Objective and subjective assessment of Dupuytren's contracture.

This paper describes the evaluation options of Dupuytren's contracture by subjective and objective methods. There are various classification schemes named after their authors, including graphical representation for objective evaluation of the disease. Subjective assessment was performed in the form of a questionnaire for patients. The QuickDASH with a small specification for Dupuytren's contracture is the most commonly used questionnaire. The Southampton Dupuytren's Scoring Scheme questionnaire appears to be a higher specification. The classifications allow evaluation of treatment success to determine prognosis of the disease. The analysis of articles is based on PubMed search from the years 1967-2022, with 28 relevant articles were retrieved. Based on this analysis, the Tubiana classification appears to be the most appropriate one for patients with Dupuytren's contracture. Of patient questionnaires, the Southampton Dupuytren's Scoring Scheme meets these parameters.

Large-scale assessment of PFAS compounds in drinking water sources using machine learning.

The monitoring of Per and Polyfluoroalkyl substances (PFAS) in drinking water sources has significantly increased due to their recognition as a major public health concern. This information has been utilized to assess the importance of potential explanatory variables in determining the presence and concentration of PFAS in different regions. Nevertheless, the significance of these variables and the reliability of the methods in regions beyond where they were initially tested is still uncertain. Hence, our research pursues two main objectives: 1) to evaluate the validity of the aforementioned variables and methods for several PFAS species in a different area and 2) to build on existing modeling work; a new PFAS predictive model is introduced which is more reliable in determining the presence and concentration of PFAS at a regional level. To achieve these goals, we reconstructed four state-of-the-art models using a statewide dataset available for Michigan. These models involve spatial regression techniques, classification and regression random forest algorithms, and boosted regression trees. They also include numerous explanatory variables, such as features of local soil and hydrology and the number of nearby contamination sources. Then, we use a Bayesian selection approach to find the most relevant among these variables. Finally, we employ the most relevant covariates to assess PFAS occurrence and estimate their concentration using a novel combination of machine learning algorithms and conditional autoregressive (CAR) modeling. In the first case, PFAS occurrence was assessed with an accuracy comparable to the reconstructed models (>90%) while using significantly fewer variables. In the second case, by maintaining low data requirements, the estimated concentrations of most PFAS compounds were more closely aligned with available observations compared to previous methods, with correlation coefficients ρ > 0.90 and R2 > 0.77.

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan.

Aim: Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths. Methods: Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates. Results: Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = -2.45, P < 0.001). Conclusion: Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for their inequitable impact on local governments' financial solvency and service quality, but also for their negative consequences for population health and racial health equity. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

Assessment of the MAGIC recommendations in context of evolving evidence based on the use of PICC in ICU.

The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data.

Urban Neighborhood Characteristics and the Spatial Distribution of Home and Community-Based Service Organizations in Michigan Metropolitan Statistical Areas.

Living in a neighborhood with dense HCBS organizations can promote older adults' health and well-being and may mitigate health disparities generated by living in materially deprived urban neighborhoods. Using 2016 US County Business Patterns and the American Community Survey (2013-2017), focused on 516 ZIP Codes in Michigan Metropolitan Statistical Areas, this study examines the association between neighborhood characteristics and the relative density of businesses offering services for older adults and persons with disabilities (e.g., senior centers, adult day service centers, personal care) and businesses offering home health care. Results from a series of spatial econometric models show that social care organization density tends to be high in neighborhoods with a greater number of residents who have a bachelor's degree, who are older, and who are in poverty. Home health care density was not explained by neighborhood factors. Multiple neighborhood socio-demographic indicators explain the spatial distribution of social care organizations.

The Assessment of COVID-19 Knowledge and Attitudes Among a Middle Eastern North African Community in Dearborn, Michigan.

In 2020, COVID-19 was the third leading cause of death among individuals between the ages of 45-84 years (Woolf 325:123-124, 2021). However, systemic inequities and disparities exacerbated the pandemic's effect on racial and ethnic groups (Tai 72:703-706, 2021). The exact impact of the pandemic within the Middle Eastern North African (MENA) community is not well documented or understood due to the lack of federal recognition of MENAs as an ethnic group. Given the lack of COVID-19 research among this community, this study was created to address COVID-19 needs, perceptions, and health-seeking behaviors regarding COVID-19 precautions, mask wearing, and routine healthcare appointments. Between June and July 2020, an anonymous survey was distributed in English and Arabic using a Community Participatory Based Research design in Dearborn, Michigan. Overall, 298 individuals were surveyed and their misconceptions regarding COVID-19 infections, spread, and precautions were identified. It is important to note that about 75% of survey respondents identified as female, while only 24% of survey participants identified as male. Survey participants slightly underestimated the distance in which COVID-19 can be transmitted as 5.5 ± 3.5. Participants severely underestimated COVID-19 deaths in the US, with 23% estimating that under 250,000 individuals would die from COVID-19. Overall, 60% of participants reported that they did not have any difficulty adhering to COVID-19 precautions and self-quarantine rules during Ramadan, while this number dropped to only 36% (87/238) after Ramadan. The goal of this study was to serve as a tool to better understand the misconceptions, difficulties, and needs regarding COVID-19 among this understudied population. The MENA community may be particularly vulnerable to the economic, medical, and social changes brought about by the COVID-19 pandemic.

Understanding Health Facility Needs for Human Trafficking Response in Michigan.

OBJECTIVES: Human trafficking is a public health issue that has substantial health consequences. However, research on the preparedness of health facilities to serve people who have experienced or are experiencing human trafficking is limited. We examined health facility preparedness related to human trafficking in Michigan. METHODS: We used a cross-sectional design to explore health facility preparedness related to human trafficking in Michigan. We sampled 10 prosperity regions according to health facility type (Federally Qualified Health Centers, health departments, and hospitals). An email invitation was sent to identified health facility personnel (eg, administrators, physicians, nurses) from May to June 2019 with a link to a 26-item survey with items about current policies, protocols, and areas for improvement related to human trafficking. RESULTS: Forty-two Federally Qualified Health Centers, health departments, and hospitals responded to the survey. Most health facilities had screening policies and response protocols related to child maltreatment (screening: 32/41 [78.0%]; response: 38/40 [95.0%]) and intimate partner violence (screening: 33/41 [80.5%]; response: 37/40 [92.5%]). However, fewer facilities had a screening policy (16/41 [39.0%]) and response protocol (25/40 [62.5%]) for human trafficking; more of these facilities focused on sex trafficking than on labor trafficking. The top needs related to human trafficking were (1) individual-level health care provider training, (2) health facility-level screening policies and response protocols, (3) community-level resources, and (4) societal-level awareness, funding allocation, and data. CONCLUSIONS: Facility-level resources are needed to ensure that health care providers have adequate training and support to address human trafficking in the health care system.

Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan.

BACKGROUND: While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting. METHODS: This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software. RESULTS: Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight. CONCLUSIONS: Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.

Opioid deaths involving concurrent benzodiazepine use: Assessing risk factors through the analysis of prescription drug monitoring data and postmortem toxicology.

BACKGROUND: A high proportion of opioid drug deaths involve concurrent benzodiazepine use. To reduce the risk of drug overdose, various prescription drug monitoring programs have been implemented. This study examined the impact of concurrent benzodiazepine use on opioid-related deaths, and the utility of the Michigan Automated Prescription System (MAPS) in predicting risk of opioid death. METHODS: Wayne County Medical Examiner's Office cases from 2018 were examined in terms of MAPS data and MAPS-derived drug risk scores, as well as postmortem toxicology. Opioid death cases with concurrent benzodiazepine use were compared to non-drug deaths. RESULTS: For cases with a MAPS history for 6 months preceding death, the incidence of opioid prescriptions filled did not differ between groups. In contrast, significantly more opioid death cases had filled a benzodiazepine prescription; alprazolam prescription was the single best predictor of opioid drug death. Groups differed in MAPS-calculated drug risk scores, though these were less predictive of opioid death than some individual measures of prescription drug use. In terms of postmortem toxicology, fentanyl was the best discriminator between cohorts, with significant associations seen for morphine, benzodiazepine, or cocaine use. Similar results were obtained in the subset of subjects filling a prescription within a month of death, except that MAPS risk scores no longer predicted drug deaths. CONCLUSION: MAPS scores did not adequately predict risk of opioid-related death. Contrary to expectations, prescription opioid use was not correlated with opioid-related death, whereas concurrent use of opioids and benzodiazepines represented a highly significant risk factor.

Racial disparities in COVID-19 mortality across Michigan, United States.

BACKGROUND: Black populations in the United States are being disproportionately affected by the COVID-19 pandemic, but the increased mortality burden after accounting for health and other demographic characteristics is not well understood. We examined characteristics of individuals who died from COVID-19 in Michigan by race stratified by their age, sex and comorbidity prevalence to illustrate and understand this disparity in mortality risk. METHODS: We evaluate COVID-19 mortality in Michigan by demographic and health characteristics, using individual-level linked death certificate and surveillance data collected by the Michigan Department of Health and Human Services from March 16 to October 26, 2020. We identified differences in demographics and comorbidity prevalence across race among individuals who died from COVID-19 and calculated mortality rates by age, sex, race, and number of comorbidities. FINDINGS: Among the 6,065 COVID-19 related deaths in Michigan, Black individuals are experiencing 3·6 times the mortality rate of White individuals (p<0.001), with a mortality rate for Black individuals under 65 years without comorbidities that is 12·6 times that of their White counterparts (p<0.001). After accounting for age, race, sex, and number of comorbidities, we find that Black individuals in all strata are at higher risk of COVID-19 mortality than their White counterparts. INTERPRETATION: Our findings demonstrate that Black populations are disproportionately burdened by COVID-19 mortality, even after accounting for demographic and underlying health characteristics. We highlight how disparities across race, which result from systemic racism, are compounded in crises. FUNDING: ASP, AP and APG were funded by NSF Expeditions grant 1918784, NIH grant 1R01AI151176-01, NSF Rapid Response Research for COVID-19 grant RAPID-2027755, and the Notsew Orm Sands Foundation. MCF was supported by NIH grant K01AI141576.

An Intercategorical Ecology of Lead Exposure: Complex Environmental Health Vulnerabilities in the Flint Water Crisis.

In 2014, city and state officials channeled toxic water into Flint, Michigan and its unevenly distributed and corroding lead service lines (LSLs). The resulting Flint water crisis is a tragic example of environmental racism against a majority Black city and enduring racial and spatial disparities in environmental lead exposures in the United States. Important questions remain about how race intersected with other established environmental health vulnerabilities of gender and single-parent family structure to create unequal toxic exposures within Flint. We address this question with (1) an "intercategorical ecology" framework that extends the "racial ecology" lens into the complex spatial and demographic dimensions of environmental health vulnerabilities and (2) a multivariate analysis using block-level data from the 2010 U.S. decennial census and a key dataset estimating the LSL connections for 56,038 land parcels in Flint. We found that blocks exposed to LSLs had, on average, higher concentrations of single-parent white, Black, and Latinx families. However, logistic regression results indicate that the likelihood of block exposure to LSLs was most consistently and positively associated with the percentage of single-father Black and single-mother Latina families, net of other racialized and gendered single-parent family structures, socioeconomic status, and the spatial concentration of LSL exposure.

The initial experience and response of vascular surgeons in Michigan during the COVID-19 pandemic.

BACKGROUND/OBJECTIVE: The unprecedented pandemic spread of the novel coronavirus has severely impacted the delivery of healthcare services in the United States and around the world, and has exposed a variety of inefficiencies in healthcare infrastructure. Some states have been disproportionately affected such as New York and Michigan. In fact, Detroit and its surrounding areas have been named as the initial Midwest epicenter where over 106,000 cases have been confirmed in April 2020. METHOD, RESULTS AND CONCLUSIONS: Facilities in Southeast Michigan have served as the frontline of the pandemic in the Midwest and in order to cope with the surge, rapid, and in some cases, complete restructuring of care was mandatory to effect change and attempt to deal with the emerging crisis. We describe the initial experience and response of 4 large vascular surgery health systems in Michigan to COVID-19.

Lead Poisoning Prevention Efforts in High-Risk Environments: Follow-up Testing Rates among Preschool Children in Flint, Michigan, 2013-2015.

OBJECTIVES: Despite the importance of screening in efforts to address lead poisoning, many children in the United States have never been tested for lead, even when required to receive blood lead testing by state and federal healthcare policy. Fewer children gain access to follow-up or confirmatory testing when elevated blood lead levels are detected. METHODS: In response to previous research that illustrates the extent to which follow-up treatment services have been underutilized and poorly coordinated, this retrospective cohort study examines follow-up testing trends for lead poisoning among Medicaid-enrolled children 6 years and younger in Flint, Michigan, between 2013 and 2015. RESULTS: These findings illustrate that compliance with follow-up testing procedures was less than adequate during the period of study. CONCLUSION: As illustrated in this bivariate analysis, subpopulations in Flint most likely to have lead poisoning were least likely to receive follow-up testing. Evidence also demonstrates that the likelihood that children with lead poisoning received follow-up testing was overwhelmingly associated with their blood lead concentration level than other indicators including socioeconomic status in this high-risk environment.

Assessment of responsiveness of four hand-related scales in stroke patients.

Self-reporting scales are commonly utilized in determining appropriate treatment strategies and follow-up in hand-related disorders. Responsiveness is described as the ability of a scale to detect clinically significant changes. We aimed to evaluate responsiveness of Michigan Hand Outcomes Questionnaire (MHQ), Duruöz Hand Index (DHI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and ABILHAND questionnaire in stroke patients. Fifty-one stroke patients were assessed in this descriptive study. Participants received conventional stroke rehabilitation program consisting of 30 sessions. Brunnstrom stages of the stroke patients were recorded before and after treatment. MHQ, DHI, DASH, ABILHAND questionnaire and patient satisfaction scores were filled in by participants before and after the conventional rehabilitation program. Significant improvements were found in MHQ, DHI, DASH, ABILHAND, patient satisfaction scores and Brunnstrom motor recovery stages after the rehabilitation program (p < 0.001). Responsiveness values of the scales were calculated as MHQ (effect size (ES) = - 0.74; standardized response mean (SRM) = - 1.25), DHI (ES = 0.64; SRM = 1.22), DASH (ES = 0.71; SRM = 1.01), and ABILHAND (ES = - 0.55; SRM = - 1.22). Our study revealed that MHQ, DHI, DASH and ABILHAND are responsive scales in detecting treatment-related changes in stroke patients. MHQ, DHI, DASH and ABILHAND can be used in the evaluation of treatment responses in stroke patients.

"I Didn't Choose This. It Chose Me." Community-Based Environmental Justice Leaders.

On 13 February 2020, the University of Michigan School for Environment and Sustainability held the Michigan Environmental Justice Summit 2020: Commemorating the Thirtieth Anniversary of Michigan's 1990 Conference on Race and the Environment and Looking Toward the Future. The Summit hosted a dynamic panel of community environmental justice leaders throughout the region who have "boots on the ground" in the progress and pursuit of environmental justice. The panelists included Donele Wilkins, the President/CEO of the Green Door Initiative in Detroit, MI; Andrea Pierce, Chair and Founder of the Anishinaabek Caucus, Idle No More Michigan, MI; and Theresa Landrum, co-founder of the 48217 Community and Environmental Health Organization, Detroit, MI. This article includes an edited transcript of the panel discussion. The panelists detail multiple grassroots efforts to remedy environmental injustice in Michigan.

Thirty Years Working for Environmental Justice: Commemorating the 1990 Michigan Conference on Race and the Environment and Looking Toward the Future.

This article introduces two panel discussions that were held at the University of Michigan School for Environment and Sustainability's 2020 Michigan Environmental Justice Summit: Commemorating the Thirtieth Anniversary of Michigan's Conference on Race and the Environment and Looking Toward the Future. The authors provide an historical overview of how the 1990 Michigan Conference helped to shape the development and progression of the environmental justice movement.

Carcinogenic, ethanol, acetaldehyde and noncarcinogenic higher alcohols, esters, and methanol compounds found in traditional alcoholic beverages. A risk assessment approach.

Greek fermentation and distillation industries produce traditional spirit beverages, such as tsipouro and tsikoudia, consumed both in bottles and bulk quantities by the general population or tourists. The same spirits are also produced by individuals at home since previous centuries, as a part of the local culture but mainly due to the Greek agricultural sector unique characteristics (small cultivation areas with great number of farmers). In this study, the concentrations of carcinogenic compounds: ethanol and acetaldehyde; and noncarcinogenic: higher alcohols (1-propanol, isobutanol, and isoamyl alcohol), esters (ethyl acetate), and methanol were measured to estimate the potential cancer risk and daily intake of these compounds. The margin of exposure (MOE) of carcinogenic compounds was found to be less than 500 (mean value), well below the toxic threshold of 10,000, above which there is not public concern, as suggested by the European Food Safety Authority. Additionally, through risk assessment of noncarcinogenic compounds, we identified two specific compounds in-bulk spirits (produced by individuals), namely ethyl acetate and isobutanol, with health risk index (HRI) greater than 1 (indicating a possibility to induce side effects by consumption of high amounts). Our results indicate that bottled spirits, which are produced in a controlled environment (alcohol industries), showed higher human safety level in terms of both carcinogenic and noncarcinogenic risk assessment studies, comparing to bulk beverages produced by individuals (with out strict regulations).

Turkish version of the Michigan Neuropathy Screening Instrument in the assessment of diabetic peripheral neuropathy: a validity and reliability study.

BACKGROUND/AIM: Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus (DM). The Michigan Neuropathy Screening Instrument (MNSI) is a simple, brief, and useful screening tool that was designed to assess DPN. The aim of this study was to develop a Turkish version of the MNSI and assess its reliability and validity. MATERIALS AND METHODS: Eighty-three patients with DM who were divided into two groups according the results of nerve conduction studies (NCS) as having DPN or without DPN were enrolled in this cross-sectional study. The Toronto clinical scoring system, pain detect questionnaire, and NCS were assessed along with the MNSI. RESULTS: Each section of the MNSI was internally consistent (Cronbach's alpha > 0.70), and the scores of both sections were positively correlated with total MNSI score (r = 0.938; r = 0.908, respectively, p < 0.001). The test-retest reliability of the Turkish version of the MNSI was determined as 0.99 for the total score (intraclass correlation coefficient = 0.996). Using the agreement between MNSI scores and DPN diagnosis by NCS as a gold standard, receiver-operating characteristic (ROC) curve values for section A and section B were estimated as 0.973 and 1.00, respectively. When a cut-off value ≥ 3.0 in section A and a cut-off value ≥ 2.0 in section B were used, we obtained a sensitivity of 97.6% and 100%; a specificity of 63.4% and 97.6%; a positive predictive value of 72.7% and 97.6%; and a negative predictive value of 96.3% and 100%, respectively. CONCLUSION: The Turkish version of MNSI is a reliable and valid tool for screening DPN in Turkish patients.

A qualitative study on the impact of the 2016 US election on the health of immigrant families in Southeast Michigan.

BACKGROUND: Given the anti-immigrant rhetoric and policy proposals by President Donald Trump during the 2016 presidential campaign and afterwards, his election to president in November 2016 and subsequent policy changes has affected immigrant families. In this study, we aim to better understand how post-election policy change may have impacted the health and well-being, including health and social service utilization, of Latino immigrants in Southeastern Michigan. METHODS: We conducted 28 in-depth interviews with frontline staff at two Federally Qualified Health Centers and a non-profit agency. These staff had intimate knowledge of and insights into the lived experiences of the mixed-status immigrant families they serve. The interviews were audio recorded, transcribed, and analyzed thematically. RESULTS: Our findings show three major themes: (1) An increased and pervasive fear of deportation and family separation among mixed-status immigrant clients, (2) The fear of deportation and family separation has resulted in fractures in community cohesion, and (3) Fear of deportation and family separation has had an impact on the healthcare utilization and health-related behaviors of mixed-status families. Staff members report that these three factors have had an impact on physical and mental health of these immigrant clients. CONCLUSIONS: These results add to previous literature on the effect of immigration policies on the health and provide key insights for interventions to improve the health of immigrants within this socio-political environment.

Economic conditions during pregnancy and preterm birth: A maternal fixed-effects analysis.

BACKGROUND: Making causal inference regarding impacts of macrolevel economic conditions during pregnancy on pregnancy outcomes is hampered by the presence of unmeasured variables that may influence women's probability of giving birth under certain economic conditions (ie, exposure) as well as her pregnancy outcomes. Maternal fixed-effects (FE) analyses, in which the association between exposure and outcomes is estimated within mothers who had discordant outcomes, can control for such unmeasured variables when they are invariant across pregnancies. METHODS: We utilised a maternally linked data set of all singleton births in Michigan from 1990 to 2012 (n = 2 657 272 for full sample; n = 269 943 for FE analytic sample) to examine the relationship between state-level unemployment rates during pregnancy and preterm birth (PTB, <37 weeks' gestation). Measured maternal characteristics that change across pregnancies, for example, age, marital status, education, parity, and infant sex, were included as covariates in the model. RESULTS: Using an FE approach, we found that each one percentage point increase in state unemployment in the first trimester of pregnancy was associated with a modest 3% increase in odds of PTB. Our results were consistent with previously published results in a national sample and held across random- versus fixed-effect models, analytic samples, and outcome measures. CONCLUSIONS: Our findings provide further evidence that economic downturn during early pregnancy may be associated with modest increases in PTB.