Abstracts / Annals of Epidemiology 23 (2013) 581e598 597

before age 65. Filling gaps in knowledge about the work-relatedness ofchronic disease can help prioritize opportunities for prevention.

Reproductive Health and Pediatrics

P71-S. Detailed Examination of Reports of Death to VAERSFollowing HPV4 Vaccination

S.L. Davlin, R.E. Rupp, A.B. Berenson. University of Texas Medical Branch,Galveston, TX

Purpose: To examine reports of death to the Vaccine Adverse EventsReporting System (VAERS) following administration of the quadrivalent HPVvaccine (HPV4).Methods: Utilizing CDC WONDER, all deaths in the U.S. were queried usingthe term HPV4. VAERS data were then downloaded for the years 2006-2013. A total of 85 deaths were retrieved using CDC WONDER and matchedto downloaded VAERS data. Forty-one observations were eliminated as itwas impossible to conclusively determine if patient had been vaccinated,when patient was vaccinated, or when death occurred. All of the elimi-nated reports were anecdotal and specific information on the patient waslacking.Results: We examined 44 death reports in detail. As many as 13 deaths mostlikely resulted from infectious diseases including flu, HIV, meningococcus,staph, or strep. Another 13 deaths were caused by a seizure disorder, cardiacarrest, or pulmonary embolism due to pre-existing conditions. One case ofGuillain-Barre Syndrome was reported; however it occurred 263 daysfollowing administration of HPV4. The remaining 17 deaths were due tovarious causes, including suicide and drug overdose.Conclusion: We found no evidence to support that any reported deathscould be attributed to the HPV4 vaccine.

P72-S. Cumulative Exposure to Neurodevelopmental Stressorsin U.S. Women of Reproductive Age

A.M. Evans, G.E. Rice, L.K. Teuschler, J.M. Wright. Oak Ridge Institute ofScience and Education, Environmental Protection Agency, Cincinnati, OH

Purpose: Maternal stress and exposures to lead (Pb) and methyl mercury(MeHg) affect human neurodevelopment and reproductive health. Here, wecharacterized cumulative exposures to stress and multiple developmentalneurotoxicants (NDTs) including Pb and MeHg and identify potentialmaternal populations that are more likely to be exposure to NDT hazards inU.S. women of reproductive age.Methods: Using data from the 2003e04 National Health and NutritionExamination Surveys, chronic stress was quantified using an aggregatemeasure of allostatic load (AL) based on 10 biomarkers. A Hazard Index (HI)was calculated for combined exposure to Pb and MeHg. Logistic regressionwas used to assess the relationship between Race/Ethnicity and a “high” HI(i.e., HI>1). The final model was stratified by AL.Results: After controlling for country of birth, age, education, smoking andiron status, both Blacks (2.2 [1.4, 3.3]) and Mexican American (1.4 [0.8, 2.6])were more likely to have a high HI compared to Whites. AL was a potentialeffect modifier as odds ratios for both Blacks and Whites varied across ALgroups and were highest for the high AL group (4.3 [2.0, 9.5] and 4.2 [1.3,14.1], respectively).Conclusion: Chronic stress, a non-chemical stressor, was found to modifythe association between race/ethnicity and likelihood of NDT hazard. Thisresearch highlights the importance of evaluating co-exposures (chemical andnon-chemical) with a common endpoint and could be used to identifypotentially susceptible populations.

* National Aeronautics and Space Administration, Hampton, VA.

P73-S. Birth Defects and Disinfection By-Products (DBPS)

J.M. Wright, Z. Rivera-Núñez, A.M. Evans. Oak Ridge Institute of Science andEducation, U.S. Environmental Protection Agency, Cincinnati, OH

Purpose: The risk of birth defects (BDs) (e.g., ventricular septal defects(VSDs)) was examined in relation to DBP exposure and other metrics.

Methods: The risk of BDs (n¼3,500) among all live births from 275 towns inMassachusetts was examined relative to different water sources, disinfectiontypes, and DBP concentrations using 2000�2004 data.Results: Preliminary unadjusted and adjusted results for combined BDswere largely null among the water source and disinfection exposure metrics.Adjusted odds ratios (ORs) ranged from 1.17 to 1.37 for obstructive urinarydefects among births linked to drinking water treated with chlorine, chlo-ramines, and other alternative disinfectants compared to untreated groundwater systems. ORs for cardiac defects among births linked to chlorinatedand chloraminated water compared to untreated ground water ranged from1.08 to 1.14. ORs ranged from 1.17 to 1.19 for hypospadias and epispadiasamong births linked to chlorinated surface water and chloraminated watercompared to untreated ground water. Preliminary analyses showed noincreased risk of combined BDs for total trihalomethane or total haloaceticacid exposures compared to the lowest quintiles. Small increased risks forVSDs were found for the upper two brominated trihalomethane quintiles(OR range¼1.05-1.24), while increased risks for obstructive genitourinarydefects were detected for the upper three bromodichloromethane (ORrange¼1.10-1.51) and total brominated trihalomethane (OR range¼1.61-1.91) quintiles.Conclusion: Preliminary analyses indicate larger risks for BDs for thebrominated DBPs, but further analyses are needed to confirm these results.

P74. Spontaneous Abortion in Flight Attendants

B. Grajewski, E.A. Whelan, C.C. Lawson, M.J. Hein, M.A. Waters, J.L. Anderson,L.A. MacDonald, C.J. Mertens,* C.-Y. Tseng, R.T. Cassinelli II, L. Luo. NationalInstitute for Occupational Safety and Health, Cincinnati, OH

Purpose: Flight attendant occupational exposures include cosmic ionizingradiation and circadian disruption. We wanted to determine whether theseand other occupational exposures were associated with spontaneous abor-tion among female flight attendants.Methods: Female flight attendants from three US airlines in three cities wereinterviewed. Company records of over 1.9 million individual flights duringthe study period were assessed for exposure to galactic cosmic radiation,solar particle event radiation, and circadian disruption. Measures of physicaljob demands and other occupational factors were obtained from theinterview.Results: Among 2654 women interviewed, 959 pregnancies among 765women met inclusion criteria. High physical job demands was a risk factorfor spontaneous abortion (OR¼2.48; 95% CI 1.48e4.15). Flying during homebase normal sleep hours for 15 hours or more during the first trimesterincreased the risk of spontaneous abortion among flight attendants(OR¼1.53; 95% CI 1.06e2.21). Models were adjusted for age and parity.Cosmic radiation dose and time zones crossed were not associated withspontaneous abortion.Conclusion: Flying during the flight attendant's sleeping hours and highphysical job demands during the first trimester were associated withincreased risk of spontaneous abortion.

P75-S. Subtypes of Bullying and Suicide Behaviors AcrossKentucky High School Students

N.C. Peiper, P.M. Clark, B. Birkby, J.L. Ulrich. Department of Epidemiology &Population Health, University of Louisville, Louisville, KY

Purpose: Suicide is the third leading cause of death among individuals ages15-24. The experience of bullying has been shown to predict suicide attemptsas well as suicide deaths. Similarly, victimization from bullying is alsoassociated with anxiety, depression, and high-risk behaviors. This studyaimed to identify bullying and suicide subtypes in a sample of Kentucky highschool students.Methods: Latent class analysis was used to identify subtypes of respondentsbased upon probabilities of self-reported bullying, depression, and suicidebehaviors with combined data from the 2009 and 2011.Kentucky Youth Risk Behavior Survey (n¼3,606). A multinomial logisticregression model was then fit to determine significant predictors of classmembership with the lowest risk class serving as the base outcome.