Racial disparities in the transgenerational transmission of low birthweight risk.

Objective: To examine the association of maternal low birthweight (LBW) with infant LBW and infant LBW subgroups (i.e. moderate and very LBW), overall and among non-Hispanic (NH) white and NH black mothers. Design: We conducted a population-based cohort study in Allegheny County, Pennsylvania, using linked birth record data of NH white and NH black mother-infant pairs (N = 6,633) born in 1979-1998 and 2009-2011, respectively. The exposure of interest was maternal LBW (birthweight <2500 grams) while the outcomes were infant LBW and LBW subgroups - moderate LBW (1,500-2,499 grams) or very LBW (<1,500 grams). Logistic regression (binomial and multinomial) models were used to estimate adjusted Odds Ratios (ORs), Relative Risk Ratios (RRRs), and related 95% confidence intervals (CI). Stratified analyses were conducted to assess effect modification by mothers' race. Results: Maternal LBW was associated with 1.53 (95%CI: 1.15-2.02) and 1.75 (95%CI: 1.29-2.37) -fold increases in risk of infant LBW and MLBW, respectively, but not VLBW (RRR = 0.86; 95%CI: 0.44-1.70). In race-stratified models, maternal LBW-infant LBW associations were observed among NH blacks (OR = 1.88; 95%CI: 1.32-2.66) and not among NH whites (OR = 1.03; 95%CI: 0.62-1.73) (P for interaction = 0.07). Among NH blacks, maternal LBW was associated with a 2.18 (95%CI: 1.49, 3.20) -fold increase in risk of infant MLBW, but not VLBW (RRR = 1.12; 95%CI: 0.54, 2.35). Among NH whites, LBW subgroup analyses could not be performed due to small numbers of VLBW infants among LBW mothers. Conclusion: Mothers who were LBW at their own birth were more likely to have MLBW infants. Maternal race modified associations of maternal LBW with infant LBW, particularly infant MLBW. Further research is needed in this area to understand the potential mechanisms involved in the transgenerational transmission of LBW risk and race-specific differences in the transmission.

Transgenerational Transmission of Preterm Birth Risk: The Role of Race and Generational Socio-Economic Neighborhood Context.

Objectives We investigated associations of mothers' preterm birth (PTB) status with her infants' PTB risk. We also examined whether this relationship differs by mothers' race and generational socio-economic neighborhood context. Methods Participants were 6592 non-Hispanic (NH) white and NH black mother-infant pairs born in 2009-2011 and 1979-1998, respectively, in Allegheny County, Pennsylvania. Birth records were used to determine gestational age at birth, PTB status (<37 completed weeks of gestation), and PTB subgroups-late and early PTB (34-36 weeks and <34 completed weeks of gestation, respectively). Census data on tract racial composition and household income were used to characterize residential race and economic environment. Logistic regression models were used to calculate Odds Ratios (ORs), Relative Risk Ratios (RRR), and 95% confidence intervals (CIs). Stratified analyses were conducted to assess effect modification. Results Overall, 8.21, 6.63 and 1.58% infants had PTB, LPTB, and EPTB, respectively. Maternal PTB status was associated with a 46% increase in infant PTB (95% CI: 1.08-1.98), EPTB (95% CI: 0.80-2.69), and LPTB (95% CI: 1.04-2.04) risk. Maternal PTB-infant PTB associations, particularly maternal PTB-infant LPTB associations, were stronger among NH blacks, mothers in neighborhoods with a high percentage of NH black residents in both generations, or mothers who moved to neighborhoods with a higher percentage of NH black residents. Conclusions for Practice Race and generational socio-economic neighborhood context modify transgenerational transmission of PTB risk. These findings are important for identification of at-risk populations and to inform future mechanistic studies.

Financial distress and depressive symptoms among African American women: identifying financial priorities and needs and why it matters for mental health.

Prior research found that financial hardship or distress is one of the most important underlying factors for depression/depressive symptoms, yet factors that contribute to financial distress remain unexplored or unaddressed. Given this, the goals of the present study were (1) to examine the relationship between perceived financial distress and depressive symptoms, and (2) to identify financial priorities and needs that may contribute to financial distress. Surveys from 111 African American women, ages 18-44, who reside in Allegheny County, PA, were used to gather demographic information and measures of depressive symptoms and financial distress/financial well-being. Correlation and regression analyses revealed that perceived financial distress was significantly associated with levels of depressive symptoms. To assess financial priorities and needs, responses to two open-ended questions were analyzed and coded for common themes: "Imagine you won a $10,000 prize in a local lottery. What would you do with this money?" and "What kinds of programs or other help would be beneficial to you during times of financial difficulties?" The highest five priorities identified by the participants were paying bills and debt, saving, purchasing a home or making home repairs, and/or helping others. The participant's perceived needs during times of financial difficulty included tangible assistance and/or financial education. The findings from this study can be used to create new and/or enhance existing programs, services, and/or interventions that focus on the identified financial priorities and needs. Collaborative efforts among professionals in different disciplines are also needed, as ways to manage and alleviate financial distress should be considered and discussed when addressing the mental health of African American women.

FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma.

OBJECTIVE: To evaluate the FAST (focused assessment with sonography in trauma) examination for determining traumatic pericardial effusion and intraperitoneal fluid indicative of injury in patients with penetrating anterior chest trauma. METHODS: An observational prospective study was conducted over a 30-month period at an urban level I trauma center. FAST was performed in the emergency department by emergency physicians and trauma surgeons. FAST results were recorded before review of patient outcome as determined by 1 or more of the following: thoracotomy, laparotomy, pericardial window, cardiologic echocardiography, diagnostic peritoneal lavage, computed tomography, and serial examinations. RESULTS: FAST was undertaken in 32 patients with penetrating anterior chest trauma: 20 (65%) had stab wounds, and 12 (35%) had gunshot wounds. Sensitivity of FAST for cardiac injury (n = 8) in patients with pericardial effusion was 100% (95% confidence interval, 63.1%-100%); specificity was 100% (95% confidence interval, 85.8%-100%). The presence of pericardial effusion determined by FAST correlated with the need for thoracotomy in 7 (87.5%) of 8 patients (95% confidence interval, 47.3%-99.7%). One patient with a pericardial blood clot on cardiologic echocardiography was treated nonsurgically. FAST had 100% sensitivity for intraperitoneal injury (95% confidence interval, 63.1%-100%) in 8 patients with views indicating intraperitoneal fluid but without pericardial effusion, again with no false-positive results, giving a specificity of 100% (95% confidence interval, 85.8%-100%). This prompted necessary laparotomy in all 8. CONCLUSIONS: In this series of patients with penetrating anterior chest trauma, the FAST examination was sensitive and specific in the determination of both traumatic pericardial effusion and intraperitoneal fluid indicative of injury, thus effectively guiding emergent surgical decision making.

Local health departments' mission to the uninsured.

It is often maintained that local health departments (LHDs) should not directly provide personal health services. However, our nationally representative sample revealed that most LHD directors (87%) believed LHDs must directly provide these services, primarily because they perceived a high level of unmet need among the uninsured. While only a minority believed LHDs should focus exclusively on the core functions, this proportion rose dramatically when we asked directors to assume that there were no uninsured people. Directors who perceived a high level of unmet need among the uninsured in their jurisdictions were much less likely to believe that LHDs should exclusively focus on the core functions. In theory, LHDs have a unique responsibility for assuring that the uninsured and vulnerable have access to personal health services. However, a majority of directors (67%) acknowledged that they have no enforceable means of assuring access to services the health department did not directly provide.

Managerial and professional beliefs influencing public health privatization: results of a national survey of local health department directors.

This article describes managerial and professional beliefs underlying decisions to privatize public health services. We drew a stratified, nationally representative sample of local health departments and interviewed 347 department directors by telephone. We used logistic regression to establish the independent effects of various beliefs on the decision to privatize. Over half of directors did not believe that there was valid evidence that privatization results in more efficient performance, and those who believed there was such evidence were not more likely to privatize. However, directors held professional and managerial beliefs that influenced their decision to privatize. Directors most likely to privatize were those who believed that local health departments should exclusively focus on the core public health functions, those who asserted that public health should become involved in an increasingly diverse array of social problems, and those who believed that employees should be used on a temporary and contractual, rather than permanent, basis wherever possible.

The privatization of environmental health services: a national survey of practices and perspectives in local health departments.

OBJECTIVES: This article presents nationally representative data on environmental health (EH) services privatized by local public health departments, enforcement and assurance mechanisms for privatized services, and administrators' views about EH services that should not be privatized. METHODS: A national sample of 380 local public health departments, stratified by jurisdiction size, was drawn from a universe of 2,488 departments. Telephone interviews were conducted with 347 administrators of departments. Results were weighted to be nationally representative. RESULTS: Approximately one-quarter of departments had privatized at least one EH service, almost always to for-profit organizations. The two most common reasons given for privatizing EH services were cost savings or increased efficiency and lack of capacity or expertise to carry out the service. The most rigorous, although infrequent, technique of enforcement and assurance of EH standards when services were privatized was double-testing of samples. Departments more commonly relied on state licensing and certification of contractors. When asked what services should not be privatized, 27% of respondents cited EH services. Many respondents argued against privatizing environmental services that have inherent regulatory functions. They expressed concern that privatization would fragment the public health infrastructure by impairing communication, diminishing control over performance, or weakening health departments' capacity to respond to environmental and other health crises. CONCLUSION: These findings raise serious concerns about the privatization of EH.

Public health privatization: proponents, registers, and decision-makers.

We previously documented the extent and consequences of the privatization of public health, using a nationally representative sample of 347 Local Health Department (LHD) directors. Here we present the directors' descriptions of the actors involved in the privatization of services. LHD top administrators are the most influential privatization decision-makers in about half of LHDs. But other groups significantly influence privatization decisions, particularly state governments, state health departments, and local officials. Nearly two thirds of LHDs experienced pressures to privatize, either from state legislatures, state health departments, funding organizations, or other source of political pressure. Almost half of LHD directors reported resistance to privatization, often from employees. The majority of directors did not believe it was desirable to put employees on a temporary, contractual basis. Many directors believed that retaining permanent, full-time employees was fairer as well as necessary to maintain a cadre of experienced public health professionals.

The perceived impact of privatization on local health departments.

OBJECTIVES: This article presents nationally representative data on the effects of privatization on local health departments (LHDs). METHODS: A stratified representative national sample of 380 LHDs was drawn from a national list of 2488 departments. Telephone interviews were conducted with 347 LHD directors. RESULTS: One half of the directors of LHDs with privatized services reported that privatization helped the performance of core functions. Privatization often resulted in increased time needed for management and administration. More than a third of LHD directors reported concern about loss of control over the performance of privatized functions and services. CONCLUSIONS: Privatization is part of a broader shift toward "managing" rather than directly providing public health services, yet privatization often reduces LHDs' control over the performance of services.