Grade-Level Differences in the Profiles of Substance Use and Behavioral Health Problems: A Multi-Group Latent Class Analysis.

We investigated associations between polysubstance use and behavioral problems among adolescents. Because substance use becomes more developmentally normative with age, we examined whether polysubstance use was less likely to co-occur with behavioral problems among older (vs. younger) adolescents. Using data from a nationally representative survey of US high school students, we compared the association between polysubstance use (i.e., use of alcohol, cannabis, tobacco/nicotine, and illicit drugs) and behavioral problems (i.e., suicide attempts, depressive symptoms, poor school performance, and sexual risk behaviors) by grade level. We conducted latent class analysis (LCA) to characterize patterns of polysubstance use, and multi-group LCA to estimate invariance by grade. Among the three latent classes that emerged, classes were distinguished by having low, moderate, and high probabilities for behavior problems and use of substances. Class I comprised 52% of the sample, whereas classes II and III comprised 35% and 12% of the sample, respectively. The multi-group LCA showed that younger adolescents had a higher relative probability of co-occurring problem behaviors and polysubstance use. Findings may be helpful in targeting screening and prevention efforts of high school students by grade. Specifically, our results provide evidence that associations between behavioral problems and alcohol/drug use are weaker in later high school grades, suggesting that substance use may not be a weaker marker of behavioral problems for students in higher grades.

Black Father's Influence on Adverse Pregnancy Outcomes in the United States: A Narrative Synthesis of Literature.

Few studies have investigated paternal characteristics in relationship with adverse pregnancy outcomes, and results are inconsistent. The purpose of this study was to review studies examining associations between characteristics of Black fathers and adverse pregnancy outcomes in the United States. A systematic narrative synthesis was conducted of research studies examining paternal characteristics of Black fathers in association with adverse pregnancy outcomes: preterm birth, hypertensive disorders of pregnancy, gestational diabetes, spontaneous abortion, and maternal mortality. Seven databases (Academic Search Premier, CINHAL, CENTRAL, ClinicalTrials.gov, Embase, PubMed, and Web of Science) were searched for original research articles from inception to February 2023. Articles were excluded if they (a) were in a language other than English, (b) did not describe original research, (c) included a geographic region outside of the United States, (d) did not include adverse maternal outcomes as a study outcome, (e) did not describe race of fathers in the study sample, and (f) did not describe a paternal characteristic of Black fathers. The search resulted in 210 articles. Six studies were included in the final review; five studies examined associations between paternal characteristics of Black fathers and preterm birth, finding significantly increased odds of preterm birth among births with Black fathers. Among births with non-Hispanic Black paternity, the odds of hypertensive disorders of pregnancy were reduced or not significantly associated. Researchers should continue to explore paternal factors that influence pregnancy outcomes in racial/ethnic-specific models to identify optimal intervention strategies to improve disparities in maternal and child health outcomes.

Apolipoprotein E and Alzheimer's disease pathology in African American older adults.

The apolipoprotein-E4 (APOE*4) and apolipoprotein-E2 (APOE*2) alleles are more common in African American versus non-Hispanic white populations, but relationships of both alleles with Alzheimer's disease (AD) pathology among African American individuals are unclear. We measured APOE allele and ß-amyloid (Aß) and tau using blood samples and positron emission tomography (PET) images, respectively. Individual regression models tested associations of each APOE allele with Aß or tau PET overall, stratified by racialized group, and with a racialized group interaction. We included 358 older adults (42% African American) with Aß PET, 134 (29% African American) of whom had tau PET. APOE*4 was associated with higher Aß in non-Hispanic white (P < 0.0001), but not African American (P = 0.64) participants; racialized group modified the association between APOE*4 and Aß (P < 0.0001). There were no other racialized group differences. These results suggest that the association of APOE*4 and Aß differs between African American and non-Hispanic white populations. Other drivers of AD pathology in African American populations should be identified as potential therapeutic targets.

Implementing Comprehensive Sex and Sexuality Education in Kindergarten-Grade 12 Schools: Guiding Practices and Examples.

BACKGROUND: Comprehensive sex and sexuality education (CSE) is an evidence-based intervention associated with improved sexual and reproductive health outcomes. Currently, there are no standardized requirements for sex and sexuality education in the United States, despite expert recommendations. CONTRIBUTIONS TO THEORY: In the United States, a Whole School, Whole Community, Whole Child theoretical model proposed by the Centers for Disease Control, and current examples of school sex education policy is used to make recommendations for the standardization of comprehensive sexual health education in K-12 schools. This article describes the necessary components to adopt CSE equitably, and provides an example of the process implemented to improve CSE in 1 school district in Pittsburgh, PA. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Understanding the key components of legislation that align with recommended standards, and the process of advocating for school policy change, allows local advocacy groups and education policymakers to create and pass feasible legislation that will ensure appropriate instruction. There is additional room for improvement in states and local districts that have current CSE legislation, to adopt approaches grounded in frameworks that critically evaluate social determinants of health and amend legislation to further improve health equity. CONCLUSIONS: Several states and local districts have passed CSE regulations, and are implementing and evaluating their efficacy, providing support and examples for other regions interested in adopting similar policies and processes. Pittsburgh Public Schools can be used as an example adapting current legislation and adopting more comprehensive language.

Fetal Sexual Dimorphism and Preeclampsia Among Twin Pregnancies.

BACKGROUND: In singleton pregnancies, fetal sexual dimorphism has been observed in hypertensive disorders of pregnancy, particularly preeclampsia, a morbid syndrome that increases the risk of adult-onset cardiovascular disease for mothers and their offspring. However, few studies have explored the effect of fetal sex on hypertensive disorders of pregnancy among twin pregnancies. METHODS: We conducted a retrospective cohort study of 1032 twin pregnancies between 2011 and 2022 using data from a perinatal database that recruits participants from 3 hospitals in Houston, TX. We categorized pregnancies based on fetal sex pairings into female/female, male/male, and female/male. Pregnancies with female/female pairs were used as our reference group. Our primary outcomes included gestational hypertension, preeclampsia, superimposed preeclampsia, and preeclampsia subtyped by gestational age of delivery. A modified Poisson regression model with robust error variance was used to calculate the relative risk and 95% CI for the association between fetal sex pairs and hypertensive disorders of pregnancy. RESULTS: Adjusted models of female/male pairs were associated with preterm preeclampsia (relative risk, 2.01 [95% CI, 1.15-3.53]) relative to those with female/female pairs. No associations with other hypertensive disorders of pregnancy were observed among pregnancies with male/male pairs compared with those with female/female fetal sex pairs. CONCLUSIONS: We found some evidence of sexual dimorphism for preterm preeclampsia among female/male twin pairs. Additional research is needed to understand what biological mechanisms could explain these findings.

Young black women's desired pregnancy and birthing support during coronavirus disease 2019 pandemic.

Objective: To document pregnancy and birthing experiences of young, Black pregnant women in one geographic area to make recommendations for improving young Black women's pregnancy and birthing experiences. Methods: Participants were recruited through The YoungMoms Study (R01 DA04640101A1) in Pittsburgh, Pennsylvania, and included Black or biracial participants ages 16-23 (n = 25). Individual interviews were conducted from March 2022-July 2022 to assess pre-, peri-, and post-natal healthcare system encounters; experiences of structural and obstetric racism and discrimination in healthcare settings while obtaining prenatal care; attitudes around healthcare systems and medical professionals; effects of COVID-19 pandemic on participants lives and the impact of enacted healthcare policies in their perinatal experience; substance use changes during pregnancy; and coping mechanisms for stress. NVivo 13 was used to code transcripts, then major themes and subthemes were identified using thematic content analysis and based on grounded theory. Results: Twenty-five interviews were conducted, and four themes emerged from participant experiences of racial discrimination in healthcare settings; (1) awareness of historical racism that influences perinatal care; (2) clinical providers assume participant substance use and enact reproductive coercion; (3) clinical providers question validity of Black women's birthing complaint; and (4) Young Black pregnant women know and will express what they desire in their perinatal experience if asked. Conclusions: Young Black pregnant women encounter structural racism and intersectional bias from healthcare providers. By centering the perspectives and experiences of this overlooked population, public health researchers and clinical providers can utilize anti-racist frameworks to create more equitable, just practices in reproductive healthcare.

Fetal sexual dimorphism and preeclampsia among twin pregnancies.

Background: In singleton pregnancies, fetal sexual dimorphism has been observed in hypertensive disorders of pregnancy (HDP), particularly preeclampsia, a morbid syndrome that increases risk of adult onset cardiovascular disease for mothers and their offspring. However, few studies have explored the effect of fetal sex on HDP among twin pregnancies. Methods: We conducted a retrospective cohort study of 1,032 twin pregnancies between 2011 - 2022 using data from a perinatal database that recruits participants from three hospitals in Houston, TX. We categorized pregnancies based on fetal sex pairings into female/female, male/male, and female/male. Pregnancies with a female/female fetal sex were used as our reference group. Our primary outcomes included gestational hypertension, preeclampsia, superimposed preeclampsia, and preeclampsia subtyped by gestational age of delivery. A modified Poisson regression model with robust error variance was used to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between fetal sex pairs and HDP. Results: Adjusted models of female/male fetal sex pairs were associated with preterm preeclampsia (RR 2.01, 95% CI 1.15-3.53) relative to those with female/female fetuses. No associations with other HDP were observed among pregnancies with male/male fetal sex compared to those with female/female fetal sex pairs. Conclusions: We found some evidence of sexual dimorphism for preterm preeclampsia among female/male twin pairs. Additional research is needed to understand what biological mechanisms could explain these findings.

Pandemic stressors and vaccine hesitancy among young, pregnant Black people: A qualitative study of health disparities during a global pandemic.

BACKGROUND: The novel coronavirus 2019 (COVID-19) pandemic exacerbated existing health inequities in the United States, but no studies have focused on the lived experiences of younger Black birthing people. The goal of this qualitative study was to center the experiences of younger pregnant and birthing Black and Biracial people during the pandemic. METHODS: We recruited 25 Black and Biracial pregnant and birthing people ages 16-23 for individual semi-structured interviews. Participants were asked about experiences with the healthcare system during the pandemic, and interviews were transcribed verbatim and coded for qualitative analysis using nVivo. We adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Participants identified pandemic-related stressors such as fears about infection, lack of support, and pressure to get vaccinated. Reasons for vaccine hesitancy included mistrust in the government and racism experienced during reproductive healthcare. Provider appeals highlighting patient autonomy and science were more effective in encouraging vaccine uptake than emotional appeals that made participants feel guilty about potentially infecting loved ones. CONCLUSIONS: Restrictions on children and support people created barriers to timely prenatal care and reduced tangible support for young Black and Biracial birthing people during the pandemic. Their vaccine hesitancy was related to mistrust, concerns that the vaccines had not been tested enough prior to roll-out, and possible side effects of the vaccine including infection with the virus and pregnancy loss. Obstetric providers need to understand and recognize the ongoing impact of obstetric and scientific racism on health communication with younger Black and Biracial patients.

Experiences of postpartum mental health sequelae among black and biracial women during the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to qualitatively examine coping mechanisms and desired supports in pregnant and birthing Black and Biracial adolescent and young adult women during the COVID-19 pandemic. METHODS: Black and Biracial participants ages 16-23 were recruited for virtual individual semi-structured interviews. Participants (n = 25) were asked about pre- and post-natal experiences with the healthcare system, effects of the pandemic, and participants' experiences of or desires for ideal care within the healthcare system. Interviews were transcribed verbatim and coded for qualitative analysis using nVivo. Discussions around postpartum mental health evolved organically when asked about how participants were coping postpartum. RESULTS: Nearly half the interviewees organically reported mental health symptoms consistent with postpartum depression (PPD) during questions regarding their postpartum experience. Of the 11 interviewees who reported mental health symptoms consistent with PPD, 2 were afraid to disclose their symptoms to a healthcare provider due to fear of child protective services involvement and their belief they would be treated unfairly because of their race. CONCLUSION: Clinicians who care for Black and Biracial adolescent and young adult mothers must be particularly attuned to structural barriers for appropriate screening and treatment of postpartum depression. Expanding investigations of intersectional influences on young mothers' perinatal health and PPD are needed.

Correlates of COVID-19 Vaccine Uptake in Black Adults Residing in Allegheny County, PA.

Introduction: Efforts to address vaccine uptake and access among black adults will be relevant for continued coronavirus disease 2019 (COVID-19) eradication efforts and can be transferable to other prevention efforts in future pandemics. This study investigated factors related to COVID-19 vaccine uptake and access among black residents in Allegheny County, PA. Methods: Surveys were administered electronically from October 2021 to January 2022 to black Allegheny County residents aged 18 and older. Questions included thoughts on COVID mitigation strategies (e.g., masking, social distancing), vaccination status, intention to vaccinate children, trust of COVID-19 information sources and vaccines, family needs, access to support services, and social media use to access information. Descriptive statistics and significant correlates of being vaccinated using adjusted logistic regression models are reported. Results: Of the overall sample (N=397), the majority were fully vaccinated (n=306, 77%). Fully vaccinated participants were more likely to be female (62.5%, p=0.010), age 60 years or older (34.3%, p=0.0002), have some college education (23.2%, p<0.0001), and be employed full time (50.0%, p=0.0001) compared with nonvaccinated individuals. Among the unvaccinated participants (n=91), the primary reason was fear of illness (8.9%), long-term effects (6.5%), mistrust in the vaccine (6.3%), and needing more information (4.5%). Vaccine-hesitant participants were more likely to be unvaccinated (adjusted odds ratio=2.3, 95% confidence interval 1.25-4.14) after adjusting for age, education, employment, insurance, health status, and income. Conclusion: Vaccine hesitancy may be improved by directly addressing fear of illness resulting from vaccines and improving clarity in the vaccine development and approval process to improve uptake among black adults.