Research-grade data in the real world: challenges and opportunities in data quality from a pragmatic trial in community-based practices.

Randomized controlled trials face cost, logistic, and generalizability limitations, including difficulty engaging racial/ethnic minorities. Real-world data (RWD) from pragmatic trials, including electronic health record (EHR) data, may produce intervention evaluation findings generalizable to diverse populations. This case study of Project IMPACT describes unique barriers and facilitators of optimizing RWD to improve health outcomes and advance health equity in small immigrant-serving community-based practices. Project IMPACT tested the effect of an EHR-based health information technology intervention on hypertension control among small urban practices serving South Asian patients. Challenges in acquiring accurate RWD included EHR field availability and registry capabilities, cross-sector communication, and financial, personnel, and space resources. Although using RWD from community-based practices can inform health equity initiatives, it requires multidisciplinary collaborations, clinic support, procedures for data input (including social determinants), and standardized field logic/rules across EHR platforms.

Diabetes Prevalence by Leisure-, Transportation-, and Occupation-Based Physical Activity Among Racially/Ethnically Diverse U.S. Adults.

OBJECTIVE: Leisure-time physical activity (LTPA) has been shown to prevent or delay the development of diabetes. However, little research exists examining how other domains of PA (e.g., occupation based [OPA] and transportation based [TPA]) are associated with diabetes prevalence across diverse racial/ethnic groups. We examined associations between OPA, TPA, and LTPA and diabetes prevalence and whether associations differed by race/ethnicity. RESEARCH DESIGN AND METHODS: Participants in the 2011-2016 National Health and Nutrition Examination Survey (NHANES) self-reported domain-specific PA. Diabetes status was determined by self-reported doctor/health professional-diagnosis of diabetes or a glycosylated hemoglobin (HbA1c) measurement of ≥6.5% (48 mmol/mol). Multivariable log binomial models examined differences in diabetes prevalence by PA level in each domain and total PA among Latinos (n = 3,931), non-Latino whites (n = 6,079), and non-Latino blacks (n = 3,659). RESULTS: Whites reported the highest prevalence of achieving PA guidelines (64.9%), followed by Latinos (61.6%) and non-Latino blacks (60.9%; P < 0.0009). Participants achieving PA guidelines were 19-32% less likely to have diabetes depending on PA domain in adjusted models. Diabetes prevalence was consistently higher among non-Latino blacks (17.1%) and Latinos (14.1%) compared with non-Latino whites (10.7%; P < 0.0001), but interaction results showed the protective effect of PA was similar across PA domain and race/ethnicity-except within TPA, where the protective effect was 4% greater among non-Latino whites compared with Latinos (adjusted difference in risk differences 0.04, P = 0.01). CONCLUSIONS: PA policies and programs, beyond LTPA, can be leveraged to reduce diabetes prevalence among all population groups. Future studies are needed to confirm potentially differential effects of transportation-based active living on diabetes prevalence across race/ethnicity.

Psychological and relational correlates of intimate partner violence profiles among pregnant adolescent couples.

We sought to identify relationship and individual psychological factors that related to four profiles of intimate partner violence (IPV) among pregnant adolescent couples: no IPV, male IPV victim only, female IPV victim only, mutual IPV, and how associations differ by sex. Using data from a longitudinal study of pregnant adolescents and partners (n = 291 couples), we used a multivariate profile analysis using multivariate analysis of covariance with between and within-subjects effects to compare IPV groups and sex on relationship and psychological factors. Analyses were conducted at the couple level, with IPV groups as a between-subjects couple level variable and sex as a within-subjects variable that allowed us to model and compare the outcomes of both partners while controlling for the correlated nature of the data. Analyses controlled for age, race, income, relationship duration, and gestational age. Among couples, 64% had no IPV; 23% male IPV victim only; 7% mutual IPV; 5% female IPV victim only. Relationship (F = 3.61, P < .001) and psychological (F = 3.17, P < .001) factors differed by IPV group, overall. Attachment anxiety, attachment avoidance, relationship equity, perceived partner infidelity, depression, stress, and hostility each differed by IPV profile (all P < .01). Attachment anxiety, equity, depression and stress had a significant IPV profile by sex interaction (all P < .05). Couples with mutual IPV had the least healthy relationship and psychological characteristics; couples with no IPV had the healthiest characteristics. Females in mutually violent relationships were at particularly high risk. Couple-level interventions focused on relational issues might protect young families from developing IPV behaviors. Aggr. Behav. 43:26-36, 2017. © 2016 Wiley Periodicals, Inc.

Breastfeeding intentions among pregnant adolescents and young adults and their partners.

BACKGROUND: Rates of breastfeeding remain disproportionately low among young mothers in the United States. Although breastfeeding behavior may be most directly related to breastfeeding intention, little is known about breastfeeding intentions among young women who are expecting a baby. SUBJECTS AND METHODS: Pregnant adolescents and young adults (14-21 years old) and their male partners were recruited for participation. Females were asked if they intended to breastfeed, and their partners were asked if they wanted their partners to breastfeed; participants indicated reasons for their responses. Logistic regression modeling was used to determine the associations between breastfeeding intentions and sociodemographic characteristics, relationship characteristics, and partner's intention to breastfeed. RESULTS: Approximately 73% of females reported intending to breastfeed, and 80% of males reported wanting his partner to breastfeed, most commonly because it is "healthier for the baby" and "a more natural way to feed the baby." Sociodemographic and relationship characteristics explained a small amount of variance of breastfeeding intention (15% and 4% among females, respectively, and 8% and 4% among males, respectively). Partner intention explained an additional 23% and 24% of the variance in individual intention for females and males, respectively. Females who had experienced intimate partner violence (IPV) from their current partner had lower odds of intending to breastfeed (odds ratio=0.37; 95% confidence interval=0.16, 0.84). Race/ethnicity modified associations among both genders. CONCLUSIONS: These findings emphasize the importance of dyadic approaches and suggest strategies for improving breastfeeding intentions and behavior among young couples expecting a baby. These results are also among the first to document the relationship between IPV and breastfeeding intentions among young women.

Associations of a sexually transmitted disease diagnosis during a relationship with condom use and psychosocial outcomes: (short) windows of opportunity.

Few studies have examined whether and how receiving an sexually transmitted disease (STD) diagnosis while in a romantic relationship relates to condom use and psychosocial sexual outcomes. Using dyadic data, we examined associations of a personal or a partner's STD diagnosis during a relationship with condom use, monogamy intentions, condom intentions and attitudes, and STD susceptibility and communication. Because beliefs about how the STD was acquired may shape associations with behavior and cognitions, gender and suspecting that one's partner had other sexual partners (i.e., partner concurrency) were examined as moderators. Participants were 592 individuals in 296 couples expecting a baby; 108 individuals had been diagnosed with an STD during the relationship. Personal STD diagnosis was unrelated to outcomes or was associated with increased risk. A partner's diagnosis related to more positive condom intentions and attitudes. Among men who suspected concurrency, both a personal and a partner's STD diagnosis were associated with less condom use. Receiving the STD diagnosis during pregnancy was associated with greater susceptibility and marginally greater condom use. Results suggest potential benefits of enhancing communication and encouraging joint risk reduction counseling among couples, engaging men more fully in preventive efforts, and capitalizing on the short window during which risk reduction occurs.

Pregnancy desire among a sample of young couples who are expecting a baby.

CONTEXT: Adolescents' desire for a pregnancy has been explored more among females than among males. A more comprehensive understanding of teenagers' pregnancy desires is needed to inform pregnancy prevention efforts and to support couples as they undergo the transition to parenthood. METHODS: In an observational cohort study conducted in 2007-2011 at clinics in Connecticut, data were collected from 296 couples (females aged 14-21 and their partners) who were expecting a baby. The degree to which each partner had wanted the pregnancy and partners' perceptions of each other's pregnancy desires were assessed. Multilevel regression models examined associations between pregnancy desire and individual, partner, family and community characteristics, and between desire and life and relationship satisfaction. RESULTS: Forty-nine percent of females and 53% of males reported having wanted the pregnancy. Pregnancy desire scores were positively associated with being male, expecting a first baby, perceived partner desire and parental response to the pregnancy; scores were negatively associated with being in school, being employed and parental support. Females' perceptions of their partners' pregnancy desires were slightly more accurate than males' (kappas, 0.36 and 0.28, respectively). Pregnancy desire was positively associated with both life and relationship satisfaction, particularly among males. CONCLUSIONS: Adolescents' pregnancy desires require further attention as a possible focus of pregnancy prevention efforts, and health care providers may want to ensure that young couples with unwanted pregnancies are offered additional psychological and social services as they transition to parenthood.

Perceptions about sexual concurrency and factors related to inaccurate perceptions among pregnant adolescents and their partners.

BACKGROUND: Inaccurate perceptions about whether a partner has concurrent sexual partners are associated with current sexually transmitted infections status. Despite high sexually transmitted infection rates among pregnant adolescents, studies have not investigated the accuracy of perceptions about sexual concurrency among young pregnant adolescents. The objectives were to assess (1) the accuracy of perceptions about whether one's partner ever had concurrent sexual partners during the relationship and (2) whether self-reported concurrency and relationship factors are related to inaccurate perceptions. METHODS: Sociodemographic, psychosocial, and sexual behavior data were collected from 296 couples recruited from antenatal clinics. Couples included pregnant adolescents, aged 14 to 21 years, and the father of the baby, aged ≥ 14 years. Percentage agreement and κ statistics assessed the accuracy of perceptions about whether one's partner ever had concurrent sexual partners during the relationship. Logistic regression models using generalized estimating equations assessed associations between respondents' self-reported concurrency, relationship factors, and inaccurate perceptions. RESULTS: Among participants whose partner was concurrent (n = 171), 60% did not accurately report their partner's concurrency, and greater relationship satisfaction (adjusted odds ratio [AOR]: 1.54) increased the likelihood of inaccuracy. Among participants with a nonconcurrent partner (n = 418), 17% were inaccurate; self-reported concurrency (AOR: 2.69) and greater partnership duration (AOR: 1.25) increased the likelihood of inaccuracy, whereas greater relationship satisfaction decreased the likelihood of inaccuracy (AOR: 0.68). CONCLUSIONS: Many pregnant adolescents and their partners inaccurately perceived their partner's concurrency status. Self-reported concurrency and relationship factors were associated with inaccuracy, reinforcing the need to improve sexual communication among this population.

Depression during pregnancy among young couples: the effect of personal and partner experiences of stressors and the buffering effects of social relationships.

STUDY OBJECTIVE: To assess the relationship between personal and romantic partner's experiences of stressful life events and depression during pregnancy, and the social moderators of this relationship, among 296 young couples with low incomes from urban areas. PARTICIPANTS AND SETTING: We recruited couples who were expecting a baby from four ob/gyn and ultrasound clinics in southern Connecticut; women were ages 14-21 and male partners were 14+. DESIGN AND OUTCOME MEASURES: We analyzed self-reports of stressful events in the previous six months, depression in the past week and current interpersonal social supports. To determine the influence of personal and partner experiences of stressful events on depression, we used multilevel dyadic models and incorporated interaction terms. We also used this model to determine whether social support, family functioning and relationship satisfaction moderated the association between stressful events and depression. RESULTS: Experiences of stressful life events were common; 91.2% of couples had at least one member report an event. Money, employment problems, and moving were the most common events. Personal experiences of stressful life events had the strongest association with depression among men and women; although partner experiences of stressful life events were also significantly associated with depression among women. Social support, family functioning, and romantic relationship satisfaction significantly buffered the association between personal and partner stressful events and depression. CONCLUSION: Interventions that improve relationships, support systems, and family functioning may reduce the negative impact of stressors, experienced both personally and by a romantic partner, on the emotional well-being of young expectant parents.