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Our objective was to systematically estimate the prevalence of <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> in Texas by measuring a direct ethanol metabolite, phosphatidylethanol (<jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>th), in 1,000 infant residual dried blood spots (ir<jats:styled-content style=\"fixed-case\">DBS<\/jats:styled-content>s) in the Texas Newborn Screening Repository.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All public health regions (<jats:styled-content style=\"fixed-case\">PHR<\/jats:styled-content>s) were represented proportional to their 2014 birth rate (~0.25% of total births). A cross\u2010sectional study design (unit of observation: individual ir<jats:styled-content style=\"fixed-case\">DBS<\/jats:styled-content> cards\/infants) with additional ecologic subanalysis (unit of observation: aggregate measures for each Texas <jats:styled-content style=\"fixed-case\">PHR<\/jats:styled-content>) was utilized. The study used <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>th\u2010ir<jats:styled-content style=\"fixed-case\">DBS<\/jats:styled-content> to estimate the prevalence of <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> within 1\u00a0month before delivery for the state of Texas and each Texas <jats:styled-content style=\"fixed-case\">PHR<\/jats:styled-content>. The ecologic subanalysis compared different geographical regions\u2019 aggregate prevalence of <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> with (i) retail liquor licenses, (ii) median household income by <jats:styled-content style=\"fixed-case\">PHR<\/jats:styled-content>, and (iii) prevalence of birth outcomes commonly associated with <jats:styled-content style=\"fixed-case\">FASD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The sample included an equal number of males and females; 47.8% non\u2010Hispanic White, 40.8% Hispanic, 6.6% African American, and 4.8% Asian infants. In the entire sample, 8.4% of ir<jats:styled-content style=\"fixed-case\">DBS<\/jats:styled-content>s were positive for <jats:styled-content style=\"fixed-case\">PE<\/jats:styled-content>th (&gt;20\u00a0ng\/ml) indicative of <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> within approximately 1\u00a0month before delivery. Large regional differences were observed with mostly urban, high median\u2010income regions demonstrating the highest prevalence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Results of this first systematic statewide <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> prevalence study demonstrate that <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> might be more prevalent than previously thought. Active case ascertainment efforts for <jats:styled-content style=\"fixed-case\">FASD<\/jats:styled-content> coupled with systematic objective assessment of <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> should expand to the national level to better estimate public health needs required to provide adequate services for children affected by <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.13375","type":"journal-article","created":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T16:23:41Z","timestamp":1489508621000},"page":"1004-1011","source":"Crossref","is-referenced-by-count":64,"title":["Prevalence of Prenatal Alcohol Exposure in the State of Texas as Assessed by Phosphatidylethanol in Newborn Dried Blood Spot Specimens"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-0211","authenticated-orcid":false,"given":"Ludmila N.","family":"Bakhireva","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice and Administrative Sciences University of New Mexico College of Pharmacy Albuquerque New Mexico"},{"name":"Department of Family and Community Medicine University of New Mexico Albuquerque New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Sharkis","sequence":"additional","affiliation":[{"name":"Texas Office for Prevention of Developmental Disabilities  Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikhar","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Administrative Sciences University of New Mexico College of Pharmacy Albuquerque New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan J.","family":"Miranda\u2010Sohrabji","sequence":"additional","affiliation":[{"name":"Texas Office for Prevention of Developmental Disabilities  Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonnie","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Administrative Sciences University of New Mexico College of Pharmacy Albuquerque New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh C.","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Experimental Therapeutics Texas A&amp;M Health Science Center, College of Medicine Bryan Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,5]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","first-page":"S49","article-title":"Limit of blank, limit of detection and limit of quantitation","volume":"29","author":"Armbruster DA","year":"2008","journal-title":"Clin Biochem Rev"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.4.377"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12349"},{"key":"e_1_2_8_5_1","first-page":"56","article-title":"Focus on: biomarkers of fetal alcohol exposure and fetal alcohol effects","volume":"34","author":"Bakhireva LN","year":"2011","journal-title":"Alcohol Res Health"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12045"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agv120"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alcohol.2009.08.002"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.7895\/ijadr.v4i2.209"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.12402"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2011.01652.x"},{"key":"e_1_2_8_12_1","unstructured":"CDC(2010)PRAMStat | Reproductive Health | CDC. 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