Gestational Diabetes Prevalence Estimates from Three Data Sources, 2018.

INTRODUCTION: We investigated 2018 gestational diabetes mellitus (GDM) prevalence estimates in three surveillance systems (National Vital Statistics System, State Inpatient Database, and Pregnancy Risk Assessment Monitoring Survey). METHODS: We calculated GDM prevalence for jurisdictions represented in each system; a subset of data was analyzed for people 18-39 years old in 22 jurisdictions present in all three systems to observe dataset-specific demographics and GDM prevalence using comparable categories. RESULTS: GDM prevalence estimates varied widely by data system and within the data subset despite comparable demographics. DISCUSSION: Understanding the differences between GDM surveillance data systems can help researchers better identify people and places at higher risk of GDM.

Addressing Racial Disparities in Pregnancy-Related Deaths: An Analysis of Maternal Mortality-Related Federal Legislation, 2017-2021.

There has been increasing national attention to the issue of racial disparities in pregnancy-related deaths. Federal legislation can support approaches at multiple levels of intervention to improve maternal health. As part of the CDC Policy Academy, a team of CDC staff completed a policy analysis to determine the approaches addressed in federal legislation to reduce racial disparities in pregnancy-related deaths. We analyzed federal maternal mortality legislation introduced January 2017 through December 2021. Common approaches addressed by the legislation were categorized into themes and reviewed for their alignment with approaches identified in clinical and public health literature to reduce pregnancy-related deaths, with an emphasis on social determinants of health (SDOH) approaches and reducing racial disparities. Thirty-seven unduplicated bills addressed pregnancy-related deaths, including 27 House or Senate bills that were introduced but not passed, 6 resolutions highlighting the maternal health crisis, 2 bills that passed the House only, and 2 bills enacted into law (Preventing Maternal Deaths Act of 2018 and Protecting Moms Who Served Act). The most common themes mentioned in federal legislation were improving maternal health care, addressing health inequities and SDOH, enhancing data, and promoting women's health. Legislation focused on health inequities and SDOH emphasized implicit bias training and improving SDOH, including racism and other social factors. The reviewed federal legislation reflected common clinical and public health approaches to prevent pregnancy-related deaths, including a significant focus on reducing bias and improving SDOH to address racial disparities.

Intimate Partner and Sexual Violence Prevention Among Youth: A Community Guide Systematic Review.

INTRODUCTION: Intimate partner violence and sexual violence are widespread and often occur early in life. This systematic review examines the effectiveness of interventions for primary prevention of intimate partner violence and sexual violence among youth. METHODS: Studies were identified from 2 previous systematic reviews and an updated search (January 2012-June 2016). Included studies were implemented among youth, conducted in high-income countries, and aimed to prevent or reduce the perpetration of intimate partner violence or sexual violence. In 2016-2017, Guide to Community Preventive Services (Community Guide) methods were used to assess effectiveness as determined by perpetration, victimization, or bystander action. When heterogeneity of outcomes prevented usual Community Guide methods, the team systematically applied criteria for favorability (statistically significant at p<0.05 or approaching significance at p<0.10) and consistency (75% of results in the same direction). RESULTS: A total of 28 studies (32 arms) met inclusion and quality of execution criteria. Interventions used combinations of teaching healthy relationship skills, promoting social norms to protect against violence, or creating protective environments. Overall, 18 of 24 study arms reported favorable results on the basis of the direction of effect for decreasing perpetration; however, favorability for bystander action diminished with longer follow-up. Interventions did not demonstrate consistent results for decreasing victimization. A bridge search conducted during Fall 2020 confirmed these results. DISCUSSION: Interventions for the primary prevention of intimate partner violence and sexual violence are effective in reducing perpetration. Increasing bystander action may require additional follow-up as effectiveness diminishes over time. Findings may inform researchers, school personnel, public health, and other decision makers about effective strategies to prevent intimate partner violence and sexual violence among youth.

Racial Disparities in the Association between Alcohol Use Disorders and Health in Black and White Women.

Adverse health attributed to alcohol use disorders (AUD) is more pronounced among black than white women. We investigated whether socioeconomic status (education and income), health care factors (insurance, alcoholism treatment), or psychosocial stressors (stressful life events, racial discrimination, alcoholism stigma) could account for black-white differences in the association between AUD and physical and functional health among current women drinkers 25 years and older (N = 8,877) in the National Epidemiological Survey on Alcohol and Related Conditions. Generalized linear regression tested how race interacted with the association between 12-month DSM-IV AUD in Wave 1 (2001-2002) and health in Wave 2 (2004-2005), adjusted for covariates (age group, alcohol consumption, smoking, body mass index, physical activity, diabetes, cardiovascular disease, and arthritis). Black women with AUD had poorer health than white women with AUD (ß = -3.18, SE = 1.28, p < .05). This association was partially attenuated after adjusting for socioeconomic status, health care, and psychosocial factors (ß = -2.64, SE = 1.27, p < .05). In race-specific analyses, AUD was associated with poorer health for black but not white women. Accounting for black-white differences in AUD and physical and functional health among women requires investigation beyond traditional explanatory mechanisms.

Undoing Racism Through Genesee County's REACH Infant Mortality Reduction Initiative.

BACKGROUND: Genesee County Racial and Ethnic Approaches to Community Health Program (REACH) is a Community-Based Public Health partnership for reducing African American infant mortality rates that hosts the Undoing Racism Workshop (URW). OBJECTIVES: Assess the URW's effectiveness in promoting an understanding of racism, institutional racism, and how issues related to race/ethnicity can affect maternal and infant health. METHODS: Recent URW participants (n=84) completed brief preassessment and postassessment forms; participants (n=101) also completed an on-line, long-term assessment (LTA). RESULTS: URWs promoted understanding of racism and institutional racism, although they were less effective in addressing racism as related to maternal and infant health. CONCLUSIONS: The URWs were most effective in the domains related to their standard content. Additional effort is necessary to customize URWs when utilized for activities beyond their original purpose of community mobilization.

Racism, health status, and birth outcomes: results of a participatory community-based intervention and health survey.

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.

Monitoring racial/ethnic mortality disparities in Wisconsin: 1991-2000.

BACKGROUND: Wisconsin has a goal to eliminate health disparities by 2010, but there is no consistent standard used to evaluate progress. Methodological debates persist regarding using individual group change or relative comparisons to monitor disparities. OBJECTIVES: To examine mortality disparities among racial/ethnic populations in Wisconsin using statistically significant changes in individual population mortality rates and rate ratios as measures of disparity. These measures are proposed to monitor and evaluate progress in eliminating racial/ethnic health disparities. METHODS: The Wisconsin Interactive Statistics on Health database was queried to obtain Wisconsin all-cause mortality data by race and age for the 1991-1995 and 1996-2000 periods. Age-specific and age-adjusted rates were compared across 5 major racial/ethnic populations in Wisconsin. RESULTS: Age-adjusted mortality generally declined for all racial/ethnic populations in Wisconsin from 19911995 to 1996-2000. However, disparities increased significantly for African American infants, African Americans 45-64 years old, and Hispanics/Latinos 25-44 years old. Using non-Hispanic whites as a referent resulted in a paradoxical increase in disparities for Hispanics/Latinos despite a significant reduction in mortality in this group. CONCLUSION: A statistically significant percent change in mortality rates and rate ratios is a useful standard to monitor health disparities and foster communication and targeted action around Wisconsin's goal to eliminate racial/ethnic health disparities.