a nonlinear association between serum selenium levels and all-cause and cancer mortality. Increasing serum selenium levels were associated with decreased mortality up to 130 ng/mL. Our study, however, raises the concern that higher serum selenium levels may be associated with increased mortality.

Higher serum gamma-glutamyltransferase (GGT) levels, a marker of oxidative stress, are implicated in the development and progression of hypertension; however, data from non-Caucasian ethnicities are limited. Also, currently there is little data available on the association between serum GGT level and clinically relevant blood pressure (BP) categories earlier in the disease continuum, when hypertension prevention efforts may be applicable. The association between serum GGT and prehypertension was examined in a nationally representative sample of US adults. Cross-sectional study among 5,827 National Health and Nutrition Examination Survey 1999-2002 participants aged > or =18 years without cardiovascular disease (CVD) and hypertension. The main outcome-of-interest was the presence of prehypertension (systolic BP 120-139 mmHg or diastolic BP 80-89 mmHg) (n=2,269). Higher serum GGT levels were positively associated with prehypertension, independent of smoking, waist circumference, diabetes, cholesterol levels and other confounders. The multivariable odds ratio (95% confidence intervals) comparing quartile 4 of GGT (>29 U/L) to quartile 1 (<13 U/L) was 1.84 (1.37-2.46), p<0.0001. This association persisted in separate analyses among men and women. The results were consistent in subgroup analyses by race-ethnicity, age, smoking, alcohol intake, body mass index, waist circumference and diabetes. In non-parametric models, the positive association between serum GGT and prehypertension appeared to be present across the full range of GGT, without any threshold effect. Higher serum GGT levels are associated with prehypertension in a nationally representative sample of US adults, free of CVD and hypertension.

With the rise of standard contracts, tensions persist between protecting consumers from unfair terms and preserving freedom of contract. A key concern is that consumers may waive legal rights, often unknowingly, particularly when dealing with trusted brands. To address this, we conducted a conjoint experiment with a representative US sample to evaluate how consumers value legal rights—such as warranties, liability, privacy, and conflict resolution—when they are fully aware, understand the terms, and must trade them off against product features like price and brand reputation. Our findings reveal that even when rights can be traded off against other features of the product, consumers value legal rights. Of the legal rights we tested, warranties and price were found to be the most decisive factors in their purchase decisions. Notably, we did not find evidence that brand reputation significantly alters the valuation of legal rights. These insights offer important empirical evidence to enrich the extensive policy debate.

Existing studies highlight numerous barriers immigrants encounter upon arrival and the economic benefits of citizenship acquisition in reducing these barriers to integration at their destinations. While researchers have extensively studied native-immigrant economic disparities and the lower monetary returns to immigrants’ education, limited knowledge exists about the distinct roles natives and immigrants play in nationwide labor markets and the principles underlying these roles. I investigate how immigrants may experience marginalization in contemporary US labor markets despite their employment participation. I propose that this marginalization may be reflected in occupational trait differentials across moral, mechanistic, and animalistic dimensions within citizenship hierarchies. Cross-sectional and longitudinal analyses of three recent nationally representative US samples provide consistent evidence that citizenship ladders contribute to stratification in workers’ occupational traits across each marginalization dimension, leading to diverging trajectories. Beyond the prominent non-monetary trait gaps between citizens and non-citizens, the results reveal persistent disparities tied to birthright and naturalized citizenship statuses, particularly for Asian and Hispanic immigrants. These trait differentials help to segment occupational roles based on citizenship hierarchies, potentially limiting immigrants’ decision-making freedom and workplace influence, and reducing access to positions emphasizing moral judgment or expressive communication skills. The conclusion discusses broader theoretical, empirical, and policy implications.

OBJECTIVES/GOALS: To examine the relationship between chronic cadmium exposure and cognitive function in later life, we estimated the association of urinary cadmium concentration on composite cognitive score, an important marker of progression toward dementia, while accounting for diet and key co-pollutants tobacco use and lead exposure. METHODS/STUDY POPULATION: After excluding those missing cognitive data (141) or covariate data (190), we included 760 persons &gt;/= 60 years of age from the National Health and Nutrition Examination Survey (NHANES), 2011-2014. Urinary cadmium reflects prolonged exposure: mean=0.41μg/L (standard deviation (SD)= 0.46μg/L). Concurrent with urine sampling, neuropsychological tests tapping memory, executive function, sustained attention and working memory were combined into a standardized z-score (mean 0, SD 1, 25th and 75th percentiles −0.68 and 0.72, respectively). We used linear models to estimate change in cognition per cadmium interquartile range, incorporating NHANES sampling weights, adjusting for demographic characteristics, diet, lead, and active tobacco use (classified by self-report or serum cotinine levels &gt;10ng/mL). RESULTS/ANTICIPATED RESULTS: A baseline model showed that an IQR (0.38 μg/L) increase in urinary cadmium exposure was associated with a 13% standard deviation lower cognitive z-score (95%CI: −0.19, −0.06), after adjusting for sampling weight and urinary creatinine (measure of urine dilution). This association was attenuated to 7% standard deviation lower cognitive z-score (95% CI −0.13, −0.02) after adjusting additionally for demographic characteristic of sex, age, age^2, race/ethnicity, marital status, education level, and poverty income ratio. Models further adjusted for smoking status (active/former/never), blood lead concentration, and key dietary sources of cadmium showed IQR increase in urinary cadmium exposure associated with 7% standard deviation lower cognitive z-score (95%CI: −0.14, −0.01). DISCUSSION/SIGNIFICANCE: Our findings suggest cadmium exposure is associated with lower cognitive scores even after accounting for confounding influence of diet, tobacco use and lead exposure. Alternate explanations include selection bias due to dropping persons missing needed variables and using concurrent cognitive measures rather than cognitive measures of over time.

ABSTRACTBackground: We propose a method for estimating the timing of in-bed intervals using objective data in a large representative US sample, and quantify the association between these intervals and age, sex, and day of the week.Methods: The study included 11,951 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2003–2006, who wore accelerometers to measure physical activity for seven consecutive days. Participants were instructed to remove the device just before the nighttime sleep period and put it back on immediately after. This nighttime period of non-wear was defined in this paper as the objective bedtime (OBT), an objectively estimated record of the in-bed interval. For each night of the week, we estimated two measures: the duration of the OBT (OBT-D) and, as a measure of the chronotype, the midpoint of the OBT (OBT-M). We estimated day-of-the-week-specific OBT-D and OBT-M using gender-specific population percentile curves. Differences in OBT-M (chronotype) and OBT-D (the amount of time spent in bed) by age and sex were estimated using regression models.Results: The estimates of OBT-M and their differences among age groups were consistent with the estimates of chronotype obtained via self-report in European populations. The average OBT-M varied significantly by age, while OBT-D was less variable with age. In the reference group (females, aged 17–22 years), the average OBT-M across 7 days was 4:19 AM (SD = 30 min) and the average OBT-D was 9 h 19 min (SD = 12 min). In the same age group the average OBT-D was 18 minutes shorter for males than for females, while the average OBT-M was not significantly different between males and females. The most pronounced differences were observed between OBT-M of weekday and weekend nights. In the reference group, compared to the average OBT-M of 3:50 am on Monday through Thursday nights, there was a 57-minute delay in OBT-M on Friday nights (entering the weekend), a 69-minute delay on Saturday nights (staying in the weekend), and a 23-minute delay on Sunday night (leaving the weekend). For both OBT-M and OBT-D, in most age groups and for most days of the week, there were no statistically significant differences between males and females, except for OBT-D on Wednesdays and Thursdays, with males having 31 (p-value < 0.05) and 45 (p-value < 0.05) minutes shorter OBT-D, respectively.Conclusions: The proposed measures, OBT-D and OBT-M, provide useful information of time in bed and chronotype in NHANES 2003–2006. They identify within-week patterns of bedtime and can be used to study associations between the bedtime and the large number of health outcomes collected in NHANES 2003–2006.

Engaging in no moderate-to-vigorous physical activity (MVPA) has been recognized as an important indicator in physical activity (PA) surveillance, as any engagement in MVPA confers health benefits compared to none. Studying the prevalence of no MVPA can provide valuable insights into physical inactivity patterns and inform public health intervention efforts. While some cross-sectional studies have examined this issue, no research has analysed year-to-year trends. Therefore, the aim of this study was to assess trends of no MVPA among adolescents and key subgroups using a nationally representative US sample. Data from 2005 to 2021 cycles of the Youth Risk Behavior Surveillance System were used, with 115,926 US adolescents aged 14-17 years included (female: unweighted sample size = 58,582, 50.5%; weighted%=49.4%). Participants self-reported their demographic (sex, age, race/ethnicity, body mass index) and behavioural information (days of ≥ 60min of MVPA over the past week, and recreational screen time). No MVPA was operationalized as reporting 0 days of ≥ 60min of MVPA. Trend analysis was performed to assess temporal variations from 2005 to 2021 using a series of binary logistic regression models after controlling for demographic and screen time related variables. Declining trends in no MVPA were observed among adolescents from 2005 (weighted: 24.3%) to 2021 (weighted: 15.5%). After stratifying by sex, age, race/ethnicity, body mass index and recreational screen time, similar downward trends were shown across all adolescent subgroups consistently (p for trend < 0.001). Girls, older adolescents, those who identified as non-White, adolescents with excess weight, and those engaging in more than 2h of recreational screen time per day tended to report no MVPA at higher rates (all p < 0.001) compared to their counterparts. No MVPA has declined among the US adolescents, especially after 2009. Notably, sociodemographic disparities were observed in no MVPA among different population subgroups. PA promotion strategies targeting girls and older adolescents should be prioritized to further reduce the prevalence of no MVPA.

ABSTRACTLow perception of risk is a risk factor for heroin use. Research is needed to determine whether this risk factor for heroin use is affected by the use of other drugs. Data were analyzed from participants in the 2015/2016 National Surveys on Drug Use and Health who denied lifetime heroin use (N= 110,102). We examined how recency of use of various drugs and number of drugs used relate to perceptions that using heroin is not a great risk. Results from multivariable models suggest that no lifetime drug use, and recent prescription opioid misuse and methamphetamine use, in particular, were associated with higher odds of perceiving that heroin use is not of great risk. Recent marijuana use was associated with lower odds of reporting that heroin use is not of great risk. Use of more drugs in one’s lifetime, past year, and/or past month tended to be associated with lower odds of reporting heroin use as not a great risk. Prevention experts should consider that recent prescription opioid misuse in particular is a risk factor for the lower perception of risk, while individuals reporting no lifetime drug use may also require better education regarding harms associated with heroin use.

For almost fifty years researchers have endeavored to identify the factors that influence individuals’ performance of environmentally significant behavior, with inconsistent results. This quest has become even more urgent as newly released scientific reports provide mounting evidence of global climate change and other types of anthropogenic environmental degradation. In order to change individuals’ behavior on a large scale, it is necessary to change their habits of thinking. Using insights from Grid-group cultural theory and cognitive sociology, this mixed-methods study examined the factors that influence pro-environmental behavior among a nationally representative US sample (n = 395). Qualitative results indicate that individuals develop culturally-specific environmental socio-cognitive schemas which they use to assign meaning to the environment and guide their environmentally significant behavior. Quantitative results indicate cultural orientation, pro-environmental orientation, environment identity, and environmental influence predict pro-environmental behavior. Applying these combined theoretical perspectives to the social problem of environmental degradation could facilitate the development of targeted strategies for bringing about impactful behavioral change.