African-American:White Disparity in Infant Mortality due to Congenital Heart Disease.

OBJECTIVE: To determine the importance of infant factors, maternal prenatal care use, and demographic characteristics in explaining the racial disparity in infant (age <365 days) mortality due to congenital heart defects (CHD). STUDY DESIGN: In this cross-sectional population-based study, stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files of term infants with non-Hispanic white (n = 3 684 569) and African-American (n = 782 452) US-born mothers. Infant mortality rate, including its neonatal (<28 day) and postneonatal (28-364 day) components, due to CHD was the outcome measured. RESULTS: The infant mortality rate due to CHD for African-American infants (296 deaths; 3.78 per 10 000 live births) exceeded that of white infants (1025 deaths; 2.78 per 10 000 live births) (relative risk [RR], 1.36; 95% CI, 1.20-1.55). The racial disparity was wider in the postneonatal period (2.08 per 10 000 vs 1.42 per 10 000; RR, 1.53; 95% CI, 1.29-1.83) compared with the neonatal period (1.70 per 10 000 vs 1.44 per 10 000; RR, 1.20; 95% CI, 0.99-1.45). Compared with white mothers, African-American mothers had a higher percentage of high-risk characteristics. In multivariable logistic regression models, the adjusted OR of postneonatal and neonatal mortality due to CHD for African-American mothers compared with white mothers was 1.20 (95% CI, 0.98-1.48) and 0.95 (95% CI, 0.77-1.19), respectively. CONCLUSION: The racial disparity in infant mortality rate due to CHD among term infants with US-born mothers is driven predominately by the postneonatal survival disadvantage of African-American infants. Commonly cited individual-level risk factors partly explain this phenomenon. The study is limited by the lack of information on neighborhood factors.

Solitary Participation in the "Choking Game" in Oregon.

OBJECTIVE: The purpose of this study was to compare characteristics of youth who participate in the choking game alone versus those who participate in a group. METHODS: Lifetime prevalence estimates were obtained from the 2011 (n = 5682) and 2013 (n = 15 150) Oregon Healthy Teens survey. The 2011 and 2013 data sets were merged (N = 20 832) to compare youth who participate alone versus those who participate in a group in the choking game. Multivariate modeling was conducted to examine individual characteristics of young people who engaged in the choking game alone versus those who engaged in the game in a group. RESULTS: In 2011, 3.8% of eighth-grade participants reported a lifetime prevalence of choking game participation; 3.7% reported lifetime prevalence of participation in 2013. In the merged 2011/2013 data set, 17.6% (n = 93) of choking game participants indicated that they had participated alone. Compared with those who reported participating in a group, youth who participated alone had significantly higher rates of suicide contemplation (odds ratio: 4.58; P < .001) and poor mental health (odds ratio: 2.13; P < .05). CONCLUSIONS: Youth who participate alone in the choking game are a particularly high risk group, exhibiting substantially higher rates of suicidal ideation and poorer mental health compared with youth who participate in the choking game in a group. Adolescent health care providers should be aware of these associations, assess whether prevention messaging is appropriate, and be prepared to explain the high risks of morbidity and mortality associated with participation.