Abstract Background Poor diet is a major public health concern due to its association with chronic diseases. Church Health, a not-for-profit and faith-based healthcare organization in Memphis, Tennessee, implemented Cook Well, Be Well (CWBW), a 4-session nutrition education program designed to improve dietary habits through instruction on the Mediterranean diet (MD), the Model for Healthy Living (MFHL), and healthy cooking. This study evaluated the program’s effectiveness in promoting healthier eating behaviors and cooking confidence. Methods Secondary data from pre- and post-intervention surveys were analyzed. CWBW comprises four weekly sessions for individuals aged ≥ 16 years. Outcomes included changes in adherence to the MD and MFHL and cooking confidence, assessed using items from the CWBW questionnaire (scored 0–2). The MD section had nine questions, the MFHL had seven, and the cooking confidence section included 11. A multivariable linear mixed-effect regression model was used to examine the effect of CWBW participation on each outcome, adjusting for baseline measurements and sociodemographic variables. The Wilcoxon Signed Rank test was used to examine differences across various sociodemographic characteristics. For each outcome, mean or median differences, 95% confidence intervals (CI), p-values, and effect sizes (Cohen’s d) were reported. Results Data from 351 participants were analyzed (52.4% female, 27.6% African American). The overall score (sum of MD, MFHL, and cooking confidence) increased significantly (mean difference [md] = 4.72; 95% CI: 2.93, 6.50, P < .01, d = 0.72). Significant increases were observed in MD scores (md = 0.96; 95% CI: 0.35, 1.57, P = .01, d = 0.43), cooking confidence (md = 2.27; 95% CI: 1.23, 3.32, P < .01, d = 0.59), and MFHL scores (md = 1.48; 95% CI: 0.79, 2.17, P < .01, d = 0.59). These improvements were sustained at 3-, 6-, and 12 months for MD and cooking confidence (P < .05). Conclusion The CWBW program significantly improved participants’ adherence to the MD, confidence in healthy cooking, and engagement with the MFHL. These findings suggest that community-based nutrition education programs, particularly when rooted in cultural and faith-based contexts, can effectively promote healthier dietary behaviors and support chronic disease prevention.

Groundwater is a major source of drinking water in the United States (US). Groundwater chemistry can contribute to lead leaching from water supply pipes due to factors such as pH and mineral content that influence corrosion. Lead exposure disproportionately affects children from low-income neighborhoods. We evaluated the association of county-level groundwater chemicals with the percentage of children with blood lead levels >5 μg/dL (BLL5%) in 1,104 US counties served by public water utilities using groundwater. Out of the 4,844 BLL5% observations, 3,525 had values of "NA" for BLL5%. We used weighted least squares regression to evaluate the associations, adjusting for covariates such as county-level median household income, educational attainment, and poverty rates. Bayesian Kernel Machine Regression (BKMR) was used to assess the joint effects of all chemicals on BLL5%. Sensitivity analyses tested the robustness of our results by imputing missing BLL5% values. A one mg/L increase in arsenic, copper, dissolved oxygen, and selenium was associated with increases in BLL5% of 0.0512% (95% CI: 0.0002%, 0.1023%), 0.0358% (95% CI: 0.0208%, 0.0508%), 0.0956% (95% CI: 0.0225%, 0.1687%), and 0.3038% (95% CI: 0.1747%, 0.4420%), respectively. Alkalinity, pH, calcium, bicarbonate, and dissolved solids were not found to be statistically significant. BKMR identified calcium, lithium, and alkalinity (posterior inclusion probabilities = 1,000) as important, though with minimal effects. Sensitivity analyses showed variability in results depending on assumptions about missing data. Our findings highlight the importance of monitoring groundwater quality and implementing interventions to reduce childhood lead exposure risks in vulnerable populations, particularly minority, and low-income children.

Health facilities often use organic solvents for cleaning and disinfection, yet little information is available on indoor air pollution by organic chemicals in outpatient clinics. This study investigates volatile organic compounds (VOCs) in two clinics, assessing their concentrations, variability, and health risks. Air monitoring was conducted from September to November 2020. Samples were collected from multiple rooms in each clinic and analyzed for 159 target VOCs. We identified 76 different VOCs in the indoor air, with ethanol and isopropanol being most abundant (2,792‒3,861 μg/m3). Other major VOCs included terpenes, C13-C15 alkanes, formaldehyde, acetaldehyde, and acetone, all exceeding 10 μg/m3. The overall VOC levels displayed cyclic fluctuations corresponding to disinfectant uses. Alcohols significantly increased, while other VOCs decreased or remained unchanged after the installation of air purifiers. Formaldehyde posed acute and chronic health risks and contributed 91.5% of the total cancer risk of 1.79 × 10-4. Results indicate that clinic air contains elevated VOC levels, and carbon air purifiers showed limited removal effectiveness for medical disinfectants. Source control and enhanced ventilation are recommended to reduce exposure risk.

Polycyclic aromatic hydrocarbons (PAHs) exist ubiquitously in the natural environment; however, studies seldom evaluate health risks from aggregate exposures to PAHs from multiple environmental media. This study aimed to estimate the doses and risks of 16 priority PAHs in soil and air for both children and adults and quantify their contributors. Soil and ambient air samples were collected at 50 and 8 sites, respectively, in Memphis, Tennessee, USA. Grab soil samples were taken from the upper 2 inches of the soil and air samples were collected every 12 days for over one year. The sum concentration of 16 PAHs (ΣPAH) averaged 7.6 ± 15.0 mg/kg (range 1.5-98.8 mg/kg) in soil and 73.6 ± 25.3 ng/m3 (range 47.0-121.2 ng/m3) in air. Source apportionment identified five broad sources of soil and airborne PAHs: vehicle emissions, petrogenic sources, coal combustion, emissions from coal tar, and natural gas combustion. For children aged 3-6 years, the average daily dose (ADD) of ΣPAH was 58.3 ng/kg-day, with 66%, 27%, and 7% from inhalation, ingestion, and dermal contact, respectively. The lifetime cancer risk from all PAHs was 0.42 × 10-6, with ingestion being the primary contributor (75%). For adults aged 21-30 years, the ADD of ΣPAH was 46.2 ng/kg-day, with contributions of 67%, 31%, and 2% from dermal contact, inhalation, and ingestion, respectively. The lifetime cancer risk from all PAHs was 0.55 × 10-6, mainly due to dermal contact (96%). Vehicle emissions, petrogenic sources, and coal combustion together contributed over 85% of the cancer risk. The findings provided bases for designing effective exposure controls, including source control and personal behavioral changes.

Literature shows that traditional measures of obesity such as body mass index (BMI), waist-to-height ratio (WtHR), waist-to-hip ratio (WHR), and waist circumference (WC) may not be precise measures of obesity compared to weight-adjusted waist-index (WWI), a relatively new obesity index. BMI, WC, WHR, and WtHR were found to be associated with sleep apnea. However, the association between WWI and sleep apnea symptoms is not known. This study investigated the association between WWI and symptoms of sleep apnea among United States adults and compared WWI’s discriminative power with BMI, WtHR, WHR, and WC in the evaluation of symptoms of sleep apnea. Data from the 2015–2018 National Health and Nutrition Examination Surveys were analyzed. WWI was calculated as WC (cm)/√weight (kg). A weighted multivariable logistic regression model and smooth curve fitting were used to investigate the association between WWI and sleep apnea symptoms. We generated the area under the receiver operating characteristics curve (ROC-AUC) to compare different obesity indices’ ability to distinguish those with and without sleep apnea symptoms. We analyzed data from 9,566 participants whose mean ± SD WWI was 11.03 ± 2.37 cm/√kg. The prevalence of sleep apnea symptoms was 13.10

Background:The increasing global prevalence of obesity and cardiovascular disease (CVD) represents a pressing public health challenge. Traditional obesity metrics, such as body mass index (BMI) and waist circumference (WC), have limitations in accurately predicting CVD risk. The weight-adjusted waist index (WWI), a novel metric combining WC and body weight, has been proposed as an alternative predictor of central obesity and its associated risks. This systematic review and meta-analysis aimed to evaluate the association between WWI and CVD. Methods:We conducted a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the study was registered with PROSPERO (ID CRD42024629861), searching PubMed, Scopus, and Google Scholar for observational studies examining the relationship between WWI and CVD. Data extraction and quality assessment were performed independently by two reviewers. A random-effects meta-analysis and subgroup analyzes were conducted to pool effect sizes, expressed as adjusted odds ratios (aORs) or adjusted hazard ratios (aHRs), and heterogeneity was evaluated using I², T², and Q statistics. Results:Ten studies comprising 170,297 participants were included. The pooled analysis revealed a significant positive association between WWI and increased CVD risk, with a pooled OR of 1.33 (95% CI: 1.17-1.48, p < 0.01). Moderate heterogeneity was observed (I² = 38.0%). Subgroup analyses showed stronger associations in studies conducted in the United States (OR: 1.35; 95% CI: 1.24 - 1.47) compared to China (OR: 1.32; 95% CI: 1.17 - 1.48). No significant differences were found between cross-sectional (OR: 1.33) and cohort studies (OR: 1.37). Conclusions:This study suggests a potential association between WWI and CVD, supporting its utility as an alternative measure of central obesity compared to traditional metrics. Despite these findings, moderate heterogeneity warrants further investigation into population-specific factors and mechanisms underlying the relationship between WWI and CVD. Future research should validate these findings across diverse populations and explore the clinical applications of WWI in CVD prevention strategies. Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024629861.

Previous research has shown that exposure to adverse childhood experiences (ACEs) is associated with increased behavior problems in children. Few studies, however, have taken a multi-informant approach to examine how different factors involving both the child and caregiver affect children’s externalizing problems. Guided by Bowen’s Family Systems Theory, the current study examined how child age and gender, caregiver age, household income, child and caregiver adversity, and child and caregiver report of caregiver involvement were associated with children’s externalizing problems. The sample included 65 caregiver-child dyads recruited from community programs in the Midsouth, United States. Youth were aged 6-12 years and primarily identified as Black or African American (95.45%) and as boys (54.55%). Two linear regression models were run with caregiver-report of child externalizing problems as the dependent variable in both models. One model focused on child variables, including child age, child gender, child adversity, and child-report of parental involvement, while the other centered caregiver variables, including caregiver age, income, caregiver ACEs, and caregiver report of their own parental involvement. Only the caregiver model was significant, with more caregiver ACEs related to higher child externalizing problems. None of the other independent variables were related to child externalizing problems. These results demonstrate the impact of caregiver’s history of adversity on child functioning. Interventions that target children’s externalizing problems may benefit from incorporating an assessment of parent adversity history. Future research should explore underlying mechanisms that may explain this association to identify modifiable factors that could be included in treatments for youth experiencing externalizing problems. KEYWORDS: Intergenerational; Behavior Problems; Adverse Childhood Experiences; ACEs; Caregiver-child Dyads; Youth Functioning; Family Systems; Multi-informant

Gun violence has continued to be the leading cause of pediatric injuries in recent years (CDC, 2022). Given the sparse literature on this topic, the current study examined correlates of the types of firearm-related injuries (i.e. intentional and unintentional) among pediatric patients within the Trauma Services Division of a Level-1 pediatric hospital (N = 87). The results indicated that patients in later developmental stages, particularly adolescence, and those with higher ACE score were significantly more likely to experience an intentional firearm injury, whereas white patients were significantly less likely to experience an intentional firearm injury, highlighting the structural factors that increase the risk of firearm violence including poverty and systemic racism. We discuss the implications and need for expanded hospital- and school-based violence prevention programs.

School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth’s school engagement. Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement. Participants were 117 youth of color aged 8–13 years (Mage = 9.96, SD = 1.40), 51

This study examines and describes circumstances involving non-fatal firearm injuries in a pediatric population from a Level I Pediatric Trauma Center in the southeastern U.S. Researchers analyzed Firearm Injury Questionnaire (FIQ) data collected from 144 children and adolescents, aged 2–17 years, who were treated in the emergency department and/or admitted to the hospital for non-fatal firearm injuries. Descriptive statistics are presented regarding participant demographics and FIQ responses, such as caregiver information, mental health history, adverse childhood experience (ACE) exposure, firearm access, injury intent, relationship to shooter, type of firearm used, and context of injury. Most patients identified as Black (82

Only a few studies investigated the link between tobacco smoking-related media and youth smoking in the Eastern Mediterranean Region (EMR). This study aimed to assess the influence of both promotional and control messages on cigarette smoking behavior among young Jordanian students. Generalized Linear Mixed Models were analyzed using data from the Irbid Longitudinal Smoking Study that followed a random sample of 2174 students (2008-2011). We examined the associations of media messaging with smoking behavior, as well as intention-to-quit smoking, and intention-to-start smoking, among young adolescents. At baseline, 12.2% and 43.7% of students were exposed to only pro-smoking or only anti-smoking messages, while 41.8% were equally exposed to both. Exposure to anti-smoking messages was associated with lower odds of ever smoking at baseline among girls (AOR = 0.4; 95% CI: 0.2, 0.8). Boys who were exposed to anti-smoking messages were more likely to report an intention to quit, with borderline significance (AOR = 2.0; 95% CI: 0.9, 4.1). The cumulative exposure to anti-smoking messages over time was associated with lower odds of intention to smoke among girls (AOR = 0.5; 95% CI: 0.3, 0.9) but with higher odds among boys (AOR = 1.8; 95% CI: 1.0, 3.1). In both sexes, media messaging was not associated with progression of the smoking habit. In conclusion, this comprehensive analysis of both pro- and anti-smoking messages advances our understanding of their role in influencing youths' smoking behaviors, and could guide the development of evidence-based interventions to address adolescent tobacco smoking in Jordan and the EMR.

Caregiver exposure to potentially traumatic events (PTEs) can negatively affect the caregiver-child relationship; PTEs also contribute to stress, which further strains this relationship. The current study examined the unique and combined effects of caregiver PTE exposure and caregiver stress on the perception of the caregiver-child relationship from both caregivers' and children's perspectives. Participants were 164 female caregivers with trauma-exposed children (Mage = 9.41, SD = 1.87). Path analysis results indicated that more caregiver PTE exposure and higher stress were associated with lower caregiver-perceived strength in the caregiver-child relationship. Higher stress enhanced this negative relationship between caregiver PTE exposure and perceived relationship strength. No direct or indirect effects were observed from the youth's perspective. Findings emphasize the value of considering caregivers' adversities and stress when working with trauma-exposed children.

Exposure to adverse childhood experiences (ACEs) contributes to increased rates of psychopathology in youth. Specific environmental factors have been linked to improved functioning following adversity, but few studies have taken a social-ecological approach to examine how resilience, social support, and community cohesion may be associated with internalizing problems (i.e., anxiety, depression) in young children. The current study included 49 children between the ages of 8 and 13 (Mage = 10.43, SD = 1.57; 55.1% male; 95.8% Black or African American) who were recruited from four community programs in the Midsouth, United States that serve families experiencing adversity. Regarding income, 77.3% of youth’s caregivers reported an annual household income under $15,000. Almost all children reported experiencing at least one ACE (92.6%). Two linear regression models were run to assess how resilience, social support, and community cohesion were related to youth’s depression and anxiety symptoms while controlling for ACEs and family income. The model examining depression was significant, (F (5, 48) = 4.16, p < .01, R2 = .33) with fewer reported ACEs (β = 1.55, p < .02) and higher resilience (β = -.73, p = .01) associated with lower depressive symptoms. The model assessing anxiety was not significant. Results indicate that personal resilience may be a key target for intervention in children exposed to ACEs as efforts to strengthen individual resources (e.g., self-efficacy, emotion regulation skills) could be linked to reduced psychopathology. KEYWORDS: Adverse Childhood Experiences; Social Ecology; Resilience; Social Support; Community Cohesion; Internalizing Symptoms; Anxiety; Depression

Objective Pediatric patients can be significantly impacted emotionally by exposure to acute trauma which may negatively impact long-term functioning and lead to an increase in overall distress. This study reports on the incidence of acute stress disorder among pediatric trauma patients in a hospital setting in the southeastern region of the USA.Methods Pediatric patient mental health assessments were conducted using the Childhood Stress Disorders Checklist- Short Form (CSDC-SF) as part of a new integrated behavioral health standard of care within the Trauma Services Division of a level 1 pediatric hospital. Mental health consultations occurred at bedside on inpatient hospital admission into trauma services, or at the outpatient hospital clinic after discharge for injuries treated in the emergency department.Results Associations among type of trauma, child age, and sex were explored in a sample of 617 children (58.9% male) aged 2–18 years (Mage=10.27). The sample was primarily ethnic minorities (56.1% black/African-American, 5% Hispanic/Latinx). Fifteen per cent or more of trauma reports were for burns (26%), motor vehicle accident (22.7%), and recreational sports or leisure activity-related injury (17.5%). Sixty-four per cent of children scored ≥1 on the CSDC-SF, indicating symptoms consistent with acute stress disorder. Higher scores were associated with female sex, age, and injury type.Level of evidence Level IV study provides evidence of the link between traumatic injury and mental health symptoms in a pediatric population. Findings highlight the critical need for mental health screening and provision of integrated mental health counseling services at time of acute pediatric trauma.

The Adverse Childhood Experience (ACE) Questionnaire is one of the most widely used assessments for trauma exposure and adversity experienced during the first 18 years of life (Felitti et al., 1998; Kia-Keating et al., 2019). While the ACE Questionnaire has shown to have good reliability and validity, inconsistencies have been demonstrated for the test-retest form of reliability (MacKenzie et al., 2005; Pinto et at, 2014; Zanotti et al., 2018). To address the lack of consensus on the test-retest reliability of the ACE Questionnaire and the appropriateness for use with adolescents, the current study examined test-retest reliability of the ACE measure for a small group of adolescents in residential treatment. Participants (n = 20) completed the ACE during week 1 and were later assessed at week 9. The test-retest reliability of the ACE was very high (r = 0.913), thereby supporting the overall reliability of the ACE questionnaire and its effectiveness in identifying baseline trauma. However, the results indicate that adolescents might not fully understand their past trauma experiences prior to receiving trauma-focused treatment. Potential explanations of unreliable reporting of ACEs, counseling implications and recommendations for multiple administrations are discussed.

Smoke from domestic tobacco smoking and biomass burning is the most harmful indoor air pollutant. This study aimed to evaluate 2,5-dimethylfuran (DMF) as a marker to indicate exposure to environmental tobacco smoke (ETS) and biomass burning smoke (BBS) in households. The evaluation consisted of three indoor air monitoring campaigns in (1) 8 apartments with different smoking scenarios, (2) 76 apartments in a Metropolitan city, and (3) 26 homes in two rural areas. All the air samples were collected in a passive way using thermal desorption (TD) tubes and analyzed by TD-gas chromatography/mass spectrometry (GC/MS). The indoor smoking experiments showed that TD tubes could detect DMF even when the occupant smoked one cigarette every day. In urban homes, DMF detection had a substantial agreement with smoking status, indicated by a Kappa coefficient of 0.67. In rural homes, DMF was detected at high concentrations in homes with biomass burning. Along with DMF, the TD tubes could detect and quantify over 70 other volatile organic compounds (VOCs), allowing exposure and risk assessment for indoor smoke. In conclusion, monitoring DMF with TD tubes offers an easy, low-cost approach to measure domestic ETS and BBS exposures. This method has the potential to measure exposure to outdoor smoke from wildfire and agricultural burning.

Although associations between developmental trauma, juvenile justice involvement and youth substance use have been previously reported in the published literature, the interconnection among these three factors has not been adequately studied. This article describes the interconnection among these three factors and calls for greater attention to the role of adverse childhood experiences (ACEs) in the diagnosis and treatment of youth who present with histories of substance use and/or offending behavior. Pilot data are presented that show high rates of self-reported trauma exposure, substance use history, justice involvement, and mental health problems in a sample of adolescents in residential treatment. The data point to the need for residential treatment centers to consider trauma histories in developing treatment plans for youth with current and prior substance use and offending behavior.

The lockdowns due to the COVID-19 pandemic have been reported to reduce ambient air pollution in many cities globally. This study aims to examine whether air pollution dropped in Memphis, a typical U.S. metropolitan city and transportation hub, during the lockdown from 25 March to 4 May, 2020. Daily air pollution data measured at five representative monitoring stations in the Memphis Metropolitan Area were downloaded from the U.S. Environmental Protection Agency’s Air Quality System. The mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone during the lockdown were compared with the baseline concentrations measured during the same periods in 2017–2019 using linear regression models. The average vehicle miles traveled (VMT) reduced by 57% in this region during the lockdown compared to that during 1–24 March, 2020. The mean (± standard deviation) concentrations of PM2.5, NO2, and ozone were 7.5 ± 2.6 μg/m3, 16.5 ± 9.4 ppb, and 44.5 ± 8.4 ppb, respectively, during the lockdown. They did not statistically differ from the baseline concentrations, nor were they lower than the mean concentrations in the prior month (25 February–24 March, 2020), after accounting for meteorological conditions. The lack of effect could be explained by the small contribution of traffic emissions to air pollution. The results suggest that the “stay-at-home” order had an insignificant impact on reducing air pollution in Memphis.

An increasingly common dialogue among mental health professionals revolves around adverse childhood experiences (ACEs) and developmental trauma. ACEs can occur in a number of ways with a myriad of potential outcomes, often making treatment choices difficult. During critical stages of neurodevelopmental growth, trauma makes a mark on the brain and body at a physiological level. Although the National Institute of Mental Health's Research Domain Criteria have been used to address this brain–body impact, the far-reaching scope of implications needs grounding in a theoretical framework. The current paper discusses developmental trauma and proposes a new reciprocally determinant model that advocates for neuroscience-informed counseling interventions such as neurofeedback therapy. Clinical implications and considerations for counselors are discussed.