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1.
Epidemiology ; 30(1): 154-159, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30299405

RESUMO

BACKGROUND: The 2003 revision of the US Standard Certificate of Live Birth (birth certificate) and Pregnancy Risk Assessment Monitoring System (PRAMS) are important for maternal weight research and surveillance. We examined quality of prepregnancy body mass index (BMI), gestational weight gain, and component variables from these sources. METHODS: Data are from a PRAMS data quality improvement study among a subset of New York City and Vermont respondents in 2009. We calculated mean differences comparing prepregnancy BMI data from the birth certificate and PRAMS (n = 734), and gestational weight gain data from the birth certificate (n = 678) to the medical record, considered the gold standard. We compared BMI categories (underweight, normal weight, overweight, obese) and gestational weight gain categories (below, within, above recommendations), classified by different sources, using percent agreement and the simple κ statistic. RESULTS: For most maternal weight variables, mean differences between the birth certificate and PRAMS compared with the medical record were less than 1 kg. Compared with the medical record, the birth certificate classified similar proportions into prepregnancy BMI categories (agreement = 89%, κ = 0.83); PRAMS slightly underestimated overweight and obesity (agreement = 84%, κ = 0.73). Compared with the medical record, the birth certificate overestimated gestational weight gain below recommendations and underestimated weight gain within recommendations (agreement = 81%, κ = 0.69). Agreement varied by maternal and pregnancy-related characteristics. CONCLUSIONS: Classification of prepregnancy BMI and gestational weight gain from the birth certificate or PRAMS was mostly similar to the medical record but varied by maternal and pregnancy-related characteristics. Efforts to understand how misclassification influences epidemiologic associations are needed.


Assuntos
Estatura , Peso Corporal , Confiabilidade dos Dados , Monitoramento Epidemiológico , Ganho de Peso na Gestação , Registros Médicos/normas , Resultado da Gravidez/epidemiologia , Adulto , Declaração de Nascimento , Índice de Massa Corporal , Feminino , Humanos , Recém-Nascido , Cidade de Nova Iorque , Gravidez , Medição de Risco , Vermont/epidemiologia
3.
Drug Alcohol Depend ; 187: 72-78, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29627409

RESUMO

BACKGROUND: We sought to describe the correlates of marijuana use during and after pregnancy, and to examine the independent relationship between prenatal marijuana use and infant outcomes. STUDY DESIGN: We used state-specific data from the Pregnancy Risk Assessment Monitoring System (N = 9013) to describe correlates of self-reported prenatal and postpartum marijuana use. We estimated differences in mean infant birth weight and gestational age among prenatal marijuana users and nonusers, controlling for relevant covariates (i.e., cigarette smoking). RESULTS: Respectively, 4.2% (95% CI: 3.8-4.7) and 6.8% (95% CI: 6.0-7.7) of women reported using marijuana during and after pregnancy. Compared to nonusers, prenatal marijuana users were more likely to be ≤24 years; non-Hispanic white, not married, have <12 years of education, have Medicaid/IHS/Other insurance, be on WIC during pregnancy, have annual household income <$20,000, cigarette smokers, and alcohol drinkers during pregnancy (p-values < 0.05). After adjustment, no differences in gestational age or birthweight were observed. Postpartum users were more likely to smoke cigarettes (48.7% vs. 20.3%), experience postpartum depressive symptoms (14.0% vs. 9.0%), and breastfeed for <8 weeks (34.9% vs. 18.1%). CONCLUSION: Co-use of substances was common among prenatal and postpartum marijuana users. Prenatal marijuana use was not independently associated with lower average birthweight or gestational age. Postpartum marijuana use was associated with depressive symptoms and shorter breastfeeding duration. Surveillance of marijuana use among pregnant and postpartum women is critical to better understanding the relationship of marijuana use with birth outcomes, and postpartum experiences such as depression and breastfeeding.


Assuntos
Abuso de Maconha/complicações , Complicações na Gravidez/psicologia , Adulto , Peso ao Nascer , Aleitamento Materno/psicologia , Depressão Pós-Parto/psicologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Abuso de Maconha/epidemiologia , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/epidemiologia , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 67(1): 39-46, 2018 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-29324729

RESUMO

INTRODUCTION: There have been dramatic improvements in reducing infant sleep-related deaths since the 1990s, when recommendations were introduced to place infants on their backs for sleep. However, there are still approximately 3,500 sleep-related deaths among infants each year in the United States, including those from sudden infant death syndrome, accidental suffocation and strangulation in bed, and unknown causes. Unsafe sleep practices, including placing infants in a nonsupine (on side or on stomach) sleep position, bed sharing, and using soft bedding in the sleep environment (e.g., blankets, pillows, and soft objects) are modifiable risk factors for sleep-related infant deaths.


Assuntos
Disparidades nos Níveis de Saúde , Cuidado do Lactente/tendências , Sono , Morte Súbita do Lactente/prevenção & controle , Adulto , Feminino , Humanos , Lactente , Mães/psicologia , Mães/estatística & dados numéricos , Fatores Socioeconômicos , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
5.
Matern Child Health J ; 19(9): 1916-24, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25676044

RESUMO

Maternal smoking is captured on the 2003 US Standard Birth Certificate based on self-reported tobacco use before and during pregnancy collected on post-delivery maternal worksheets. Study objectives were to compare smoking reported on the birth certificate to maternal worksheets and prenatal and hospital medical records. The authors analyzed a sample of New York City (NYC) and Vermont women (n = 1,037) with a live birth from January to August 2009 whose responses to the Pregnancy Risk Assessment Monitoring System survey were linked with birth certificates and abstracted medical records and maternal worksheets. We calculated smoking prevalence and agreement (kappa) between sources overall and by maternal and hospital characteristics. Smoking before and during pregnancy was 13.7 and 10.4% using birth certificates, 15.2 and 10.7% using maternal worksheets, 18.1 and 14.1% using medical records, and 20.5 and 15.0% using either maternal worksheets or medical records. Birth certificates had "almost perfect" agreement with maternal worksheets for smoking before and during pregnancy (κ = 0.92 and 0.89) and "substantial" agreement with medical records (κ = 0.70 and 0.74), with variation by education, insurance, and parity. Smoking information on NYC and Vermont birth certificates closely agreed with maternal worksheets but was underestimated compared with medical records, with variation by select maternal characteristics. Opportunities exist to improve birth certificate smoking data, such as reducing the stigma of smoking, and improving the collection, transcription, and source of information.


Assuntos
Registros Médicos/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Cidade de Nova Iorque/epidemiologia , Gravidez , Autorrelato , Fumar/psicologia , Vermont/epidemiologia , Estatísticas Vitais
6.
Am J Obstet Gynecol ; 210(4): 335.e1-335.e5, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24184397

RESUMO

OBJECTIVE: The birth certificate variable obstetric estimate of gestational age (GA) has not been previously validated against GA based on estimated date of delivery from medical records. STUDY DESIGN: We estimated sensitivity, specificity, positive predictive value, negative predictive value and the corresponding 95% confidence intervals (CIs) for preterm delivery (<37 weeks' gestation) based on obstetric estimate using estimated date of delivery-based GA as the gold standard. Trained abstractors obtained the estimated date of delivery from the prenatal record (64.8% in New York City, and 94.6% in Vermont), or, when not available, from the hospital delivery record for 2 population-based samples: 586 live births delivered in New York City and 649 live births delivered in Vermont during 2009. Weights were applied to account for nonresponse and sampling design. RESULTS: In New York City, the preterm delivery rate based on estimated date of delivery was 9.7% (95% CI, 7.6-12.4) and 8.2% (95% CI, 6.3-10.6) based on obstetric estimate; in Vermont, it was 6.8% (95% CI, 5.4-8.4) based on estimated date of delivery and 6.3% (95% CI, 5.1-7.8) based on obstetric estimate. In New York City, sensitivity of obstetric estimate-based preterm delivery was 82.5% (95% CI, 69.4-90.8), specificity 98.1% (95% CI, 96.4-99.1), positive predictive value 98.0% (95% CI, 95.2-99.2), and negative predictive value 98.8% (95% CI, 99.6-99.9). In Vermont, sensitivity of obstetric estimate-based preterm delivery was 93.8% (95% CI, 81.8-98.1), specificity 99.6% (95% CI, 98.5-99.9), positive predictive value 100%, and negative predictive value 100%. CONCLUSION: Obstetric estimate-based preterm delivery had excellent specificity, positive predictive value and negative predictive value. Sensitivity was moderate in New York City and excellent in Vermont. These results suggest obstetric estimate-based preterm delivery from the birth certificate is useful for the surveillance of preterm delivery.


Assuntos
Declaração de Nascimento , Idade Gestacional , Adulto , Feminino , Humanos , Registros Médicos/estatística & dados numéricos , Cidade de Nova Iorque , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/epidemiologia , Sensibilidade e Especificidade , Vermont , Adulto Jovem
7.
Am J Health Promot ; 27(3 Suppl): S43-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23286663

RESUMO

PURPOSE: To provide estimates for prevalence of health care provider advice offered to reproductive-aged women and to assess their association with behavior change. DESIGN: Cross-sectional study using the 2009 Behavioral Risk Factor Surveillance System. Setting. Nineteen states/areas. SUBJECTS: Women aged 18 to 44 years with a self-reported history of hypertension or current antihypertensive medication use (n = 2063). MEASURES: Self-reported hypertension; sociodemographic and health care access indicators; and provider advice and corresponding self-reported behavior change to improve diet, limit salt intake, exercise, and reduce alcohol use. ANALYSIS: We estimated prevalence and prevalence ratios for receipt of provider advice and action to change habits. We calculated 95% confidence interval (CI) and used χ(2) tests to assess associations. RESULTS: Overall, 9.8% of reproductive-aged women had self-reported hypertension; most reported receiving advice to change eating habits (72.9%), reduce salt intake (74.6%), and exercise (82.1%), and most reported making these changes. Only 44.7% reported receiving advice to reduce alcohol intake. Women who received provider advice were more likely to report corresponding behavior change compared to those who did not (prevalence ratios ranged from 1.3 [95% CI, 1.2-1.5, p < .05] for exercise to 1.6 [95% CI, 1.4-1.8, p < .05] for reducing alcohol use. CONCLUSION: Health care providers should routinely advise hypertensive reproductive-aged women about lifestyle changes to reduce blood pressure and improve pregnancy outcomes.


Assuntos
Aconselhamento , Pessoal de Saúde , Hipertensão/prevenção & controle , Cuidado Pré-Concepcional , Comportamento de Redução do Risco , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Relações Profissional-Paciente , Autorrelato , Estados Unidos , Adulto Jovem
8.
Matern Child Health J ; 17(6): 989-95, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22798140

RESUMO

To describe characteristics, referrals, service utilization, and self-reported quit rates among pregnant and non-pregnant women enrolled in a smoking cessation quitline. This information can be used to improve strategies to increase pregnant and non-pregnant smokers' use of quitlines. We examined tobacco use characteristics, referral sources, and use of services among 1,718 pregnant and 24,321 non-pregnant women aged 18-44 years enrolled in quitline services in 10 states during 2006-2008. We examined self-reported 30-day quit rates 7 months after enrollment among 246 pregnant and 4,123 non-pregnant women and, within groups, used Chi-square tests to compare quit rates by type of service received. The majority of pregnant and non-pregnant callers, respectively, smoked ≥10 cigarettes per day (62 %; 83 %), had recently attempted to quit (55 %; 58 %), smoked 5 or minutes after waking (59 %; 55 %), and lived with a smoker (63 %; 48 %). Of callers, 24.3 % of pregnant and 36.4 % of non-pregnant women were uninsured. Pregnant callers heard about the quitline most often from a health care provider (50 %) and non-pregnant callers most often through mass media (59 %). Over half of pregnant (52 %) and non-pregnant (57 %) women received self-help materials only, the remainder received counseling. Self-reported quit rates at 7 months after enrollment in the subsample were 26.4 % for pregnant women and 22.6 % for non-pregnant women. Quitlines provide needed services for pregnant and non-pregnant smokers, many of whom are uninsured. Smokers should be encouraged to access counseling services.


Assuntos
Aconselhamento/métodos , Linhas Diretas/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Gravidez , Gestantes , Fatores Socioeconômicos , Telefone , Estados Unidos , Adulto Jovem
9.
Matern Child Health J ; 16(1): 60-71, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21153761

RESUMO

The aim is to describe the burden of chronic disease and related risk factors among low-income women of reproductive age. We analyzed population-based data from the 2005-2006 Pregnancy Risk Assessment Monitoring System (PRAMS) for 14,990 women with a live birth in 7 states. We examined the prevalence of selected chronic diseases and related risk factors (preexisting diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, obesity, smoking or binge drinking prior to pregnancy, smoking or excessive weight gain during pregnancy, and postpartum depressive symptoms) by Federal Poverty Level (FPL) (≤100% FPL; 101-250% FPL; >250% FPL). Approximately one-third of women were low-income (≤100% FPL), one-third were near-low-income (101-250% FPL), and one-third were higher-income (>250% FPL). Compared to higher-income women, low-income women were significantly more likely to smoke before or during pregnancy (34.2% vs. 14.4%, and 24.8% vs. 5.4%, respectively), be obese (22.2% vs. 16.0%), experience postpartum depressive symptoms (23.3% vs. 7.9%), have 3 or more chronic diseases and/or related risk factors (28.1% vs. 14.4%) and be uninsured before pregnancy (48.9% vs. 4.8%). Low-income women of reproductive age experienced a higher prevalence of selected chronic diseases and related risk factors. Enhancing services for these women in publicly-funded family planning clinics may help reduce disparities in pregnancy and long-term health outcomes in the poor.


Assuntos
Doença Crônica/epidemiologia , Comportamentos Relacionados com a Saúde , Mães , Pobreza , Adulto , Comorbidade , Serviços de Planejamento Familiar , Feminino , Humanos , Vigilância da População , Gravidez , Cuidado Pré-Natal , Prevalência , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
10.
Am J Prev Med ; 41(6): 588-95, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22099235

RESUMO

BACKGROUND: Blood pressure and cholesterol screening among women of reproductive age are important for early disease detection and intervention, and because hypertension and dyslipidemia are associated with adverse pregnancy outcomes. PURPOSE: The objective of this study was to examine associations of sociodemographic characteristics, cardiovascular disease risk factors, and healthcare access indicators with blood pressure and cholesterol screening among women of reproductive age. METHODS: In 2011, prevalence estimates for self-reported blood pressure screening within 2 years and cholesterol screening within 5 years and AORs for screenings were calculated for 4837 women aged 20-44 years, using weighted 2008 National Health Interview Survey data. RESULTS: Overall, recommended blood pressure and cholesterol screening was received by 89.6% and 63.3% women, respectively. Those who were underinsured or uninsured had the lowest screening percentage at 76.6% for blood pressure (95% CI=73.4, 79.6) and 47.6% for cholesterol (95% CI=43.8, 51.5) screening. Suboptimal cholesterol screening prevalence was also found for women who smoke (54.5%, 95% CI=50.8, 58.2); obese women (69.8%, 95% CI=66.3, 73.0); and those with cardiovascular disease (70.3%, 95% CI=63.7, 76.1), prediabetes (73.3%, 95% CI= 64.1, 80.8), or hypertension (81.4%, 95% CI=76.6, 85.4). CONCLUSIONS: Most women received blood pressure screening, but many did not receive cholesterol screening. Universal healthcare access may improve screening prevalence.


Assuntos
Pressão Sanguínea , Colesterol/sangue , Programas de Rastreamento/estatística & dados numéricos , Adulto , Dislipidemias/diagnóstico , Feminino , Acesso aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico , Classe Social , Estados Unidos , Adulto Jovem
11.
Prev Chronic Dis ; 8(6): A120, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22005613

RESUMO

INTRODUCTION: Some potentially modifiable risk factors and chronic conditions cause significant disease and death during pregnancy and promote the development of chronic disease. This study describes recent trends of modifiable risk factors and controllable chronic conditions among reproductive-aged women. METHODS: Data from the 2001 to 2009 Behavioral Risk Factor Surveillance System, a representative state-based telephone survey of health behavior in US adults, was analyzed for 327,917 women of reproductive age, 18 to 44 years. We calculated prevalence ratios over time to assess trends for 4 selected risk factors and 4 chronic conditions, accounting for age, race/ethnicity, education, health care coverage, and individual states. RESULTS: From 2001 to 2009, estimates of 2 risk factors improved: smoking declined from 25.9% to 18.8%, and physical inactivity declined from 25.0% to 23.0%. One risk factor, heavy drinking, did not change. From 2003 to 2009, the estimates for 1 risk factor and 4 chronic conditions worsened: obesity increased from 18.3% to 24.7%, diabetes increased from 2.1% to 2.9%, high cholesterol increased from 10.3% to 13.6%, asthma increased from 13.5% to 16.2%, and high blood pressure increased from 9.0% to 10.1%. All trends were significant after adjustment, except that for heavy drinking. CONCLUSION: Among women of reproductive age, prevalence of smoking and physical inactivity improved, but prevalence of obesity and all 4 chronic conditions worsened. Understanding reasons for the improvements in smoking and physical activity may support the development of targeted interventions to reverse the trends and help prevent chronic disease and adverse reproductive outcomes among women in this age group.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Doença Crônica/epidemiologia , Saúde Reprodutiva/tendências , Assunção de Riscos , Saúde da Mulher/tendências , Adolescente , Adulto , Feminino , Humanos , Morbidade/tendências , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
12.
Prev Chronic Dis ; 8(6): A121, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22005614

RESUMO

INTRODUCTION: Prenatal smoking prevalence remains high in the United States. To reduce prenatal smoking prevalence, efforts should focus on delivering evidence-based cessation interventions to women who are most likely to smoke before pregnancy. Our objective was to identify groups with the highest prepregnancy smoking prevalence by age within 6 racial/ethnic groups. METHODS: We analyzed data from 186,064 women with a recent live birth from 32 states and New York City from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of postpartum women. We calculated self-reported smoking prevalence during the 3 months before pregnancy for 6 maternal racial/ethnic groups by maternal age (18-24 y or ≥25 y). For each racial/ethnic group, we modeled the probability of smoking by age, adjusting for education, Medicaid enrollment, parity, pregnancy intention, state of residence, and year of birth. RESULTS: Younger women had higher prepregnancy smoking prevalence (33.2%) than older women (17.6%), overall and in all racial/ethnic groups. Smoking prevalences were higher among younger non-Hispanic whites (46.4%), younger Alaska Natives (55.6%), and younger American Indians (46.9%). After adjusting for confounders, younger non-Hispanic whites, Hispanics, Alaska Natives, and Asian/Pacific Islanders were 1.12 to 1.50 times as likely to smoke as their older counterparts. CONCLUSION: Age-appropriate and culturally specific tobacco control interventions should be integrated into reproductive health settings to reach younger non-Hispanic white, Alaska Native, and American Indian women before they become pregnant.


Assuntos
Grupos Étnicos , Comportamentos Relacionados com a Saúde/etnologia , Disparidades nos Níveis de Saúde , Nascimento Vivo , Comportamento Materno/etnologia , Fumar/efeitos adversos , Saúde da Mulher , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Cidade de Nova Iorque/epidemiologia , Vigilância da População , Gravidez , Prevalência , Saúde Reprodutiva , Estudos Retrospectivos , Medição de Risco/métodos , Fumar/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
Addict Behav ; 34(12): 1069-72, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19646820

RESUMO

Current cigarette smoking combined with ever use of other tobacco products (lifetime polytobacco use) is important to examine as users may be at greater risk for illicit drug use, nicotine addiction, and adverse health outcomes. We determined estimates and patterns of lifetime polytobacco use and conducted multivariable analyses to determine demographic, family and friend, psychosocial, and lifestyle factors associated with use among a sample of Canadian young adults. Overall prevalence was 36.3% for current cigarette use; 10.1% for current cigarette use only and 26.2% for lifetime polytobacco use. Among polytobacco users, current cigarette use and ever cigar use was most frequent (67.2%). For males, the final model contained demographic, family and friends, and lifestyle factors. For females, the final model also included psychosocial factors. Illicit drug use was the strongest significant predictor for lifetime polytobacco use among males. We found gender specific differences when comparing lifetime polytobacco users to current cigarette-only users, in particular; male lifetime polytobacco users were more likely to use drugs and alcohol. Interventions focusing on individual substances should consider addressing combinations of use.


Assuntos
Fumar/epidemiologia , Tabagismo/epidemiologia , Canadá/epidemiologia , Estudos de Coortes , Família , Feminino , Humanos , Estilo de Vida , Masculino , Grupo Associado , Fatores de Risco , Fatores Sexuais , Meio Social , Adulto Jovem
14.
MMWR Surveill Summ ; 58(4): 1-29, 2009 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-19478726

RESUMO

PROBLEM: Smoking among nonpregnant women contributes to reduced fertility, and smoking during pregnancy is associated with delivery of preterm infants, low infant birthweight, and increased infant mortality. After delivery, exposure to secondhand smoke can increase an infant's risk for respiratory tract infections and for dying of sudden infant death syndrome. During 2000-2004, an estimated 174,000 women in the United States died annually from smoking-attributable causes, and an estimated 776 infants died annually from causes attributed to maternal smoking during pregnancy. REPORTING PERIOD COVERED: 2000-2005. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) was initiated in 1987 and is an ongoing state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants in the United States. Self-reported questionnaire data are linked to selected birth certificate data and are weighted to represent all women delivering live infants in the state. Self-reported smoking data were obtained from the PRAMS questionnaire and birth certificates. This report provides data on trends (aggregated and site-specific estimates) of smoking before, during, and after pregnancy and describes characteristics of female smokers during these periods. RESULTS: For the study period 2000-2005, data from 31 PRAMS sites (Alabama, Alaska, Arkansas, Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, New York City, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Washington, and West Virginia) were included in this report. All 31 sites have met the Healthy People 2010 (HP 2010) objective of increasing the percentage of pregnant smokers who stop smoking during pregnancy to 30%; site-specific quit rates in 2005 ranged from 30.2% to 61.0%. However, none of the sites achieved the HP 2010 objective of reducing the prevalence of prenatal smoking to 1%; site-specific prevalence of smoking during pregnancy in 2005 ranged from 5.2% to 35.7%. During 2000--2005, two sites (New Mexico and Utah) experienced decreasing rates for smoking before, during, and after pregnancy, and two sites (Illinois and New Jersey) experienced decreasing rates during pregnancy only. Three sites (Louisiana, Ohio, and West Virginia) had increases in the rates for smoking before, during, and after pregnancy, and Arkansas had increases in rates before pregnancy only. For the majority of sites, smoking rates did not change over time before, during, or after pregnancy. For 16 sites (Alaska, Arkansas, Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, New Mexico, New York [excluding New York City], North Carolina, Oklahoma, South Carolina, Utah, Washington, and West Virginia) for which data were available for the entire 6-year study period, the prevalence of smoking before pregnancy remained unchanged, with approximately one in five women (from 22.3% in 2000 to 21.5% in 2005) reporting smoking before pregnancy. The prevalence of smoking during pregnancy declined (p = 0.01) from 15.2% in 2000 to 13.8% in 2005, and the prevalence of smoking after delivery declined (p = 0.04) from 18.1% in 2000 to 16.4% in 2005. INTERPRETATION: The results indicate that efforts to reduce smoking prevalence among female smokers before pregnancy have not been effective; however, efforts targeting pregnant women have met some success as rates have declined during pregnancy and after delivery. Current tobacco-control efforts and smoking-cessation efforts targeting pregnant women are not sufficient to reach the HP 2010 objective of reducing prevalence of smoking during pregnancy. PUBLIC HEALTH ACTION: The data provided in this report are important for developing, monitoring, and evaluating state tobacco-control policies and programs to reduce smoking among female and pregnant smokers. States can reduce smoking before, during, and after pregnancy through sustained and comprehensive tobacco-control efforts (e.g., smoke-free policies and tobacco excise taxes). Health-care providers should increase efforts to assess the smoking status of their patients and offer effective smoking-cessation interventions to every female or pregnant smoker to whom they provide health-care services.


Assuntos
Vigilância da População , Medição de Risco , Fumar/epidemiologia , Adulto , Feminino , Política de Saúde , Humanos , Gravidez , Prevalência , Fumar/etnologia , Abandono do Hábito de Fumar , Estados Unidos/epidemiologia , Adulto Jovem
15.
Nicotine Tob Res ; 10(11): 1581-9, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18988070

RESUMO

The extent of concurrent use of cigarettes and one or more other tobacco products (polytobacco use) is important to explore because users may be at an increased risk for adverse health effects and nicotine dependency. We determined national population estimates of current cigarette and current polytobacco use for at least 50,000 students from the 2002 and 2004 National Youth Tobacco Surveys. We identified which tobacco products were most often used in conjunction with cigarettes and used multivariate analyses to identify factors associated with polytobacco use. The overall prevalence was 16.0% for current cigarette smoking among all respondents and 15.0% for current cigarette smoking among respondents with complete information on concurrent cigarette and other tobacco product use: 8.1% used cigarettes only, and 6.9% were polytobacco users. Among current male cigarette smokers, 62.0% used other tobacco products; among current female cigarette smokers, 30.9% did. Among current cigarette smokers using one other tobacco product, cigars or smokeless tobacco were the most frequently used products. In multivariate analysis, polytobacco use was associated with being male; being in middle school; residing in the Midwest, South, or West; being able to obtain cigarettes from a retailer; being subject to peer influence; having favorable beliefs about tobacco; being willing to use tobacco promotional items; being exposed to tobacco advertisements; and having higher levels of lost autonomy (an indicator of nicotine dependency). Youth interventions need to broaden their focus to address the use of all tobacco products, paying particular attention to adolescent males and youth living outside of the Northeast.


Assuntos
Comportamento do Adolescente/psicologia , Atitude Frente a Saúde , Comportamento Aditivo/epidemiologia , Fumar/epidemiologia , Tabagismo/epidemiologia , Adolescente , Comportamento Aditivo/psicologia , Causalidade , Comorbidade , Feminino , Humanos , Masculino , Grupo Associado , Rotulagem de Produtos , Fatores de Risco , Assunção de Riscos , Autoimagem , Fatores Sexuais , Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Inquéritos e Questionários , Tabagismo/psicologia , Tabaco sem Fumaça , Estados Unidos/epidemiologia
16.
Tob Control ; 16(5): 318-24, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17897990

RESUMO

OBJECTIVE: To identify the level of effort state tobacco control programmes and partners have expended on interventions recommended by the community guide and how those efforts have changed over time between 1999 and 2004. DESIGN: Longitudinal study. SETTING: United States. PARTICIPANTS: State tobacco control partners, including the state health department, voluntary agencies and tobacco control coalitions. MAIN OUTCOME MEASURE: We used the Strength of Tobacco Control survey responses in 1999, 2002 and 2004 to calculate the mean proportion of state tobacco control partners working on recommended interventions and subsequently analysed changes in effort over time. RESULTS: The proportion of state tobacco control partners working to promote clean indoor air legislation remained at more than 70% in all three years. The proportion working to increase taxes on tobacco rose significantly between 1999 and 2002 (from 54% to 70%), and those working to reduce patient costs for tobacco cessation treatments never exceeded 31% in any year. Use of mass media targeting youths decreased significantly in all years (from 40% to 32% to 26%), and the proportion of state tobacco control partners participating in a quitline has increased steadily and significantly in all years (from 24% to 36% to 41%). The level of effort in each area varied widely between states and over time. CONCLUSIONS: State tobacco control partners are implementing evidence based interventions, but more focus is needed on the tobacco cessation and mass media campaign components of comprehensive tobacco control programmes.


Assuntos
Promoção da Saúde/organização & administração , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Planos Governamentais de Saúde/organização & administração , Promoção da Saúde/métodos , Humanos , Estudos Longitudinais , Meios de Comunicação de Massa , Avaliação de Programas e Projetos de Saúde , Estados Unidos
17.
Addict Behav ; 32(10): 2411-9, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17490825

RESUMO

BACKGROUND: The primary focus of tobacco prevention and cessation interventions has been on cigarette smoking. Polytobacco use (the concurrent use of cigarettes and one or more other tobacco product[s]), may present additional health risks and make cessation more difficult. METHODS: We determined population estimates of tobacco product use and of polytobacco use for more than 50000 adults from 10 states. Logistic regression analyses were used to determine factors independently associated with polytobacco use among men only (due to low use among women). RESULTS: The overall adult prevalence was 22.4% for cigarettes and 3.4% for polytobacco use. Polytobacco use was more common among men who smoked cigarettes, with 26.0% using at least one other product, compared to 4.4% of women cigarette smokers. Polytobacco use among men was significantly associated with younger age, all races/ethnicities except Hispanic, less educational attainment, less income, and more-than-moderate alcohol use. CONCLUSIONS: Prevention and cessation efforts need to target use of other forms of tobacco besides cigarettes, especially among younger men and men who are more-than-moderate drinkers of alcohol.


Assuntos
Tabagismo/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Grupos Étnicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fumar/epidemiologia , Tabagismo/etnologia , Tabaco sem Fumaça , Estados Unidos/epidemiologia
18.
Am J Prev Med ; 28(3): 251-8, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15766612

RESUMO

BACKGROUND: Arthritis and other rheumatic conditions are a common cause of disability among adults in the United States. Telephone interviews of the state-based Behavioral Risk Factor Surveillance System (BRFSS) are used by states and territories to estimate the prevalence of arthritis. The purpose of this study was to assess the validity and reliability of the 1996-2001 BRFSS arthritis case definition in a senior center population. METHODS: A total of 487 respondents at selected senior centers in Georgia were surveyed by telephone, evaluated 3 to 4 weeks later by board-certified rheumatologists, and completed a written survey in 2000 to 2001. Using the rheumatologists' summary assessment "Does this person have arthritis or a related condition" as the standard, the sensitivity and specificity of the BRFSS arthritis case definitions were calculated. Reliability for the BRFSS arthritis case definition was also calculated by comparing responses to the telephone survey with responses to a written survey. RESULTS: Sensitivity was 70.8% (95% confidence interval [CI]=65.9-75.6), and the specificity was 70.3% (95% CI=62.9-77.8). The agreement between the telephone and written responses indicating self-reported arthritis was high (kappa=0.68). Analyses were conducted in 2002 to 2004. CONCLUSIONS: Self-reported arthritis in the 1996-2001 BRFSS was highly reliable, and moderately sensitive and specific among these senior center participants.


Assuntos
Artrite/epidemiologia , Nível de Saúde , Vigilância da População/métodos , Idoso , Artrite/diagnóstico , Feminino , Georgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autorrevelação
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