Medical Malpractice Liability Exposure and OB/GYN Physician Delivery Decisions.

OBJECTIVE: This study examines the effect of physician medical malpractice liability exposure on primary Cesarean and vaginal births after Cesarean (VBACs). DATA SOURCES/STUDY SETTING: Secondary data on hospital births from Florida Hospital Inpatient File, physician characteristics from American Medical Association Physician Masterfile, and physician malpractice claim history from Florida Office of Insurance Regulation. STUDY DESIGN: Our study estimates the effects of physician malpractice liability exposure on Cesareans and VBACs using panel data and a multivariate, fixed effects model. DATA COLLECTION: We merge three secondary data sources based on unique physician license numbers between 1994 and 2010. PRINCIPAL FINDINGS: We find no evidence that the first malpractice claim affects primary Cesarean deliveries. We find, however, that the first malpractice claim decreases the likelihood of a VBAC (conditional on a prior Cesarean delivery) by 1.2-1.9 percentage points (approximately 10 percent relative to mean VBAC incidence). This finding is robust to focusing on obstetrics-related malpractice claims, as well as to considering different malpractice claims (first report, first severe report, and first lawsuit). CONCLUSIONS: Given the increase in both primary and repeat Cesarean deliveries, our results suggest that physician malpractice liability exposure is responsible for a relatively small share of the VBAC decrease.

Do Smoking Bans Improve Neonatal Health?

RESEARCH OBJECTIVE: To estimate the effects of smoking bans on neonatal health outcomes and maternal smoking behavior during pregnancy. DATA SOURCES: Restricted-use 1991-2009 Natality Detail Files, a Clean Air Dates Table Report, and the Tax Burden of Tobacco. STUDY DESIGN: A quasi-experimental study using difference-in-differences estimation based on legislative history of smoking restrictions or bans by type/place/county/state level. Dependent variables included average monthly percentage of healthy neonates, of term neonates born with low and very low birth weight, of premature births, of maternal smokers, and average number of cigarettes smoked daily during pregnancy. The analyses were restricted to singleton births and those that occurred in the same county as mother's county of residence. DATA COLLECTION/EXTRACTION METHODS: The data from three data sources were combined using Federal Information Processing Standard codes. PRINCIPAL FINDINGS: Results of the overall and stratified by maternal smoking status, educational level, and age regression analyses suggested no appreciable effect of smoking bans on neonatal health. Smoking bans had also no effect on maternal smoking behavior. CONCLUSION: While there are health benefits to the general population from smoking bans, their effects on neonatal health outcomes and maternal smoking during pregnancy seem to be limited.

Measures of the consumer food store environment: a systematic review of the evidence 2000-2011.

Description of the consumer food environment has proliferated in publication. However, there has been a lack of systematic reviews focusing on how the consumer food environment is associated with the following: (1) neighborhood characteristics; (2) food prices; (3) dietary patterns; and (4) weight status. We conducted a systematic review of primary, quantitative, observational studies, published in English that conducted an audit of the consumer food environment. The literature search included electronic, hand searches, and peer-reviewed from 2000 to 2011. Fifty six papers met the inclusion criteria. Six studies reported stores in low income neighborhoods or high minority neighborhoods had less availability of healthy food. While, four studies found there was no difference in availability between neighborhoods. The results were also inconsistent for differences in food prices, dietary patterns, and weight status. This systematic review uncovered several key findings. (1) Systematic measurement of determining availability of food within stores and store types is needed; (2) Context is relevant for understanding the complexities of the consumer food environment; (3) Interventions and longitudinal studies addressing purchasing habits, diet, and obesity outcomes are needed; and (4) Influences of price and marketing that may be linked with why people purchase certain items.

Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?

OBJECTIVE: To examine the effects of state legislation mandating direct access to obstetricians and gynecologists (OB/GYNs) on maternal health behaviors and infant health outcomes. DATA SOURCES: 1992-2002 Natality Detail File; 1994-2002 Pregnancy Assessment and Monitoring Survey (PRAMS). STUDY DESIGN: Using variation in state policy over time, we use individual-level data from two sources to consider the effects of direct access legislation on prenatal care utilization, maternal health behaviors during pregnancy, and infant health outcomes. PRINCIPAL FINDINGS: Our results suggest that there is little evidence that direct access laws are effective at improving prenatal care access or conferring benefits to mothers and infants. These results are consistent across two data sets, a variety of specifications, and specific subgroups of women who are most likely to be affected by direct access legislation. CONCLUSION: We conclude that direct access to OB/GYNs is not related to improvements in maternal health behaviors or infant health outcomes. If policy makers are interested in reforms that improve maternal and infant health, we recommend a focus on alternative policies.