Experience of violence among teenage mothers in Alaska.

PURPOSE: To quantify the experience of violence before, during, and after pregnancy among teenage mothers compared to older mothers and to identify the proportion of births to teenagers that result from statutory rape. METHODS: We analyzed data collected during 1991-1994 from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based, stratified sample survey of 200 of the approximately 900 Alaska resident women each month who have delivered a live infant. RESULTS: Compared to new mothers at least 20 years of age, mothers < 18 and 18-19 years of age were approximately twice as likely to report having experienced violence during pregnancy (10% vs. 4%) and were two to three times as likely to have experienced violence after pregnancy (10% and 6%, respectively, vs. 3%). When controlling for potentially confounding factors, however, age was associated with the experience of violence only for mothers < 18 years after pregnancy. The percentage of women who reported experiencing violence each week increased following pregnancy for mothers of all ages. At least 38.9% and up to 66.2% of all births to unmarried teenagers younger than 16 years of age resulted from second-degree statutory rape. CONCLUSIONS: Teenage mothers are more likely to experience violence during and after their pregnancy than older women and for women of all ages the risk increases after pregnancy. Nearly half of the births to the youngest teenagers result from second-degree statutory rape.

PIP: Data collected in 1991-94 as part of the Alaska Pregnancy Risk Assessment Monitoring System were used to assess the experience of violence before, during, and after pregnancy among teenage mothers compared with older mothers and to identify the proportion of births to teenagers that result from statutory rape. A total of 7178 new mothers 13-45 years of age were included in this population-based data set. 9.7% of mothers under 18 years of age and 9.4% of those 18-19 years old reported having experienced domestic violence during pregnancy compared with 3.8% of mothers at least 20 years of age; violence after pregnancy was reported by 10%, 6%, and 2.9% of mothers, respectively. When potentially confounding factors (marital status, an unplanned pregnancy, enrollment in a medical assistance program) were controlled, however, age was associated with the experience of violence only for mothers under 18 years of age after pregnancy. The percentage of women who reported domestic violence each week increased after pregnancy for mothers of all ages. 66.2% of all births to unmarried teens under 16 years of age for which the age of the father was recorded resulted from second-degree statutory rape. Pediatricians and family practitioners should be aware of the increased risk of violence that occurs after pregnancy, especially in teen mothers. Recommended are violence prevention and intervention programs at school-based clinics, increased public awareness of the extent and consequences of violence against women, and identification of the specific reasons that teenage mothers experience an increased risk of violence.

Physicians' screening practices for female partner abuse during prenatal visits.

OBJECTIVE: Our purpose was to examine physicians' screening practices for female partner abuse during prenatal visits and to identify barriers to screening. METHODS: A self-administered questionnaire was developed to collect data on physicians' screening practices and their beliefs about screening for female partner abuse. The survey was mailed to all primary care physicians practicing in Alaska. The response rate was 80% (305/383). These analyses were limited to physicians who indicated that they provided prenatal care (n = 157). RESULTS: More than one-half of respondents providing prenatal care estimated that 10% or more of their female patients had experienced abuse. Less than one-half of respondents had recent training on partner abuse. Only 17% of respondents routinely screened at the first prenatal visit and 5% at follow-up visits. Respondents were more likely to screen at the first prenatal visit compared to follow-up visits. Multivariate analyses failed to support any associations between physicians' characteristics and screening practices. Physicians' perception that abuse was prevalent among their patients and physicians' belief that they have a responsibility to deal with abuse were the only variables that were independently associated with screening at prenatal visits. Other barriers frequently cited in the literature were not predictive of screening. CONCLUSION: Most Alaskan physicians do not routinely screen for abuse during prenatal visits. Medical education should increase physicians' index of suspicion for abuse, emphasize physicians' responsibility to address partner abuse, and reinforce the importance of routine screening throughout the pregnancy. More research is needed to identify barriers to screening and strategies for integrating routine screening into prenatal care.

Correlates of drinking during the third trimester of pregnancy in Alaska.

OBJECTIVES: To examine characteristics related to drinking during pregnancy among a population-based sample of women. METHOD: We analyzed data related to third-trimester drinking collected from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS used a population-based, stratified sampling design to survey 9733 of the approximately 44,000 live births to Alaska-resident women during 1991-1994. We defined regular drinking as one or more drinks per week on average during the third trimester. Analyses included bivariate and multivariate associations with any and regular drinking. RESULTS: Of women mailed a survey, 6973 responded and answered the questions related to alcohol consumption. Nine percent reported any drinking during the third trimester and 2.5% were regular third-trimester drinkers. The strongest risk factors for both any and regular third-trimester drinking were older age and marijuana or cocaine use. Other risk factors for any third-trimester drinking included prenatal cigarette smoking, greater education, non-Alaska Native race, the experience of significant life stressors, and residence in a community that did not restrict the sale of alcohol. Other risk factors for regular third-trimester drinking included prenatal cigarette smoking and the experience of domestic violence. Prenatal counseling regarding the effects of alcohol consumption during pregnancy and adequacy of prenatal care were not significantly associated with either outcome variable. CONCLUSIONS: Efforts to decrease prenatal alcohol consumption should be directed at older women and should address social determinants of health, such as education, domestic violence, drug use, and the availability of alcohol. In the absence of these efforts, prenatal alcohol education by health care providers may have little impact on pregnancy-related drinking.

Use of capture-recapture analyses in fetal alcohol syndrome surveillance in Alaska.

Capture-recapture methods were used to estimate the prevalence of fetal alcohol syndrome among Alaska Natives born during the period 1982-1989. Potential cases were identified through an Indian Health Service (IHS) patient case file, a pediatric practice case file, and Medicaid claims from private physicians. A total of 74 Alaska Native children aged 3-10 years were identified with a notation of fetal alcohol syndrome by a physician in a medical record. Because not all of these cases had supporting documentation regarding the syndrome, they were classified as possible cases. Of these possible cases, 50 met all five criteria for chart verification of the syndrome: physician notation of fetal alcohol syndrome, growth deficiency, facial features of the syndrome, central nervous system impairment, and a maternal history of alcohol abuse. These data provided observed prevalence rates of chart-verified fetal alcohol syndrome of 3.1 per 1,000 live births for children born 1982-1985 (age 7-10 years), and 2.0 per 1,000 live births for children born 1986-1989 (age 3-6 years). Capture-recapture analyses were conducted using cases identified by IHS and private physicians. These analyses estimated a prevalence of the syndrome of 3.8 per 1,000 live births for children born 1982-1985, and 3.1 per 1,000 live births for children born 1986-1989. Based on the capture-recapture predicted number of cases, the IHS case file ascertained a greater percentage of cases among the older cohort (75%) than among the younger cohort (56%). These data illustrate the use of capture-recapture analyses in identifying the extent to which observed trends in rates may reflect differences in cases ascertainment over time (or by birth cohort). The application of capture-recapture in fetal alcohol syndrome surveillance, however, requires careful attention to the underlying assumptions of capture-recapture methods.

Association between sudden infant death syndrome and prone sleep position, bed sharing, and sleeping outside an infant crib in Alaska.

OBJECTIVE: To determine the contribution of prone sleeping, bed sharing, and sleeping outside an infant crib to sudden infant death syndrome (SIDS). METHODS: We conducted a retrospective descriptive study of all SIDS cases in Alaska from January 1, 1992, through December 31, 1997. Reviewed data sources included maternal and infant medical records, autopsy reports, birth and death certificates, police and state trooper death scene investigations, and occasionally home interviews. RESULTS: The death certificate identified SIDS as a cause of death for 130 infants (cause-specific infant mortality rate: 2.0 per 1000 live births). Among infants for whom this information was known, 113 (98%) of 115 were found in the prone position, sleeping outside an infant crib, or sleeping with another person. By contrast, 2 (1.7%) were found alone and supine in their crib (1 of whom was found with a blanket wrapped around his face). Of 40 infants who slept with a parent at the time of death, only 1 infant who slept supine with a non-drug-using parent on an adult nonwater mattress was identified. CONCLUSION: Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib. In the absence of other risk factors, SIDS deaths associated with parental bed sharing were rare.

Fetal alcohol syndrome in Alaska, 1977 through 1992: an administrative prevalence derived from multiple data sources.

OBJECTIVES: The prevalence and characteristics of fetal alcohol syndrome cases and the usefulness of various data sources in surveillance were examined in Alaska to guide prevention and future surveillance efforts. METHODS: Sixteen data sources in Alaska were used to identify children with fetal alcohol syndrome. Medical charts were reviewed to verify cases, and records were reviewed to provide descriptive data. RESULTS: Fetal alcohol syndrome rates varied markedly by birth year and race, with the highest prevalence (4.1 per 1000 live births) found among Alaska Natives born between 1985 and 1988. Screening and referral programs to diagnostic clinics identified 70% of all recorded cases. The intervention program for children 0 to 3 years of age detected 29% of age-appropriate cases, and Medicaid data identified 11% of all cases; birth certificates detected only 9% of the age-appropriate cases. CONCLUSIONS: Our findings indicate a high prevalence of fetal alcohol syndrome in Alaska and illustrate that reliance on any one data source would lead to underestimates of the extent of fetal alcohol syndrome in a population.