Family-Centered Care and Delayed or Missed Pediatric Preventive Care due to the COVID-19 Pandemic.

OBJECTIVE: To examine the association between family-centered care and its components with delayed or missed preventive care due to the COVID-9 pandemic among US children. METHODS: This is a cross-sectional study using nationally representative data from the 2021 National Survey of Children's Health (NSCH). Children were eligible if they received health care services in the past 12 months (n = 42,649; 79.3%). We excluded children with missing data, for a final sample of 40,511 (93.7% of the eligible sample). Children were deemed to have received family-centered care if caregivers responded "always" or "usually" to all five measures of family-centered care. Poisson regression was used to ascertain weighted prevalence ratios (PRs) and 95% confidence intervals (CIs). Predisposing, enabling, and need factors of health care services use were evaluated as potential confounders. RESULTS: Approximately 86.7% of children received family-centered care during the pandemic, with significant racial and ethnic differences, findings consistent with pre-pandemic data. In multivariable analyses adjusted for the child's race and age, family-centered care was associated with a 30% reduced likelihood of delayed or missed preventive care (95% CI: 0.64-0.78). Individual components of family-centered care were associated with a 26%-43% reduced likelihood of delayed or missed preventive care. CONCLUSIONS: Family-centered care and its components were associated with a reduced likelihood of delayed or missed pediatric preventive care. Our findings highlight the important role of health care providers in curbing the negative effects of the COVID-19 pandemic on pediatric preventive care utilization and emphasize the need to expand family-centered care among racial and ethnic minority groups.

Factors associated with unmet pediatric health care needs during the coronavirus pandemic.

PURPOSE: To examine risk factors for unmet pediatric health care needs during the coronavirus pandemic in a national sample of US children under 17 years of age. DESIGN AND METHODS: In this cross-sectional study, we used data from the 2021 National Survey of Children's Health (n = 50,892). Unmet pediatric health care needs were assessed as follows: "during the past 12 months, was there any time when this child needed health care but it was not received?". Logistic regression with multiple imputations was used to evaluate bivariate and multivariable associations between predisposing, enabling, and need factors of health care services use and unmet pediatric health care needs. RESULTS: Approximately 3.6% of children had unmet health care needs, with significant differences by sample characteristics. Unmet health care needs were notably prevalent among select groups, including children with difficulty covering basic needs (10.6%) and those with ≥2 health conditions (8.9%). In multivariable analyses, factors associated with unmet pediatric health care needs included predisposing factors such as older age, ≥2 children with special health care needs in the household, primary language other than English or Spanish, and poor caregiver health; enabling factors such as difficulty covering basic needs, no insurance, and no personal doctor or nurse; and need factors such as poor perceived or evaluated child health. Reasons for unmet needs included financial, nonfinancial, and accessibility barriers. CONCLUSIONS: Several factors were associated with unmet health care needs. PRACTICE IMPLICATIONS: We identified children who would benefit from targeted interventions aimed at promoting health care services use.

Racial and Ethnic Differences in Factors Associated With Delayed or Missed Pediatric Preventive Care in the US Due to the COVID-19 Pandemic.

Importance: The COVID-19 pandemic has disrupted medical care use. Yet information on how the pandemic has affected pediatric preventive care use in the US is lacking. Objective: To examine the prevalence of and risk and protective factors for delayed or missed pediatric preventive care in the US due to the COVID-19 pandemic, further stratified by race and ethnicity to assess associations by groups. Design, Setting, and Participants: This cross-sectional study used data from the 2021 National Survey of Children's Health (NSCH) collected between June 25, 2021, and January 14, 2022. Weighted data from the NSCH survey are representative of the population of noninstitutionalized children aged 0 to 17 years in the US. For this study, race and ethnicity were reported as American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, or multiracial (≥2 races). Data analysis was performed on February 21, 2023. Exposures: The Andersen behavioral model of health services use was used to assess predisposing factors, enabling factors, and need factors. Main Outcomes and Measures: The main outcome was delayed or missed pediatric preventive care due to the COVID-19 pandemic. Bivariate and multivariable Poisson regression analyses were performed using multiple imputation with chained equations. Results: Of the 50 892 NSCH respondents, 48.9% were female and 51.1% were male; their mean (SD) age was 8.5 (5.3) years. With regard to race and ethnicity, 0.4% were American Indian or Alaska Native, 4.7% were Asian or Pacific Islander, 13.3% were Black, 25.8% were Hispanic, 50.1% were White, and 5.8% were multiracial. More than one-fourth of children (27.6%) delayed or missed preventive care. In multivariable Poisson regression using multiple imputation, Asian or Pacific Islander children (prevalence ratio [PR], 1.16 [95% CI, 1.02-1.32]), Hispanic children (PR, 1.19 [95% CI, 1.09-1.31]), and multiracial children (PR, 1.23 [95% CI, 1.11-1.37]) were more likely to have delayed or missed preventive care compared with non-Hispanic White children. Among non-Hispanic Black children, risk and protective factors included age 6 to 8 years (vs 0-2 years [PR, 1.90 (95% CI, 1.23-2.92)]) and difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.68 (95% CI, 1.35-2.09)]). Among multiracial children, risk and protective factors included age 9 to 11 years (vs 0-2 years [PR, 1.73 (95% CI, 1.16-2.57)]), lower household income (<100% vs ≥400% federal poverty level: 0.52 [0.35-0.79]), and 2 or more vs 0 health conditions (PR, 1.54 [95% CI, 1.14-2.08]). Among non-Hispanic White children, risk and protective factors included older age (9-11 years vs 0-2 years [PR, 2.05 (95% CI, 1.78-2.37)]), 4 or more children vs 1 child in the household (PR, 1.22 [95% CI, 1.07-1.39]), fair or poor vs excellent or very good caregiver health (PR, 1.32 [95% CI, 1.18-1.47]), difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.36 (95% CI, 1.22-1.52)]), good vs excellent or very good perceived child health (PR, 1.19 [95% CI, 1.06-1.34]), and 2 or more vs 0 health conditions (PR, 1.25 [95% CI, 1.12-1.38]). Conclusions and Relevance: In this study, the prevalence of and risk factors for delayed or missed pediatric preventive care varied by race and ethnicity. These findings may guide targeted interventions to enhance timely pediatric preventive care among different racial and ethnic groups.

Maternal Malnutrition During Pregnancy Among Women with Metabolic and Bariatric Surgery.

INTRODUCTION: As the utilization of metabolic and bariatric surgery (MBS) continues to rise, it is important to address the nutritional needs of women who had MBS who become pregnant. Not meeting those nutritional needs could lead to complications associated with malnutrition. To better understand the relationship between MBS, pregnancy, and malnutrition, this study sought to determine whether differences exist in the presence of malnutrition during pregnancy in women with a history of MBS compared to women without a history of MBS. METHODS: This cross-sectional study used the National Inpatient Sample (NIS) from 2012 to 2017, which samples 20% of hospital discharges in the USA. Multivariate logistic regression models were fitted, and odds rations and 95% confidence intervals were calculated with obesity and MBS as the independent variables and malnutrition during pregnancy as the dependent variable. Covariates included in the multivariate model were age, primary payer, hypertension, hyperlipidemia, and depression. RESULTS: Compared to women who did not have MBS, women who had MBS had higher odds of malnutrition during pregnancy (aOR = 8.33, 95% CI 7.30-9.50), this result was moderated by racial category (aORBlack = 6.35, 95% CI 4.97-8.13; aORwhite = 8.25, 95% CI 7.00-9.73; aORLatina = 10.93, 95% CI 8.38-14.25). Women with obesity also had higher odds of malnutrition during pregnancy. CONCLUSIONS: The increased odds of malnutrition among women with MBS suggests that it is important to consider tailoring nutrition recommendations to address the different nutritional needs of pregnant women who had MBS and may be at risk for malnutrition.

Stroke-related risk factors during pregnancy in women who underwent metabolic and bariatric surgery compared with women who have not undergone metabolic and bariatric surgery.

BACKGROUND: Stroke during pregnancy is rare, occurring in 30 of 100,000 pregnancies and accounting for 7% of maternal deaths in the United States from 2016 to 2018. Metabolic and bariatric surgery (MBS) has been shown to reduce symptoms of chronic conditions that are risk factors for stroke, including hypertension, hypercholesterolemia, and diabetes in women. However, little is known about the impact of MBS on stroke risk during pregnancy. OBJECTIVES: To examine stroke and stroke risk factors including preeclampsia, eclampsia, gestational hypertension, and embolism/thrombosis in women of reproductive age who have had MBS. SETTING: We used the National Inpatient Sample, a publicly available data set from the Healthcare Cost and Utilization Project that samples 20% of hospital discharges in the United States. METHODS: This cross-sectional study included women between the ages of 20 and 44 years who had a maternal admission code. Weighted logistic regression was conducted to assess the odds of stroke and stroke risk factors in women with a history of MBS compared with other women of reproductive age. RESULTS: Women with a history of MBS have 12% lower adjusted odds of developing preeclampsia/eclampsia and 10% lower adjusted odds of gestational hypertension than women who did not undergo MBS. When stratified by race, the difference was significant in White women (preeclampsia/eclampsia: adjusted odds ratio [aOR] = .89; 95% confidence interval [CI], .81-.98; gestational hypertension: aOR = .91; 95% CI, .83-1.00). Latinas with MBS had significantly lower odds of preeclampsia/eclampsia (aOR = .75; 95% CI, .64-.90). CONCLUSIONS: MBS helps women lose weight and decrease the incidence of some pregnancy-related risk factors for stroke. However, there is a notable racial health disparity.

Men's Preconception Health and Fertility Intentions: A Latent Class Analysis Approach.

Men's pregnancy intention is associated with a host of positive outcomes for families, yet this topic remains understudied. Because unintended pregnancies are more likely to occur at suboptimal parental health, this study aimed to examine the extent to which men improve their preconception health in the context of future fertility planning. This study used pooled data from the 2011-2019 National Survey of Family Growth for a final sample size of 10,223. Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight preconception health risk factors were used to determine class membership. A classify-analyze approach was used to create the preconception health phenotype (PhP) exposure variable. The outcome of interest was men's fertility intentions. Multinomial regression models were used to examine the association between the exposure and the outcome. Three unique PhPs were identified (lowest risk, substance users, and sexual risk-takers) from the LCA model. Men in the substance users' group (22.9%) were characterized by high-risk alcohol use and drug use, while sexual risk-takers (8.1%) were characterized by having multiple sexual partners. Belonging in the phenotypes of substance users or sexual risk-takers was associated with increased odds for definite no fertility intention than definite yes intentions (adjusted odds ratio [aOR]: 1.47, 95% confidence interval [CI]: [1.18, 1.84] and aOR: 1.51, 95% CI: [1.13, 2.01], respectively). Results provide new insights on how preconception health can be measured and fills a knowledge gap on its relationship to men's future fertility planning. Findings can be applied to preconception care intervention frameworks, and guide family planning interventions and contraceptive counseling.

Men's preconception health and the social determinants of health: What are we missing?

Background: Life course perspectives suggest that optimizing men's health before conception is requisite to equitably improve population health, an area of increasing public health focus. Although scholarship on the social determinants of health (SDOH) suggests that men's health and health behaviors do not occur in a vacuum, preconception health studies have not explicitly examined how these factors influence men's preconception health. Objective: To identify latent classes of men's preconception health and the role of the SDOHs in predicting class membership. Methods: Pooled data from the 2011-2019 male file of the National Survey of Family Growth were analyzed (n = 10,223). Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight manifest variables were used to fit latent class models. A classify-analyze approach was subsequently used to create a preconception health phenotype (PhP) outcome variable. SDOHs (exposure variable) were assessed in four domains (rural/urban residence, health access, socioeconomic status, and minority/immigrant status) to predict class membership. Survey-weighted multinomial regression models were fitted to examine the association between the exposure and the outcome. Results: Three unique PhPs were identified (lowest risk (69%), substance users (22.9%), and sexual risk-takers (8.1%) from the LCA model. Health access, socioeconomic status, and minority/immigrant status were significant predictors of class membership but not rural/urban residence. Sexual risk takers were more likely to be uninsured (aOR: 1.25, 95% CI 1.02, 1.52), college-educated (aOR: 1.94 95% CI: 1.34, 2.79), and non-Hispanic Black (aOR: 1.99 95% CI: 1.55, 2.54) while substance users were more likely to have unstable employment (aOR: 1.23 95% CI:1.04, 1.45) and have a high school degree or higher (aOR 1.48 95% CI: 1.15, 1.90) than men in the lowest risk category. Conclusion: Social determinants may impact men's preconception health in ways that are not conventionally understood. These findings raise important questions about how preconception health interventions should be created, tailored, and/or retooled. Specifically, studies that examine the sociocultural and political contexts underpinning the relationship between social class, masculinity, and men's preconception health are needed to provide nuanced insights on factors that shape these outcomes.

Refreshing the Perinatal Periods of Risk: A New Reference Group and Nationwide Large-County-Level Analyses.

INTRODUCTION: The Perinatal Periods of Risk approach (PPOR) is designed for use by communities to assess and address the causes of high fetal-infant mortality rates using vital records data. The approach is widely used by local health departments and their community and academic partners to inform and motivate systems changes. PPOR was developed and tested in communities based on data years from 1995 to 2002. Unfortunately, a national reference group has not been published since then, primarily due to fetal death data quality limitations. METHODS: This paper assesses data quality and creates a set of unbiased national reference groups using 2014-2016 national vital records data. Phase 1 and Phase 2 analytic methods were used to divide excess mortality into six components and create percentile plots to summarize the distribution of 100 large US counties for each component. RESULTS: Eight states with poor fetal death data quality were omitted from the reference groups to reduce bias due to missing maternal demographic information. There are large Black-White disparities among reference groups with the same age and education restrictions, and these vary by component. PPOR results vary by region, maternal demographics, and county. The magnitude of excess mortality components varies widely across US counties. DISCUSSION: New national reference groups will allow more communities to do PPOR. Percentile plots of 100 large US counties provide an additional benchmark for new communities using PPOR and help emphasize problem areas and potential solutions.

Non-linear Relationship of Maternal Age With Risk of Spontaneous Abortion: A Case-Control Study in the China Birth Cohort.

Background: Spontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world. Objective: The current study is aimed to evaluate the association between maternal age and risk for spontaneous abortion among pregnant women in China. Methods: This was a case-control study based on the China Birth Cohort, we compared 338 cases ending in spontaneous abortion with 1,352 controls resulting in normal live births. The main exposure indicator and outcome indicator were maternal age and spontaneous abortion, respectively. We used both a generalized additive model and a two-piece-wise linear model to determine the association. We further performed stratified analyses to test the robustness of the association between maternal age and spontaneous abortion in different subgroups. Results: We observed a J-shaped relationship between maternal age and spontaneous abortion risk, after adjusting for multiple covariates. Further, we found that the optimal threshold age was 29.68 years old. The adjusted odds ratio (95% confidence interval) of spontaneous abortion per 1 year increase in maternal age were 0.97 (0.90-1.06) on the left side of the turning point and 1.25 (1.28-1.31) on the right side. Additionally, none of the covariates studied modified the association between maternal age and spontaneous abortion (P > 0.05). Conclusions: Advanced maternal age (>30 years old) was significantly associated with increased prevalence of spontaneous abortion, supporting a J-shaped association between maternal age and spontaneous abortion.

Association of types of diabetes and insulin dependency on birth outcomes.

BACKGROUND: Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes. AIM: To investigate differences in birth outcomes (preterm birth, macrosomia, and neonatal death) by diabetes status. METHODS: Cross-sectional design, using linked Missouri birth and death certificates (singleton births only), 2010 to 2012 (n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and infant mortality. Confounders included demographic characteristics, adequacy of prenatal care, body mass index, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status. RESULTS: Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87, aOR 1.77, and aOR 1.73, respectively) and having a very large baby [macrosomia] (aOR 3.01, aOR 2.12, and aOR 1.96, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women. CONCLUSION: Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Pregnancy Complications in Women with Weight Loss Surgery Compared to a Non-Surgical Population of Women with Obesity.

BACKGROUND: The objective of this study was to assess the effect of WLS on pregnancy and delivery complications in women who had WLS compared to women with obesity who did not undergo WLS. METHODS: We used the National Inpatient Sample data from 2012 to 2017, with a study population of women between the ages of 20 and 44 who had a maternal admission code in the NIS data (n = 663,795). Weighted logistic regression models were fitted and the models were stratified by race. Covariates included age, race, primary payer, previous cesarean delivery, physical health comorbidities, and depression. RESULTS: There were decreased odds of gestational diabetes in women of all races (aORall = 0.47, 95% CIall = 0.44-0.49). There were decreased odds for gestational hypertension in women of all races (aORall = 0.55, 95% CIall = 0.51-0.59). Compared to women who did not have WLS, there were lower odds of cesarean delivery among women with a history of WLS (aORall = 0.62, 95% CIall = 0.60-0.65), which was true for White women, Black women, and Latinas with a history of WLS (aORWhite = 0.57, 95% CIWhite = 0.53-0.60; aORBlack = 0.67, 95% CIBlack = 0.61-0.74; aORLatina = 0.71, 95% CILatina = 0.64-0.78). CONCLUSIONS: Overall, women with history of WLS had lower odds of most of the pregnancy outcomes (gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia, and cesarean delivery) with results mediated by race.

Association between maternal outdoor physical exercise and the risk of preterm birth: a case-control study in Wuhan, China.

BACKGROUND: China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China. METHODS: A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM). RESULTS: Compared to women not involved in any physical activity, those who participated in physical exercise 1-2 times, 3-4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval [95% CI]: 0.68-0.92), 30% (aOR: 0.70, 95% CI: 0.60-0.82), and 32% (aOR: 0.68, 95% CI: 0.59-0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day. CONCLUSION: Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.

Neighborhood built and social environment and meeting physical activity recommendations among mid to older adults with joint pain.

Arthritis is a leading cause of disability in the United States, with the most efficacious treatments being physical activity (PA). Arthritis patients are less likely to meet PA recommendations and the neighborhood environment may play a role. This study examines the effect of neighborhood walkability and social cohesion on PA among arthritis patients in a sample of US adults. This cross-sectional study used 2015 National Health Interview Survey data. Eligible participants were age ≥45 years, had arthritis, recent leg-joint pain and complete data. Walkability was based on 6 questions regarding amenities and destinations that promote walking. Social cohesion was based on 4 validated questions. Meeting PA was defined as 150 min/week. Chi-squared testing and logistic regression determined associations between neighborhood environment and PA, including interaction between social cohesion and walkability. The final unweighted sample included 3,826 participants with mean age 64.6 years (SE = 0.26), 61.8% female and 78.1% non-Hispanic White. In adjusted, weighted analysis, not, slightly, and moderately-walkable neighborhoods all had lower odds of meeting PA recommendations verses highly-walkable neighborhood (OR = 0.61[95% CI 0.41-0.92], OR = 0.65[95% CI 0.50-0.85], OR = 0.75[95% CI 0.59-0.97], respectively). Social cohesion was independently associated with decreased odds of meeting PA guidelines (p = 0.003). No interaction with walkability was found (p = 0.405). Less than a highly-walkable neighborhood and lower social cohesion were independently associated with decreased odds of meeting PA recommendations among adults with arthritis and recent joint pain. Since walking is one of the most effective treatments for arthritis, clinicians should be sensitive to barriers patients may perceive to walking.

Smoking Cessation and Pregnancy: Timing of Cessation Reduces or Eliminates the Effect on Low Birth Weight.

BACKGROUND: Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW, < 2500 g) which increases risks of infant mortality and morbidity, including chronic conditions later in life. OBJECTIVE: Smoking cessation during pregnancy can reduce the risk of poor birth outcomes. However, the effect that timing of smoking cessation has on the reduction of poor birth outcomes in term pregnancies is unknown. STUDY DESIGN: This retrospective cohort study used birth certificate data from Missouri singleton, full-term, live births from 2010 to 2012 (N = 179,653) to examine the rates and timing of smoking cessation during pregnancy on birthweight. Smoking exposure was categorized as non-smoker, preconception cessation, first trimester cessation, second trimester cessation, and smoker. The outcome was low birth weight (LBW). Covariates included maternal race/ethnicity, age, education level, type of payment for the delivery, marital status, paternal acknowledgement, prenatal sexually transmitted infection (STI), comorbidities, and body mass index. Bivariate and multivariable analyses were used to assess relationships between smoking and LBW status. RESULTS: Preconception cessation did not have a statistically higher risk for LBW than mothers who never smoked (aOR 1.12; 95% CI 0.98, 1.28). First trimester cessation (aOR 1.26; 95% CI 1.05, 1.52), second trimester cessation (aOR 2.00; 95% CI 1.60, 2.67), and smoker (aOR 2.46; 95% CI 2.28, 2.67) had increasing odds for LBW relative to mothers who did not smoke. All covariates had significant relationships with the smoking exposure. CONCLUSION: Preconception cessation yielded LBW rates comparable to non-smokers. The risk for LBW increased as smoking continued throughout pregnancy among full term births, an important new finding in contrast with other studies.

Are Statutory Requirements Followed in the Certification of Traumatic, Unexpected, and Unattended Deaths in Missouri?

Medical examiners and coroners (ME/Cs) investigate deaths important to public health. This cross-sectional study evaluated 343,412 death certificates from 2007 to 2012 in Missouri. We examined agreement between cause and manner of death by year and ME/C contact as well as 2010-2012 trends in ME/C contact. There was near perfect agreement between cause and manner of death when an ME/C was contacted (kappa=0.97, p < 0.0001) and a significant increase in the proportion of deaths with ME/C contact from 2010 to 2012 (p =< 0.0001). There was a significantly higher proportion of ME/C-certified deaths using the electronic system in 2010-2012 (aOR = 1.18, 95% CI 1.15, 1.21) compared to the manual system in 2007-2009. Black, non-Hispanic (aOR = 1.50, 95% CI 1.43,1.57) and Hispanic (aOR = 1.31, 95% CI 1.13, 1.51) deaths, compared to White, non-Hispanic deaths, were associated with a significantly greater odds of ME/C certification. Race as an independent predictor of ME/C death certification warrants further research.

Effects of in utero and Postnatal Exposure to Secondhand Smoke on Lung Function by Gender and Asthma Status: The Seven Northeastern Cities (SNEC) Study.

BACKGROUND: Little information exists on whether gender or asthma status modifies the effects of secondhand smoke (SHS) exposure on lung function. OBJECTIVE: To evaluate whether gender or asthma status modifies the association of SHS exposure with lung function. METHODS: A total of 6,740 children (average 11.6 years) were recruited from 24 districts of 7 cities in northeast China in 2012. SHS exposure included exposure to environmental and maternal smoking both in utero and during early childhood (postnatal). Lung function was measured using electronic spirometers. Two-step regressions were used to analyze the association between SHS and lung function. RESULTS: In utero and postnatal exposure to SHS was independently associated with decreased lung function in both genders; however, this association was greater among males. For example, when exposed to maternal smoking during pregnancy, the adjusted odds ratio (aOR) for decreased forced vital capacity (FVC) was 6.46 (95% confidence interval [CI]: 2.58-16.17) among males, while only 2.16 (95% CI: 0.96-4.88) among females. More positive associations between SHS exposure and decreased lung function were detected among nonasthmatic compared with asthmatic children. Nonasthmatics had significantly larger deficits from in utero exposure to maternal smoking, which concerned decreased lung FVC function (aOR = 2.58, 95% CI: 1.28-5.21) and decreased lung forced expiratory volume in 1 s (FEV1) function (aOR = 2.32, 95% CI: 1.01-5.33). A similar pattern was also observed for the associations between SHS exposure and continuous pulmonary function test measurements. CONCLUSIONS: SHS exposure was associated with decreased lung function. Males and nonasthmatics seem to be more susceptible than their respective counterparts.

Socioeconomic Status, Alcohol Use, and Pregnancy Intention in a National Sample of Women.

Using data from the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional study was conducted to explore the role of socioeconomic status as a potential modifier on the relationship between a woman's intention to become pregnant and her drinking behaviors. The analytic sample included 37,777 fertile women aged 18-44 years. The primary outcomes were any, heavy, or binge drinking. The analysis included three separate multivariable logistic regression models to account for the complex survey methodology utilized in the BRFSS. In the unadjusted models, women intending a pregnancy were less likely to drink at heavy (OR = 0.68, CI = 0.50, 0.93) or binge (OR = 0.80, CI = 0.67, 0.96) levels compared to those not intending a pregnancy. Adjusted regression models indicated that both education and income modified the relation between pregnancy intention and any drinking and binge drinking. After performing a multivariable regression model stratified by education, women who had more than a high school education and were intending to become pregnant were 28 % less likely to binge drink than those not intending a pregnancy (OR = 0.72, CI = 0.57, 0.90). Stratification by income indicated that women intending to become pregnant within the middle income categories were less likely to drink any alcohol compared to those not intending a pregnancy. Pregnancy intention and binge drinking were associated among women with more than a high school education, with those intending a pregnancy being less likely to binge drink. Generally, as education increased, the association between income and binge drinking weakened.

Risk Factors Associated with Very Low Birth Weight in a Large Urban Area, Stratified by Adequacy of Prenatal Care.

OBJECTIVES: This study examined risk and protective factors associated with very low birth weight (VLBW) for babies born to women receiving adequate or inadequate prenatal care. METHODS: Birth records from St. Louis City and County from 2000 to 2009 were used (n = 152,590). Data was categorized across risk factors and stratified by adequacy of prenatal care (PNC). Multivariate logistic regression and population attributable risk (PAR) was used to explore risk factors for VLBW infants. RESULTS: Women receiving inadequate prenatal care had a higher prevalence of delivering a VLBW infant than those receiving adequate PNC (4.11 vs. 1.44 %, p < .0001). The distribution of risk factors differed between adequate and inadequate PNC regarding Black race (36.4 vs. 79.0 %, p < .0001), age under 20 (13.0 vs. 33.6 %, p < .0001), <13 years of education (35.9 vs. 77.9 %, p < .0001), Medicaid status (35.7 vs. 74.9, p < .0001), primiparity (41.6 vs. 31.4 %, p < .0001), smoking (9.7 vs. 24.5 %, p < .0001), and diabetes (4.0 vs. 2.4 %, p < .0001), respectively. Black race, advanced maternal age, primiparity and gestational hypertension were significant predictors of VLBW, regardless of adequate or inadequate PNC. Among women with inadequate PNC, Medicaid was protective against (aOR 0.671, 95 % CI 0.563-0.803; PAR -32.6 %) and smoking a risk factor for (aOR 1.23, 95 % CI 1.01, 1.49; PAR 40.1 %) VLBW. When prematurity was added to the adjusted models, the largest PAR shifts to education (44.3 %) among women with inadequate PNC. CONCLUSIONS: Community actions around broader issues of racism and social determinants of health are needed to prevent VLBW in a large urban area.

Predictors of size for gestational age in St. Louis City and County.

OBJECTIVE: To identify social, behavioral, and physiological risk factors associated with small for gestational age (SGA) by gestational age category in St. Louis City and County. METHODS: A retrospective cohort study was conducted using birth certificate and fetal death records from 2000 to 2009 (n = 142,017). Adjusted associations of risk factors with SGA were explored using bivariate logistic regression. Four separate multivariable logistic regression analyses, stratified by gestational age, were conducted to estimate adjusted odds ratios. RESULTS: Preeclampsia and inadequate weight gain contributed significantly to increased odds for SGA across all gestational age categories. The point estimates ranged from a 3.41 increased odds among women with preeclampsia and 1.76 for women with inadequate weight gain at 24-28 weeks' gestational age to 2.19 and 2.11 for full-term infants, respectively. Among full-term infants, smoking (aOR = 2.08), chronic hypertension (aOR = 1.46), and inadequate prenatal care (aOR = 1.25) had the next most robust and significant impact on SGA. CONCLUSION: Preeclampsia and inadequate weight gain are significant risk factors for SGA, regardless of gestational age. Education on the importance of nutrition and adequate weight gain during pregnancy is vital. In this community, disparities in SGA and smoking rates are important considerations for interventions designed to improve birth outcomes.

Very low birth weight and perinatal periods of risk: disparities in St. Louis.

OBJECTIVE: Very low birth weight (VLBW) is a significant issue in St. Louis, Missouri. Our study evaluated risk factors associated with VLBW in this predominantly urban community. METHODS: From 2000 to 2009, birth and fetal death certificates were evaluated (n = 160, 189), and mortality rates were calculated for perinatal periods of risk. The Kitagawa method was used to explore fetoinfant mortality rates (FIMR) in terms of birth weight distribution and birthweight specific mortality. Multivariable logistic regression was used to assess the magnitude of association of selected risk factors with VLBW. RESULTS: VLBW contributes to 50% of the excess FIMR in St. Louis City and County. The highest proportion of VLBW can be attributed to black maternal race (40.6%) in St. Louis City, inadequate prenatal care (19.8%), and gestational hypertension (12.0%) among black women. Medicaid was found to have a protective effect for VLBW among black women (population attributable risk (PAR) = -14.5). DISCUSSION: Interventions targeting the health of women before and during conception may be most successful at reducing the disparities in VLBW in this population. Interventions geared towards smoking cessation and improvements in Medicaid and prenatal care access for black mothers and St. Louis City residents can greatly reduce VLBW rates.