Young Epidemiology Scholars Competition

“The YES Competition is unique in that it is the only competition that really focuses on one field. This allows participants to meet and learn from experts in the field of epidemiology. The judging panel does a phenomenal job encouraging future scientists in continuing to pursue science and their research.”

Broad coverage of the avian influenza, or bird flu, outbreak in 2006 was the source of inspiration for Alexander's project, in which he used computer-based modeling and simulation to predict the timeline for outbreaks of avian influenza and potential risk areas of infection in humans. Alexander's model included data and features such as the tracking of migrating waterfowl, stationary waterfowl, and poultry to determine the routes by which avian influenza infection can spread. His study focused on the potential application of the forecasts of his model to the World Health Organization process of selecting the three strains of influenza included in the flu vaccine each year. Because of the sophistication and complexity of his model, Alexander ran his bio-simulations at the Ohio Supercomputer Center.

Alexander is on the math team and founded the student chapter of the Mason ACM, William Mason High School's computer and technology club. He received the second-place team award in the 2008 Intel International Science and Engineering Fair and has placed as both a semifinalist and regional finalist in the Siemens Competition in Math, Science and Technology. Alexander will study biology and computer science when he goes to college next year and hopes to attend the Massachusetts Institute of Technology, the California Institute of Technology, or Carnegie Mellon University.

Abstract
Influenza A viruses, including the highly pathogenic H5N1 strains, undergo punctuated genetic evolutions in hemagglutinin (HA) that significantly alter their antigenic characteristics, potentially giving rise to pandemic strains. In the past, pandemic strains have emerged due to reassortment events in a host coinfected by human and avian strains. In 1997, the first outbreak of H5N1 human infections demonstrated the capability of humans to serve as mixing vessels for such reassortment events. Consequently, forecasting areas of infection of humans with avian influenza as well as timelines of outbreaks is vital for vaccine development and to effectively combat this disease. Accordingly, this paper describes a novel methodology involving the use of temporo-spatial, in silico macro-epidemiological analysis coupled with bioinformatics to identify HA isolates from regions of infection with human and avian influenza. The study involves the use of global eco-modeling and bio-simulation to represent the macro-epidemiology of human and avian influenza. The SIR/Markov Process model is based on the real-world statistical data on human infections with avian viruses, waterfowl migration (the primary vector of avian influenza), global poultry population (an intermediary host), and global human population. The bio-simulations are performed on supercomputer clusters. The resulting HA isolates are proposed for use in the vaccine design for a geographically optimized, heterologous influenza vaccine targeted for pathogens emerging in humans infected with avian influenza viruses.

“The finalists at the YES Competition were in high school, yet when they presented their research they sounded like prestigious professors! Every project was innovative and clever, and I honestly learned more about the world and people around me through their projects than I have in my entire life.”

While working at the Institute of Clinical Outcomes Research and Education (ICORE) in Palo Alto, California, Amrita wondered if teenagers like her were taking enough calcium to help them prevent osteoporosis later in their lives. She found that only 38 percent of students participating in her study met the requirement for the recommended daily calcium intake, with just 20 percent of girls and 52 percent of boys getting the recommended daily amount. She also found that teenagers got less calcium in their diet as they got older. Amrita believes her results show a need for increased health education among teenagers to promote the importance of calcium intake.

Amrita is an active member of the Outreach Club and volunteers for the Alexandra Chiles Foundation. Her hobbies include golfing, reading, and Indian dance. Amrita will work at ICORE this summer researching the prevalence of osteoporotic hip fractures in males. In the fall, she will attend the University of California, Berkeley, and looks forward to a career in public health.

Abstract
Osteoporosis is a disease of the elderly in which the bones become fragile and more prone to fracture. It is caused by a leaching of calcium from bones with aging. Osteoporosis is more serious among women for two reasons: 1) Women have less bone mass. 2) The process of leaching is accelerated in women during menopause due to decreases in estrogen levels. Evidence suggests that building healthy bones through a daily intake of a recommended dose of calcium during one's youth helps prevent osteoporosis later in life. The Food and Nutrition Board of the National Academy of Sciences recommends a daily calcium intake of 1300 mg for ages 9 years to 18 years. The objective of my study was to see if teenagers take enough calcium to build healthy bones, if there was any difference between boys and girls in calcium intake, and if awareness about importance of bone building had any impact on calcium intake. A brief validated questionnaire was used to assess calcium intake in 199 adolescents at the Menlo-Atherton High School. Statistical analysis was carried out by using the two-proportion z-test. There was a total of 199 participants in the survey; 111 were boys and 88 girls. Of these, 76 participants took in 1300 mg or more of calcium daily (only 38% of all kids surveyed). Significantly more teenage boys (52%) consumed enough calcium when compared to girls (20%). The teenage girls took 30% less calcium then the teenage boys (p-value = .000002). Calcium intake between adolescents in advanced science classes and regular science classes was not statistically different (p = .45). There was also no difference in calcium intake between the students who were aware that the peak bone mass is built during adolescent years and those who were not. As the adolescent gets older, he or she takes less and less calcium. Specifically, 50% of 14-year-olds took enough calcium, 49% of 15-year-olds, 43% of 16-year-olds, 33% of 17-year-olds, and 14% of 18-year-olds (p-value = .012). This may be because parents have less of a say in what their adolescent eats as they approach adulthood and make their own choices, and in this case, not-so-healthy choices. Adolescents, especially teenage girls, need to complement their diet with a calcium supplement, which would help in increasing bone mineral content and combat osteoporosis.

“Students with wide interests should look into the YES Competition because epidemiology isn't just about infectious diseases. The methods used by epidemiologists can be used to study anything from psychology to audiology to sports. The range of subjects is unbelievable!”

Allan based his study on a database that collects information from certified athletic trainers at over 100 high schools across the nation, and his study is the largest national study of anterior cruciate ligament (ACL) injuries in high school athletics ever conducted. Allan found that athletes were eight times more likely to be injured during competition than during practice and that the highest-risk sport for ACL injury was football for boys and soccer or basketball for girls. He also found that in sports played by both boys and girls, girls were eight times more likely than boys to suffer an ACL injury, confirming the results of other studies. To prevent ACL injuries, Allan recommends that coaches and trainers be made aware of the highest-risk activities, enforce better officiating to minimize injury, and add exercises that strengthen the muscles around the knee to provide greater stability.

Allan participated in the 2008 JETS TEAMS Engineering Competition where his team finished eighth nationally. He volunteers with several youth groups, enjoys playing sports, and will intern at the Nationwide Children's Hospital Center for Cardiovascular and Pulmonary Research this summer. This fall, Allan will attend the University of Notre Dame where he will major in pre-med. His career plans include pediatric surgery, public health, or laboratory research.

Abstract
Anterior cruciate ligament (ACL) injuries are among the most serious injuries a young athlete can suffer due to the often long-lasting implications. Prevention of such injuries can be extremely beneficial to an athlete's overall health. The purpose of this experiment is to describe the epidemiology of ACL injuries in various sports and compare the results across sports, genders, and exposure. One hundred U.S. high schools were randomly selected to participate in the High School RIO™ program, through which athletic trainers reported exposure and injury data. The schools constituted a nationally representative sample. In 2007-08, 142 ACL injuries were reported in 2,077,780 athlete-exposures for a rate of 6.83 ACL injuries per 100,000 AEs. Athletes were 8 times more likely to suffer such injuries in competition than practice (RR: 7.64; CI: 5.21, 11.02). Boys are 11 times more likely to suffer an ACL injury playing football than any other sport (RR: 10.71; CI: 6.89, 16.64); girls are 20 times more likely to injure an ACL playing soccer or basketball than other sports (RR: 20.3; CI: 9.92, 41.52). Girls are 8 times more likely than boys to suffer an ACL injury in gender-comparable sports (RR: 8.00; CI:4.80, 13.31). Over 60% of the reported injuries were caused by some sort of contact. In conclusion, certain activities pose extremely high risk of ACL injuries, especially for those who may be predisposed to such injuries. Effective preventive methods must be utilized to decrease the high risk associated with certain activities. Further research is necessary to determine trends in additional sports and over long periods of time.

“YES is an incredible experience, and one that should not be passed by. The possibilities extend far beyond the opportunity to win money. You have the chance to expand your research, improve it, and learn to apply it in the real world. What you feel at this competition is of course a great sense of responsibility, but also a great sense of privilege to be among the best and brightest in their fields.”

For her study, Ilana recruited 29 couples where the male was a combat veteran, including at least one veteran from each of the last five major U.S. military conflicts. She found that veterans with high anxiety and low self-esteem as well as those whose partners avoided being in close proximity to them had significantly more severe posttraumatic stress disorder (PTSD). Ilana also noted that greater veteran anxiety was associated with increased alcohol use, increased depression, and marital dissatisfaction. Her findings could be used to improve the use of couples therapy to assist in PTSD treatment.

Ilana has won numerous science competitions and was a semifinalist in the Intel Science Talent Search competition. She is a member of the Model United Nations, the Junior State of America, and many other school clubs. Ilana has been accepted to Barnard College where she will study political science, journalism, and international relations and will continue her work as an advocate for veterans benefits.

Abstract
Previous research indicates a cross-sectional relationship between posttraumatic stress disorder (PTSD) and the romantic relationship, yet limited research connects these variables through Bowlby's Attachment Theory. The present study sought to determine the connection between partner attachment and combat-related PTSD severity. Also studied were possible relationships between the PTSD-romantic relationship connection and depression and alcohol use, other factors shown to be strongly associated with both PTSD severity and conflict in romantic relationships. Twenty-nine couples, all including one veteran of at least one of five major U.S. military conflicts, were studied. The anxiety and avoidance dimensions of attachment were measured through the use of the Experiences in Close Relationships—Revised Questionnaire, and PTSD severity was measured with the PTSD Checklist Military Version. Relationship satisfaction, depression, and alcohol use were measured and analyzed for correlations. Veteran anxiety (negative self-view) (p = .003) and partner avoidance (negative view of others) (p = .008) were found to have a strong positive relationship to PTSD severity. Both anxiety (mean difference = .73) (p = .010) and avoidance (mean difference = 1.21) (p < .001) were heightened in the veteran partner. It was also found that correlations between attachment and factors such as relationship satisfaction, depression, and alcohol use were more significant for veterans (p < .001, p = .037, and p = .019 respectively for veteran anxiety) than partners, indicating potential influence of combat on attachment. The results of the present research suggest that the romantic relationship can be more effectively examined in connection to PTSD by breaking down its impact into the study of the two dimensions of attachment. The results herein may also be used in the development of couple therapies that target individual attachment styles for returning combat veterans.

“My experiences as a peer drug educator inspired me to continue exploring the myths and realities surrounding adolescent alcohol use in particular. I began to pursue this area of research so that I could explore the relationship between parents and their children and the role that the relationship plays in predicting teen drinking.”

Chelsea surveyed over 120 students at her school and found that teens were more likely to accept underage drinking or be underage drinkers themselves if they think that their own parents drank as teens. Her data indicated that the same was true if their parents permitted them to drink and did not closely monitor their activities outside the home. As a result of her findings, Chelsea recommends that parents shouldn't share stories of their own underage experimentation with alcohol; should pay close attention to their children's whereabouts and activities; and be firm rather than permissive about alcohol use.

Chelsea will be working as a camp counselor this summer and her hobbies include singing, creative writing, and photography. She has participated in multiple science fairs and placed fifth in the Intel Science Talent Search competition. Chelsea will attend Yale University in the fall and will continue to study different facets of human behaviors and health.

Abstract
Research has established that a variety of factors are linked to the prevalence of adolescent alcohol consumption; however, the relationship between teens' perceptions of parent underage drinking and adolescents' own drinking behaviors has been inadequately researched. One hundred and twenty-three students were randomly selected to complete a 40-item survey on their drinking behaviors, attitudes towards alcohol, and perceptions of parent drinking and parenting behaviors. Given that adolescent alcohol use and adolescent alcohol acceptance were only moderately correlated (r = .54), separate multiple regression analyses were run to test the predictors of each outcome variable. The model accounted for 21.6% of the variance in adolescent alcohol use. Parent general monitoring was a negative predictor, while parent permissiveness and perceived parent underage drinking were positive predictors. The model also accounted for 21.7% of the variance in adolescent alcohol acceptance. Parent underage drinking was the strongest predictor and had a positive relationship with adolescent alcohol acceptance, while parent support was a significant negative predictor. Although the study was correlational in nature, the results suggest that parents should be cautious about sharing stories of their own underage drinking with their children. Parents should also strive to maintain strict supervision while still creating a supportive atmosphere for their children.

“The most memorable part of the YES Competition was the people. The judges are at the top of their field and all the other high school students there were really awesome—I still keep in touch with them. One of the speakers said that we would be levitating due to the energy in the room. I wasn't sure I believed that at first, but I definitely did when I left!”

The goal of Joanna's study is to reduce the risk of blindness in babies born prematurely. Joanna investigated the possible influence of two factors on the risk of eye damage or blindness in premature babies due to retinopathy of prematurity (ROP). Previous studies of the possible relationship between bilirubin level and ROP, and between bottle versus breastfeeding and ROP, have conflicting results. Joanna designed a matched case-control study using data collected from 2001 to 2008 at the University Hospital in Iowa City, Iowa. Joanna found a positive trend toward higher bilirubin levels and breastfeeding being protective against development of ROP.

Joanna is a member of several school clubs including the Programming and Electronics Club and the student orchestra. She volunteers with Habitat for Humanity and is a member of the NASA INSPIRE program. Joanna will attend the Massachusetts Institute of Technology in the fall with an interest in electrical/biomedical engineering and computer science. Her career plans include a medical career in neonatology or developing medical-related technology and continuing research in the area of epidemiology and public health.

Abstract
This retrospective case-control study examined the independent and combined effects of bilirubin and breastfeeding on retinopathy of prematurity (ROP). Previous studies of ROP risk factors have not examined the combined effects of bilirubin and breastfeeding. ROP affects thousands of premature infants in the United States every year. Efforts to decrease the incidence of ROP have had limited success. Using SAS, cases (infants with ROP) were matched with controls (infants without ROP) using the greedy algorithm for case-control matching based on birth weight, time on oxygen, gender, gestational age, and use of phototherapy, in that order of importance. The 63 case-control matched pairs included infants born under 32 weeks gestation or under 1500 grams. Exclusion factors included multiple birth and nonwhite race. The data were analyzed using conditional logistic regression. There was a negative association between highest serum bilirubin level and risk of ROP (OR = 0.86, 95% CI = 0.71 to 1.04; p = 0.11) independent of whether infants were being fed breast milk at discharge. The magnitude of this association was virtually unchanged after controlling for breastfeeding (adjusted OR = 0.85, 95% CI = 0.70 to 1.04; p = 0.11). There was also a negative association between breastfeeding and risk of ROP (OR = 0.65, 95% CI = 0.32 to 1.31; p = 0.23) independent of bilirubin levels. This effect was very similar after controlling for bilirubin level (adjusted OR = 0.64, 95% CI = 0.31 to 1.30; p = 0.22). Although these associations are not statistically significant, the trends suggest that both high bilirubin and breastfeeding may have protective effects against ROP.

“The YES Competition is a great way for talented students to apply their skills to important, real-life issues, and to improve the world in which they live. The Competition fosters collaboration, which is an increasingly vital skill in science and especially in public health.”

Hannah's study focused on factors that could cause social difficulties in young Chinese and Korean immigrant children. She investigated whether two related factors, a mother's rating of the quality of her marriage and her level of depressive symptoms, were associated with the social behaviors of her children. Her findings suggest that community services targeted toward improving healthy adaptation of immigrant families, including marital and depression counseling, could improve social and behavioral outcomes for both parents and children.

Hannah is involved with the Math Club and the Student Government Association at her school and is president of the local chapter of the National Honor Society. Her hobbies include fencing, swimming, and videography. She will attend the Whiting School of Engineering at Johns Hopkins University in order to pursue a career as an environmental engineer.

Abstract
The purpose of this study was to contribute to the psychological literature about a quickly growing but under-studied section of the U.S. population: Asian immigrants (Chinese and Korean) with young children. The present study focused on two public health issues (social, emotional, and behavioral difficulties and depression) and the quality of marital relationships. The aim of the current study was to examine the role of Asian immigrant mothers' marital satisfaction and their depressive symptoms in predicting their children's social adaptation. The pathway by which Asian immigrant mothers' marital satisfaction may impact their children's social adaptation was assessed; specifically, the effect of mothers' marital satisfaction on their children's social adaptation through mothers' depressive symptoms. It was predicted that maternal depression would partially mediate the relation between maternal marital satisfaction and total child social difficulties. These findings will provide needed information on individual and relational factors that predict parenting Asian immigrant children's social, emotional, and behavioral adaptation. These results can contribute to community planning of services targeted towards the healthy adaptation of immigrant children and their parents in one of the largest U.S. immigrant populations.

“The YES Competition is not your ordinary science fair. Be prepared to be amazed by the talents of dozens of other high school kids from across the country. You'll be surprised by how much you can learn from your peers in just one weekend.”

Inspired by her summer internship at the Norton Cancer Institute in Jefferson County, Kentucky, Sydney decided to research the effectiveness of the Institute's program of delivering breast-cancer screening to medically underserved women in the areas of the county with the highest number of deaths due to breast cancer. She found that the combination of approaches used by the Institute was successful in reaching women who had never before been screened and also in detecting breast cancer early enough for successful treatment.

Sydney volunteers with several youth groups, is an accomplished gymnast, and enjoys playing the guitar and listening to music. She will participate in the Summer Scholars Program at Washington University and will work at the Norton Cancer Institute to continue her YES research. Currently a junior, Sydney plans to pursue a career in medicine with a focus on plastic/reconstructive surgery.

Abstract
Inconsistent screening and follow-up leads to increased likelihood of cancer mortality. The objective of this study was to determine if a combination of approaches were successful in locating uninsured women and women who had not been screened for mammography by targeting high-risk areas, and to determine a connection between insurance status, screening practices, and abnormal mammogram results. This was a retrospective case-control study. The de-identified data set was analyzed using descriptive analysis. High-risk-identified zip codes were based on data provided by the Louisville Metro Health Department. Odds ratios and confidence intervals were calculated to compare frequency of exposure to risk factors. During the period of 1/1/08-10/31/08, 844 women were screened for breast cancer. Fourteen percent had an abnormal result. There was no statistical difference in the rate of abnormal results between women living in high-risk areas and women who did not (OR 1.687, CI 0.868-3.33). Thirty percent of the screened women had never had a mammogram or had not had one within the past five years (never or rarely screened). Women who were never or rarely screened were nearly two times more likely to have abnormal results than women who had been screened recently (OR 1.779, CI 1.16-2). There was a significant connection between lack of screening and abnormal results. Finding the target group of never or rarely screened women by using the previously defined high-risk areas was not accurate because the two variables were not statistically connected. In the future, this group might be reached by constructing surveys or by formulating a more accurate definition of a high-risk area.

“After working on a tuberculosis project in a microbiology lab, I saw the extreme effect this disease has on humans. A major problem in TB control is distribution, and this led me to my project. I hope my research could aid in creating more effective treatment programs to combat tuberculosis.”

Jason's interest in tuberculosis was sparked by seeing first-hand the consequences of TB infection while working in a microbiology lab at Johns Hopkins University. He used his advanced computational programming and mathematical skills to develop a computer simulation of the epidemiology of tuberculosis in India and used the simulation to test the best methods of identifying and rapidly treating TB-infected people to stop the spread of the disease. His findings have important implications for optimal use of the funds available for TB control in India.

Jason is a member of the Key Club, the Model United Nations, and the Boy Scouts of America and enjoys reading and debate. He will attend Stanford University next fall and plans to study biology in order to pursue a career in medical research.

Abstract
National TB-control programs in countries with limited resources need to choose whether to improve and maintain high case-detection rates at their existing clinics or to increase the number of accessible clinics. My objective was to compare the impact on TB incidence of strategies emphasizing excellence in the treatment of TB vs. reduction in diagnostic delay. The researcher developed a computer simulation of TB epidemics using the NetLogo agent-based modeling platform. Trials were run varying the patient delay time between symptoms and access to medical care and the provider's probability of successfully diagnosing and initiating treatment for TB. Outcomes were summarized in terms of cumulative TB incidence over a 50-year horizon in a semi-urban community in India. There was a significant interaction between shortening delay and improving the proportion diagnosed (P-value < 0.01). Reducing delay has a greater impact on incidence the shorter delay is to begin with. Case-detection rates have a greater influence on incidence than delay. However, the effects of decreasing delay are magnified as case-detection rates improve. In conclusion, there is no universally correct approach to controlling TB. The best way to lower TB incidence will depend on the current delay and percent correctly diagnosed.

“The most memorable part of YES for me was the opportunity to discuss my study in front of the judging panel. Answering questions and defending my hypothesis in front of incredibly impressive judges was an amazing learning experience. YES is truly a once-in-a-lifetime experience. Nowhere else will high school students have such an opportunity to learn about what it means to be an epidemiologist and create a study while at the same time having fun and making new friends.”

Avtalya's project was inspired by an influenza B outbreak at her brother's school during which officials closed the school for five days in an attempt to prevent further transmission. Her study found that while 80 percent of students exposed at the school developed symptoms of influenza B, only 8 percent of household members who were also exposed developed symptoms. This indicates that influenza B spreads much more rapidly at school than at home. Avtalya's research could suggest that being exposed to one person who is sick, even for an extended period of time, may not transmit the disease as effectively as being exposed to a number of people who are sick. Her study recommends a number of guidelines that will give schools the ability to detect spikes in the flu and other illnesses early enough to prevent serious outbreaks.

Avtalya is a member of the Jewish Community Teen Foundation and her hobbies include volunteering, reading, and hiking. This summer she will participate in a mentorship program at Santa Clara Valley Medical Center where she will have the opportunity to shadow doctors as they see patients and perform procedures. Avtalya is currently a junior and has not yet chosen a career path, but she plans to study health sciences in college next year.

Abstract
This study examines an influenza B outbreak in an 8th-grade class in order to analyze and compare the spread patterns of the disease at school and at home. The study consisted of phone interviews with 90% of the students in the class, including questions concerning dates of illness, symptoms, vaccinations, class schedules, friendships, and information about household members. The results were coded and analyzed using regression analyses to indentify statistically significant results. Of particular significance, while 80% of students who were exposed developed symptoms of influenza B, only 8% of household members who were exposed developed those symptoms. This result demonstrates a dramatically different likelihood of transmission at school than at home, a surprising result given the contagious nature of influenza B. The study then explores a possible hypothesis that could cast new light on the spread of influenza B in concentrated communities such as schools and nursing homes. The hypothesis theorizes that being exposed to one person who is sick, even for an extended period of time, may not transmit the disease as effectively as being exposed to a number of people who are sick. This could occur not because a person has more chances of being sneezed on, for example, but because the intensity of exposure to so many flu contaminates eventually overwhelms the immune system. The study concludes with suggestions for further investigation as well as a four-part recommendation to help schools better control outbreaks of influenza B.

“I was introduced to medicine at an early age. My interest lies in the realm of clinical research, health-services research, and public health. Working as a research technician opened my eyes to the importance of epidemiology and biostatistics and the possibility of public health as a career choice.”

Marilyn's project investigated the best way to manage bloodstream infections contracted by patients who were in the hospital being treated for other illnesses. She focused on patients infected with enterococcal bacteria, which contribute to approximately 10 percent of all hospital-acquired infections. The rate of enterococcal bloodstream infections associated with central venous catheters is increasing. Marilyn examined hospital data of patients diagnosed with an enterococcal bloodstream infection and compared the outcomes of patients whose central venous catheters were removed to those of patients whose intravenous lines were left in place. Her analysis suggests that removal of the catheter is associated with better results in curing the bloodstream infections and other major medical complications.

Marilyn is involved in the Math Honor Society and National Honor Society; volunteers at a local nursing home; and enjoys playing the piano, ballet, and cooking. She participated in the Greater St. Louis Science Fair and the Intel International Science and Engineering Fair. This fall, Marilyn will study public health, biochemistry, and international relations at Washington University in St. Louis.

Abstract
Enterococci are an important cause of central venous catheter-associated bacteremia. It is unclear whether catheter removal is a necessary component of management of these infections. Records of 65 patients diagnosed with enterococcal catheter-associated bacteremia between 1/1/2006 and 12/31/2006 were retrospectively reviewed. Patient information was obtained. A catheter was considered retained if it was present for ≥96 hours after the detection of bacteremia. A 10% difference or greater between patients who had their catheter removed versus those who retained their catheter in recurrence of bacteremia was considered clinically significant. Of the 65 bloodstream infections, 30 were caused by E. faecalis, 32 by E. faecium, and 3 by other Enterococcus species. The catheter was retained for ≥96 hours in 28 (43%) patients, and the catheter was removed <96 hours in 37 (57%). Patients with retained catheters had a higher rate of recurrent bacteremia when compared to patients whose catheters were removed [4 (14. 3%) vs. 1 (2.7%); absolute risk difference 11.6% 95% CI -2% to 26%; p = 0.16]. Impact of removal also favored other secondary outcomes. These results suggest that removal of catheter is beneficial in the management of patients with enterococcal catheter-associated bacteremia. Although the differences were not statistically significant, the interpretation of the confidence intervals suggests that removal is likely to be beneficial. Definitive conclusions await future studies with larger sample sizes.

“I strongly believe the key to health promotion is education. The two major contributing factors of obesity (nutrition and physical activity) can be changed through preventive measures. If we research the underlying socioeconomic factors that affect these behaviors, we can design a more effective intervention program that can help a nationwide population.”

After volunteering at a local clinic, Visakha wondered if the socioeconomic status of the surrounding neighborhood affected the nutrition and exercise habits of the people living there. She contrasted a low-income and an affluent neighborhood near Plano, Texas. Her study found that the affluent neighborhood had three times more places to get healthy foods than the poorer neighborhood had. She also found that there were three times more areas for physical activity in the affluent neighborhood. When she observed people in both neighborhoods participating in physical activities, she found that moderate to vigorous exercise was significantly more common in the wealthier neighborhood. Her findings confirm other studies showing that the availability of healthy food and opportunities for physical activity are associated with neighborhood economic status.

Visakha has competed in several science fairs and is a member of numerous clubs including Mensa and the French Honor Society. She volunteers at Habitat for Humanity and is a Student Voices columnist in the Dallas Morning News. Currently a junior, Visakha intends to double-major in public health and biomedical engineering before continuing to medical school.

Abstract
The purpose of this cross-sectional study was to find the effect of demographic status on the availability and pricing of healthy and unhealthy foods and on the accessibility and method of use of physical activity (PA) resources. If the availability and prices of foods are compared in two socioeconomically different neighborhoods, then there will be a negative correlation between the underprivileged community and the availability of healthy foods. There will also be a positive correlation between the affluent area and accessibility and mode of usage of PA resources. West Plano was chosen as the affluent community, Desoto was used as the disadvantaged community. Demographic characteristics were recorded for each. The number of restaurants and supermarkets and the type and price of food were recorded. The number of PA areas, the variety of equipment available, and overall exercise intensity were recorded. Correlations made between nutritional behavior, PA habits, and socioeconomic factors were recorded and compared to government census data. This experiment proved that the wealthier neighborhood was at an advantage in both nutritional availability and PA resources. West Plano had three times as many supermarkets and PA resources as did Desoto. West Plano had a total of 92 PA areas, Desoto had only 30. Grocery store visits showed that West Plano had more access to healthy food, whereas low-priced junk food was more available in Desoto. And 13% of all West Plano restaurants were fast-food restaurants, compared to 29% in Desoto. The levels of exercise intensity were recorded at randomly chosen PA areas. Intensities were recorded as light, moderate, or vigorous. In West Plano, 5% of those observed were engaged in light PA, 87% in moderate, and 8% in vigorous. In Desoto, 56% of those observed were engaged in light PA, 43% in moderate, and 1% in vigorous. A gender-based trend was found in the PA behavioral patterns of both areas. In West Plano, 57% of people using PA areas were men, and in Desoto, 69% were men. Hence, males are more likely to utilize PA areas irrespective of demographics. This study also discovered that in areas of lower socioeconomic status, public PA areas are not being used effectively. If this behavioral pattern were shifted from light to moderate exercise, then optimum physical fitness could be attained, even in a demographically disadvantaged population. This experiment has successfully proven that there is a definite positive correlation between socioeconomic status and beneficial nutritional behaviors and appropriate PA levels. These findings suggest that demographic determinants trigger health disparities in neighborhoods of differing demographics.