Adverse childhood experiences and interpersonal violence among college students: does a relationship exist?

OBJECTIVE: Previous research has found women who experience eight or more Adverse Childhood Experiences (ACEs) are 3.5 times as likely to be victims of adult IPV. This study examined the relationship between ACEs and IPV (physical violence, sexual violence, psychological violence, and stalking) among college students. PARTICIPANTS: This study was conducted among undergraduate students (N = 2,900) at two large, non-profit, public universities in the United States. METHODS: Students completed a web-based survey addressing self-reported ACEs and violence that occurred within the current academic year. Chi-square tests and logistic regression models were used to evaluate the relationship between ACEs and violence. RESULTS: College students with higher ACE scores were more likely to experience violence. Students with ACE scores of four or higher were between 1.9-4.9 times more likely to experience violence. A dose response relationship was found between ACE score and experiences of violence. CONCLUSIONS: Campus violence prevention programs may benefit from incorporating discussion of ACEs into programing.

Contamination Risk During Fecal Management Device Removal: An In vitro, Simulated Clinical Use Study.

Fecal management devices (FMDs) are used to drain and contain fecal matter in incontinent, often acutely or critically ill patients to protect their skin as well as the environment from contamination. However, there is potential for contamination and resultant infection at various stages of FMD use. PURPOSE: This in vitro study was conducted to compare device removal factors and subsequent splash of simulated fecal matter of 3 different designs of FMDs using a simulated rectum. METHODS: A Universal Test Machine was used to automatically measure removal forces (in newtons [N]) and tube extensions as the FMDs were pulled from the simulated rectum by the machine. Splash distance and quantity were measured using a splash-capture cylinder and image analysis software. Each device was tested 3 times. Two-sample t tests were conducted to examine statistical differences in removal forces, removal extensions, and splash areas. RESULTS: The forces required to remove the FMDs from the simulated rectum were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (12.0 ± 0.3 N vs. 32.6 ± 4.3 N and 34.8 ± 3.1 N, respectively; P <.05). The extensions of the catheter tubing were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (32.0 ± 7.5 mm vs. 81.3 ± 9.1 mm and 105.2 ± 10.6 mm, respectively; P <.05). Simulated fecal matter was splashed over mean areas of 25.5 ± 16.1 cm2 and 27.3 ± 13.5 cm2 for the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon, respectively; no splash was observed for the device with a collapsible, donut-shaped retention balloon. CONCLUSION: In vitro observations suggest contamination and potential infection risk during FMD removal from the patient are influenced by FMD design. Future in vitro and clinical studies assessing the infectious nature of effluent and methods for containment are warranted.

Previous cesarean delivery associated with subsequent preterm birth in the United States.

OBJECTIVE: To examine the relationship between previous cesarean delivery and subsequent preterm birth in the second pregnancy among women in the United States with registered birth records. STUDY DESIGN: We conducted a retrospective cohort study utilizing United States birth certificate data to generate the study population, which consisted of women delivering a singleton infant in their second live birth (n = 1,076,517) in the year 2016. Preterm birth and previous cesarean delivery measures were derived from United States birth certificates. Covariates included maternal age, race/ethnicity, education, marital status, payer source for delivery, pre-pregnancy body mass index, previous preterm birth, interpregnancy interval, and factors in the second pregnancy such as hypertensive disorders, diabetes, and cigarette use, trimester prenatal care began, weight gain during pregnancy, and presence of congenital anomalies. Women who experienced a cesarean delivery in the first pregnancy were compared to those who did not. RESULTS: When controlling for all covariates, women who had a cesarean delivery in their first pregnancy were 14% more likely to have a preterm birth in their second pregnancy (OR = 1.137, 95% CI = 1.117-1.158) compared to women who had not previously experienced a cesarean delivery. When risk was analyzed by sub categories of preterm birth based on gestational age, a differential association was noted, with a 10% increased risk of delivering before 34 weeks, a 1% increased risk for delivery between 34-36 weeks and no increased risk for delivery after 36 weeks compared to delivery at 39-40 weeks. CONCLUSION: This small, but statistically significant association between previous cesarean section and subsequent preterm birth suggests that efforts to reduce the number of index cesarean sections may contribute to reducing the overall preterm birth rate in the United States.

Kentucky Health Access Nurturing Development Services Home Visiting Program Improves Maternal and Child Health.

BACKGROUND AND OBJECTIVES: Home visitation programs are one of the numerous efforts to help reduce the rates of preterm birth and low birth weight as well as offering other improvements in maternal and child health and development. The Kentucky Health Access Nurturing Development Services (HANDS) is a voluntary, home visiting program serving first-time, high-risk mothers. This study's objective was to evaluate the impact of HANDS on maternal and child health outcomes. METHODS: HANDS administrative data, live birth certificate records and data from the Division of Child Protection and Safety were used in these analyses. We analyzed 2253 mothers who were referred to HANDS between July 2011 and June 2012 and received a minimum of one prenatal home visit (mean number of prenatal visits = 12.9) compared to a demographically similar group of women (n = 2253) who did not receive a visit. Chi square statistics and conditional logistic regression models were used to evaluate the impact of HANDS. RESULTS: HANDS participants had lower rates of preterm delivery (OR 0.74, 95% CI 0.61-0.88) and low birth weight infants (OR 0.54, 95% CI 0.44-0.67). HANDS participants also were significantly less likely to have a substantiated report of child maltreatment compared to controls (OR 0.53, 95% CI 0.43-0.65). HANDS participants also had an increase in adequate prenatal care and a reduction in maternal complications during pregnancy. Of particular important, outcomes improved as the number of prenatal home visits increased: among women receiving 1-3 prenatal home visits was 12.1%, the rate among women receiving 4-6 prenatal home visits was 13.2%, while the rate of PTB among those receiving 7 or more prenatal home visits was 9.4%. CONCLUSIONS: HANDS program participation appears to result in significant improvements in maternal and child health outcomes, most specifically for those receiving seven or more prenatal home visits. As a state-wide, large scale home visiting program, this has significant implications for the continued improvement of maternal and child health outcomes in Kentucky.

Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance.

BACKGROUND: Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to nonpregnant women, but US national data have not been reported since the implementation of enhanced mortality surveillance. OBJECTIVE: The objective of the study was to estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death with nonpregnant/nonpostpartum women. STUDY DESIGN: Death certificates (n = 465,097) from US states with enhanced pregnancy mortality surveillance from 2005 through 2010 were used to compare mortality among 4 groups of women aged 10-54 years: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death), and nonpregnant/nonpostpartum. We estimated pregnancy-associated mortality ratios and compared with nonpregnant/nonpostpartum mortality ratios to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature. RESULTS: Pregnancy-associated homicide victims were most frequently young, black, and undereducated, whereas pregnancy-associated suicide occurred most frequently among older white women. After adjustments, pregnancy-associated homicide risk ranged from 2.2 to 6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared with 2.5-2.6 per 100,000 nonpregnant/nonpostpartum women aged 10-54 years. Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared with 5.3-5.5 per 100,000 women aged 10-54 years among nonpregnant/nonpostpartum women. Assuming the most conservative published estimate of misclassification, the risk of homicide among pregnant/postpartum women was 1.84 times that of nonpregnant/nonpostpartum women (95% confidence interval, 1.71-1.98), whereas risk of suicide was decreased (relative risk, 0.62, 95% confidence interval, 0.57-0.68). CONCLUSION: Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the United States.

Multi-College Bystander Intervention Evaluation for Violence Prevention.

INTRODUCTION: The 2013 Campus Sexual Violence Elimination Act requires U.S. colleges to provide bystander-based training to reduce sexual violence, but little is known about the efficacy of such programs for preventing violent behavior. This study provides the first multiyear evaluation of a bystander intervention's campus-level impact on reducing interpersonal violence victimization and perpetration behavior on college campuses. METHODS: First-year students attending three similarly sized public university campuses were randomly selected and invited to complete online surveys in the spring terms of 2010-2013. On one campus, the Green Dot bystander intervention was implemented in 2008 (Intervention, n=2,979) and two comparison campuses had no bystander programming at baseline (Comparison, n=4,132). Data analyses conducted in 2014-2015 compared violence rates by condition over the four survey periods. Multivariable logistic regression was used to estimate violence risk on Intervention relative to Comparison campuses, adjusting for demographic factors and time (2010-2013). RESULTS: Interpersonal violence victimization rates (measured in the past academic year) were 17% lower among students attending the Intervention (46.4%) relative to Comparison (55.7%) campuses (adjusted rate ratio=0.83; 95% CI=0.79, 0.88); a similar pattern held for interpersonal violence perpetration (25.5% in Intervention; 32.2% in Comparison; adjusted rate ratio=0.79; 95% CI=0.71, 0.86). Violence rates were lower on Intervention versus Comparison campuses for unwanted sexual victimization, sexual harassment, stalking, and psychological dating violence victimization and perpetration (p<0.01). CONCLUSIONS: Green Dot may be an efficacious intervention to reduce violence at the community level and meet Campus Sexual Violence Elimination Act bystander training requirements.

Three Positive Parenting Practices and Their Correlation with Risk of Childhood Developmental, Social, or Behavioral Delays: An Analysis of the National Survey of Children's Health.

OBJECTIVES: (1) Investigate the relationship between three specific positive parenting practices (PPP)-reading to children, engaging in storytelling or singing, and eating meals together as a family-and parent-reported risk of developmental, behavioral, or social delays among children between the ages of 1-5 years in the US. (2) Determine if a combination of these parenting practices has an effect on the outcome. METHODS: Chi square and multiple logistic regression analyses were used to analyze cross-sectional data from the National Survey of Children's Health 2011/2012 in regards to the relationship between each of the three individual PPP as well as a total PPP score and the child's risk of being developmentally, socially, or behaviorally delayed (N = 21,527). Risk of delay was calculated using the Parents' Evaluation of Developmental Status Questionnaire, which is a parental self-report measure that has been correlated with diagnosed child delays. These analyses controlled for poverty and parental education. All analyses were completed using SAS Version 9.3. RESULTS: A strong correlation was found between each of the three PPP as well as the total PPP score and the child's risk of developmental, social, or behavioral delays (p < 0.05 for each test). These associations were found to have a dose-response relationship (p < 0.05 in all but one analysis). CONCLUSIONS: Daily engagement in PPP could possibly reduce children's risk of delay, and specifically engaging in all three PPP may have greater benefit.

Validity and psychometric properties of the measure of psychologically abusive behaviors among young women and women in distressed relationships.

The Measure of Psychologically Abusive Behaviors (MPAB) was developed recently to improve on prior scales. Two nationally solicited samples of women were utilized to further validate the MPAB through the use of a criterion group, factor analysis, and designation of a threshold for accurate classification. MPAB scores were twice as high in the criterion group (M = 38.75 vs. M = 18.85; F = 22.17). Using a cutpoint of 1, the sensitivity and specificity for MPAB were .725 and .628, respectively. Cronbach's alpha was .97 for both samples. These data provide additional evidence for the MPAB as valid and internally consistent.

Evaluation of the Green Dot Bystander Intervention to Reduce Interpersonal Violence Among College Students Across Three Campuses.

Evidence suggests that interventions to engage bystanders in violence prevention increase bystander intentions and efficacy to intervene, yet the impact of such programs on violence remains unknown. This study compared rates of violence by type among undergraduate students attending a college campus with the Green Dot bystander intervention (n = 2,768) with students at two colleges without bystander programs (n = 4,258). Violent victimization rates were significantly (p < .01) lower among students attending the campus with Green Dot relative to the two comparison campuses. Violence perpetration rates were lower among males attending the intervention campus. Implications of these results for research and practice are discussed.

Sexual harassment victimization and perpetration among high school students.

This large, population-based study is one of the few to examine prevalence rates of sexual harassment occurring during the past 12 months by victimization and perpetration among adolescents. In this large, cross-sectional survey of students attending 26 high schools, sexual harassment was defined using three questions from the Sexual Experiences Questionnaire. Among 18,090 students completing the survey, 30% disclosed sexual harassment victimization (37% of females, 21% of males) and 8.5% reported perpetration (5% of females, 12% of males). Sexual harassment perpetration was highly correlated with male sex, minority race/ethnicity, same-sex attraction, bullying, alcohol binge drinking, and intraparental partner violence.

Victimization and perpetration of unwanted sexual activities among high school students: frequency and correlates.

The objective of this study was to report the frequency of perpetration and victimization of unwanted sexual activities (threatened to end relationship or other pressures to engage in sexual activities, threatened or actual physical force, and facilitated by drugs or alcohol) in a large, statewide sample of high school males and females. Among 18,030 students, 18.5% reported victimization and 8.0% perpetration in the past year. Although females were more likely to report unwanted sexual activities due to feeling pressured, there were no significant sex differences among those reporting physical force or unwanted sexual activities due to alcohol or drug use.

Dating violence victimization and perpetration rates among high school students.

This school-based sample provides the largest estimate of physical and psychological dating violence (DV) victimization and the only report of DV perpetration among high school students. Among 14,190 students in relationships, 33.4% disclosed DV by a partner (victimization) and 20.2% used these same behaviors against a partner (perpetration) in the past 12 months. Physical DV victimization (13%) was less frequently disclosed than psychological DV (23%). Rates of DV victimization and perpetration were highest among females, those receiving free or reduced-price meals, those not exclusively attracted to the opposite sex, students reporting parental or guardian partner violence, binge drinking, and bullying.

Statewide estimates of stalking among high school students in Kentucky: demographic profile and sex differences.

This large, statewide sample from 26 high schools provided the first population-based estimates of stalking victimization and perpetration among adolescent females and males. Our stalking definition required that pursuing tactics occurred at least 3 times in the past 12 months and included being followed, spied on, or monitored; someone showed up or waited for you when you did not want them to; and receiving unwanted messages. Among 18,013 students, 16.5% disclosed being stalked and 5.3% stalking; 2.8% disclosed both stalking victimization and perpetration. A majority of students reported being most afraid of a former boyfriend or girlfriend as the stalker.

Effective dual method contraceptive use and HPV vaccination among U.S. adolescent and young adult females.

BACKGROUND: Problem Behavior Theory posits that risky behaviors cluster in individuals, implying that protective behaviors may follow a similar pattern. The purpose of this study was to determine whether the protective behavior of effective dual method contraception use at first and most recent sexual intercourse is associated with HPV vaccination among adolescent and young adult females. METHODS: National Survey of Family Growth (2006-2010) data were used to examine the association between women's contraception use during first and most recent sexual intercourse and HPV vaccination. Women aged 15 to 24 years (n = 1,820) served as the study sample. FINDINGS: At first and last sexual intercourse, effective dual method contraception use was reported by 15.3% and 16.8% women, respectively; 27.8% reported receiving at least one dose of the human papillomavirus (HPV) vaccine. Higher HPV vaccination rates were observed among dual method users at first and last sexual intercourse (36.4% and 48.2%, respectively). This trend was also observed across age groups (15-19 year olds vs. 20-24 year olds). In adjusted models, among all respondents, dual users at last sexual intercourse were significantly more likely to be vaccinated, whereas at first sexual intercourse only younger dual users were more likely to report HPV vaccination. CONCLUSIONS: Findings suggest that the protective behavior of dual method contraceptive use at first and most recent sexual intercourse may serve as a predictor of another complementary health behavior, HPV vaccination, particularly among adolescent females. More research is needed to understand behavioral clustering to design related multi-focused women's health interventions.

Challenge and opportunity in evaluating a diffusion-based active bystanding prevention program: Green Dot in high schools.

Increasing attention has recently been paid to the development of prevention programs designed to actively engage bystanders in prevention efforts to reduce the risk of sexual and dating violence; yet, few evaluations have been conducted. Our proposed plan to rigorously evaluate a randomized intervention trial of the Green Dot bystander program as it is implemented in high schools across Kentucky is presented. We highlight the value of measuring violence victimization and perpetration outcomes, capturing actual and observed student bystander behaviors, and testing the diffusion of Green Dot training through students' social networks.

Sexual coercion and sexual violence at first intercourse associated with sexually transmitted infections.

BACKGROUND: Violence against women has been associated with subsequent risky sexual behaviors and sexually transmitted infections (STIs). We explored whether sexual coercion or violence at first intercourse was associated with self-reported STIs. METHODS: Using nationally representative data from the 2006 to 2010 National Survey of Family Growth, we analyzed female respondents aged 18 to 44 (n = 9466) who answered questions on coercion at first intercourse (wantedness, voluntariness, and types of force used) and STIs using logistic regression analyses. We explored degrees of coercion, which we label as neither, sexual coercion (unwanted or nonphysical force), or sexual violence (involuntary or physical force). RESULTS: Eighteen percent of US women reported sexual coercion, and 8.4% experienced sexual violence at first intercourse. Compared with women who experienced neither, the odds of reporting an STI was significantly greater for women who experienced sexual coercion (odds ratio, 1.27; 95% confidence interval, 1.01-1.60), after controlling for all variables. The association between sexual violence at first intercourse and STIs (odds ratio, 1.20; 95% confidence interval, 0.91-1.57) seemed to be attenuated by subsequent sexual violence. CONCLUSIONS: Understanding that women who reported a variety of coercive sexual experiences are more likely to have contracted an STI may indicate a need to focus on the broader continuum of sexual violence to fully understand the impact of even subtle forms of violence on women's health. In addition, focusing on subsequent sexual behaviors and other negative consequences remains important to improve the sexual health of women who have experienced coercive sexual intercourse.

Associations of breastfeeding with bulimic behaviors and eating disorders among adolescents.

PURPOSE: To use the lifecourse framework to examine the association between duration of breastfeeding and risk of developing bulimic behaviors or a diagnosed eating disorder. METHOD: Questionnaires were sent every 12-24 months between 1996 and 2005 to 6,436 females and 5,756 males in the Growing Up Today Study, who were 9-14 years at baseline. Duration of breastfeeding was reported by the participants' mothers in 1997. We used generalized estimating equations to estimate the association of breastfeeding with purging, binge eating, engaging in bulimic behaviors, and having a diagnosed eating disorder. RESULTS: Compared to girls who were breastfed for more than 9 months, those who were breastfed for less than 4 months did not have a significantly different prevalence of purging, binge eating, bulimic behaviors, and self-reported history of diagnosed eating disorders. Adjusting for gestational age/birthweight, age, age at menarche, maternal history of an eating disorder, and maternal body mass index, short duration of breastfeeding was not associated with any outcome among the girls [adjusted odds ratios (AOR) ranged from 0.8 to 1.1]. Among the boys, the results showed no significant associations between duration of breastfeeding and purging, binge eating, and self-reported history of diagnosed eating disorder. However, there was a suggestion that boys who had been breastfed for less than 4 months were at a higher risk of engaging in bulimic behaviors [AOR: 1.5, 95% confidence interval (CI), 1.0-2.3]. DISCUSSION: No association was found between duration of breastfeeding and risk of developing bulimic behaviors or a diagnosed eating disorder among girls or boys with the one exception of longer duration of breastfeeding associated with fewer bulimic behaviors in boys. Although there are many benefits to breastfeeding, our data suggest that breastfeeding does not offer any protection against binge eating or purging, nor does it present harmful effects.

Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada / Home Intervention and Predictor Variables for Rehospitalization in Chronic Obstructive Pulmonary Disease Exacerbations

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) agudizada aumenta la mortalidad y los recursos asociados con la hospitalización. Se estudia si un control domiciliario precoz disminuye la tasa de reingresos y si existen variables que puedan predecirlo. Pacientes y métodos: Se realiza un estudio prospectivo, controlado en grupos paralelos en pacientes ingresados por EPOC. Los pacientes que residían a menos de 15km del hospital fueron asignados a un grupo de intervención (visita domiciliaria por una enfermera en las 48-72h tras el alta) y los restantes a un grupo de cuidados habituales. Se compararon en ambos grupos la tasa de reingresos hospitalarios en el primer mes y las variables capaces de predecirlo. Resultados: Fueron incluidos 71 enfermos, 35 en el grupo de cuidados convencionales y 36 en el grupo de intervención; en este último se modificó el tratamiento en 13 sujetos (36% de los enfermos). La tasa de reingreso fue del 17%, siendo similar en ambos grupos (p=0,50). Por cada aumento de 5 años en la edad, el riesgo de reingreso fue de 2,54 (IC95%, 1,06 a 5,07) y por cada incremento de 10mmHg en la PaCO2, el riesgo de reingreso fue de 8,34 (IC95%, 2,43 a 18,55). Conclusiones: El control domiciliario precoz no disminuyó la tasa de reingresos durante el primer mes. Una mayor edad y una PaCO2 elevada son factores que identifican a un grupo con elevado riesgo de reingreso(AU)

Background: Chronic obstructive pulmonary disease (COPD) exacerbation increases mortality and resources used associated with hospitalization. We studied whether early home monitoring reduces the rate of readmission and if there are any predictor variables. Patients and methods: We performed a prospective, controlled, parallel-group study in patients who were hospitalized for COPD. Patients whose residence was within less than 15km from the hospital were assigned to an interventional group (home visits by nurses about 48-72hours after discharge), the remainder were assigned to a conventional care group. The rate of rehospitalization within the first month was compared between the two groups, as well as those variables that showed a predictive capability. Results: Seventy one patients were included: 35 in the conventional care group and 36 in the interventional group. In the latter, the treatment was modified in 13 patients (36%). The hospital readmission rate was 17%, which was similar in both groups (P=.50). For every 5-year increase in age, the risk for readmission was 2.54 (95%CI, 1.06-5.07) and for each increase of 10mmHg in PaCO2, the risk of readmission was 8.34 (95%CI, 2.43-18.55). Conclusions: Early home monitoring did not decrease the readmission rate during the first month. Older age and high PaCO2 are factors that identify the group with a high risk for rehospitalization(AU)

Association of intimate partner violence and childhood sexual abuse with cancer-related well-being in women.

BACKGROUND: Limited evidence suggests that intimate partner violence (IPV) may be associated with poorer cancer outcomes. We hypothesized that timing and type of IPV as well as childhood sexual abuse (CSA) may negatively affect depression, perceived stress, and cancer-related well-being. METHODS: This was a cross-sectional study of women diagnosed with either breast, cervical, or colorectal cancer in the prior 12 months included in the Kentucky Cancer Registry. Consenting women were interviewed by phone (n=553). Multivariate analysis of covariance (MANCOVA) was used to determine the association between IPV (37% lifetime prevalence) and type, timing, and the range of correlated cancer-related well-being indicators, adjusting for confounding factors. RESULTS: IPV (p=0.002) and CSA (p=0.03) were associated with the six correlated well-being indicators. Specifically, lifetime and current IPV were associated with lower Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) (p=0.006) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-SP) (p=0.03) scores, higher perceived stress at diagnosis (p=0.006), and depressive symptom scores at diagnosis (p<0.0001), whereas CSA was associated with lower FACT-B (p=0.02), increased number of comorbid conditions (p=0.03), and higher current stress levels (p=0.04). Current and past IPV, as well as psychologic abuse, were associated with poorer well-being among women with a recent cancer diagnosis. CONCLUSIONS: Our results provide evidence that both IPV and CSA negatively influence cancer-related well-being indicators. These data suggest that identification of lifetime IPV and other stressors may provide information that healthcare providers can use to best support and potentially improve the well-being of female cancer patients.

Universal psychosocial screening and adverse pregnancy outcomes in an academic obstetric clinic.

OBJECTIVE: To test the hypothesis that women screened for psychosocial factors, including partner abuse, as recommended by the American College of Obstetricians and Gynecologists would have higher neonatal birth weight, longer gestational age at delivery, higher Apgar scores, and fewer maternal complications. METHODS: We evaluated a universal psychosocial screening intervention using a retrospective cohort (n=881 prenatal care patients). Pregnancy outcomes among patients screened beginning in 2008 (n=464) were compared with outcomes among women receiving care before universal screening was implemented (n=417). Data were obtained from medical records between 2007 and 2009. Multivariable logistic regression and analysis of covariance were used to estimate the association between screening and pregnancy outcomes among singleton births adjusting for confounders (prior preterm births, insurance, and mode of delivery). RESULTS: Screened women were less likely than women not universally screened to have low birth weight neonates (4.5% of screened, 10.3% of unscreened; adjusted odds ratio [OR] 0.41, 95% confidence interval [CI] 0.23-0.73), preterm births (9.9% of screened, 14.9% of unscreened; adjusted OR 0.62, 95% CI 0.41-0.96), and any maternal complication (30.0% of screened, 41.2% of unscreened; adjusted OR 0.67, 95% CI 0.50-0.88). Newborn Apgar scores were higher (P=.01) among screened relative to unscreened mothers. CONCLUSION: Our results provide evidence that universal screening was associated with improved pregnancy outcomes. LEVEL OF EVIDENCE: II.