Ansah H, Mayfield H, & Davila V. The moderating influence of community social support on the association between adverse childhood experiences and persistent feelings of sadness among adolescents in Texas. Texas Public Health Journal. 2024;76(4).

Abstract:

Background: Adverse childhood experiences (ACEs) have long-lasting effects on adolescents' mental health, impacting their ability to form healthy relationships and lifestyles later in life. Social support may act as a resource that helps adolescents cope with stress and provides a sense of community, support, and hope. However, few studies have explored the moderating role of perceived community social support on the impact that ACEs have on poor mental health among adolescents in Texas.

Methods: The 2021 Texas Youth Risk Behavior Surveillance System (YRBS) survey data were used to address this gap. Unadjusted and adjusted bivariate and multivariable logistic regression models were used to examine the association between self-reported ACEs and feelings of sadness, adjusting for sociodemographic variables, and assessing community social support as a potential moderator.

Results: The sample included 1,259 students (49.8% female). Overall, 87.4% of Texas adolescents experienced one or more ACEs, 50.1% of students reported past-year persistent feelings of sadness, and 42.1% of Texas adolescents reported perceived community social support. The top three most reported ACEs were verbal abuse (65.3%), followed by physical abuse (37.6%) and household mental illness (33.0%). Total ACE score was found to be associated with feelings of sadness in both crude (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.49-1.78) and adjusted (aOR = 1.60, 95% CI = 1.47- 1.74) models. While the magnitude of the odds of persistent feelings of sadness was higher among those who reported no community social support (aOR = 1.68, 95% CI = 1.51-1.87) compared to those who received community social support (aOR = 1.47, 95% CI = 1.30-1.67), there was no significant difference between the groups.

Conclusions: The results suggest that community social support may impact the relationship between ACEs and adolescent's emotional well-being; however, more research is needed to determine this effect.

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Haas CB, Shiels MS, Pfeiffer RM, et al. Cancers with epidemiologic signatures of viral oncogenicity among immunocompromised populations in the United States. J Natl Cancer Inst. 2024;116(12):1983-1991. 
doi:10.1093/jnci/djae159

Abstract

Background: Immunosuppressed individuals have elevated risk of virus-related cancers. Identifying cancers with elevated risk in people with HIV and solid organ transplant recipients, 2 immunosuppressed populations, may help identify novel etiologic relationships with infectious agents.

Methods: We used 2 linkages of population-based cancer registries with HIV and transplant registries in the United States. Cancer entities were systematically classified according to site and histology codes. Standardized incidence ratios were used to compare risk in people with HIV and solid organ transplant recipients with the general population. For selected cancer entities, incidence rate ratios were calculated for indicators of immunosuppression within each population.

Results: We identified 38,047 cancer cases in solid organ transplant recipients and 53,592 in people with HIV, yielding overall standardized incidence ratios of 1.66 (95% confidence interval [CI] = 1.65 to 1.68) and 1.49 (95% CI = 1.47 to 1.50), respectively. A total of 43 cancer entities met selection criteria, including conjunctival squamous cell carcinoma (people with HIV standardized incidence ratio = 7.1, 95% CI = 5.5 to 9.2; solid organ transplant recipients standardized incidence ratio = 9.4, 95% CI = 6.8 to 12.6). Sebaceous adenocarcinoma was elevated in solid organ transplant recipients (standardized incidence ratio = 16.2, 95% CI = 14.0 to 18.6) and, among solid organ transplant recipients, associated with greater risk in lung and heart transplant recipients compared with recipients of other organs (incidence rate ratio = 2.3, 95% CI = 1.7 to 3.2). Salivary gland tumors, malignant fibrous histiocytoma, and intrahepatic cholangiocarcinoma showed elevated risk in solid organ transplant recipients (standardized incidence ratio = 3.9, 4.7, and 3.2, respectively) but not in people with HIV. However, risks for these cancers were elevated following an AIDS diagnosis among people with HIV (incidence rate ratio = 2.4, 4.3, and 2.0, respectively).

Conclusions: Elevated standardized incidence ratios among solid organ transplant recipients and people with HIV, and associations with immunosuppression within these populations, suggest novel infectious causes for several cancers including conjunctival squamous cell carcinoma, sebaceous adenocarcinoma, salivary gland tumors, malignant fibrous histiocytoma, and intrahepatic cholangiocarcinoma.

 

Ludorf KL, Benjamin RH, Canfield M, et al. Low Apgar score and risk of neonatal mortality among infants with birth defects. Am J Perinatol. Published online November 25, 2024.

doi:10.1055/a-2452-0047

Abstract

Objective: The Apgar score is a clinical tool to assess newborn health at delivery and has shown utility in predicting neonatal mortality in the general population, but its predictive ability in neonates with birth defects remains unexplored. As such, we aimed to investigate the performance of the 5-minute Apgar score in predicting neonatal mortality among neonates with a spectrum of major birth defects.

Study design: Data for neonates with birth defects born between 1999 and 2017 were obtained from the Texas Birth Defect Registry. We generated receiver operating characteristic curves and corresponding area under the curve (AUC) values for neonatal mortality (death within the first 28 days of life) by 5-minute Apgar score (<7 vs. ≥7) to measure discrimination capacity. We performed secondary analyses to determine the predictive ability of the Apgar score: (1) among infants with an isolated birth defect and (2) separately in preterm and term neonates.

Results: Low Apgar score yielded substantial predictive ability for neonatal mortality, with 25 out of 26 AUC values > 0.70 across a spectrum of defect categories. High predictive ability was consistent among neonates with isolated defects, and preterm and term neonates.

Conclusion: The Apgar score is likely useful for predicting neonatal mortality among most neonates with birth defects. Despite small sample sizes limiting some secondary analyses, the findings emphasize the potential continued use of the Apgar score as a rapid clinical assessment tool for newborns with birth defects. Continued research may refine the Apgar score's application in this important population, both in clinical practice and population health research.

 

Ludorf KL, Benjamin RH, Canfield MA, Swartz MD, Agopian AJ. Prediction of preterm birth among infants with orofacial cleft defects. Cleft Palate Craniofac J. 2025;62(1):35-43.

doi:10.1177/10556656231198945

Abstract

Objective: To develop risk prediction models for preterm birth among infants with orofacial clefts.

Design: Data from the Texas Birth Defects Registry for infants with orofacial clefts born between 1999-2014 were used to develop preterm birth predictive models. Logistic regression was used to consider maternal and infant characteristics, and internal validation of the final model was performed using bootstrapping methods. The area under the curve (AUC) statistic was generated to assess model performance, and separate predictive models were built and validated for infants with cleft lip and cleft palate alone. Several secondary analyses were conducted among subgroups of interest.

Setting: State-wide, population-based Registry data.

Patients/participants: 6774 infants with orofacial clefts born in Texas between 1999-2014.

Main outcome measure(s): Preterm birth among infants with orofacial clefts.

Results: The final predictive model performed modestly, with an optimism-corrected AUC of 0.67 among all infants with orofacial clefts. The optimism-corrected models for cleft lip (with or without cleft palate) and cleft palate alone had similar predictive capability, with AUCs of 0.66 and 0.67, respectively. Secondary analyses had similar results, but the model among infants with delivery prior to 32 weeks demonstrated higher optimism-corrected predictive capability (AUC = 0.74).

Conclusions: This study provides a first step towards predicting preterm birth risk among infants with orofacial clefts. Identifying pregnancies affected by orofacial clefts at the highest risk for preterm birth may lead to new avenues for improving outcomes among these infants.