Relationship status and health: Does the use of different relationship indicators matter?

Studies that analyse the association between relationship status and health usually disregard non-marital relationships. The present study examines if the use of different relationship indicators leads to different associations between relationship status and physical and mental health. The database used for this analysis is the Survey of Health and Ageing in Europe, a large population-based survey of Europeans aged 50 and over and their cohabitants. This study combines cross-sectional and retrospective data of 13 European countries. The sample size is 9298 men and 11,631 women for grip strength and 9609 men and 12,333 women for depression. Generalised estimating equations are used. For men, the goodness-of-fit measure quasi-likelihood under the independence model criterion indicates that marital status is a better predictor than cohabitation status or partnership status for predicting grip strength. However, for grip strength of women, there are only small differences in the model fit between the different relationship indicators. For both men and women, the partnership status (marriage, cohabitation or dating relationship) shows the best model fit for explaining depression. The results suggest that future health research could benefit from the use of relationship indicators other than marital status, particularly regarding mental health.     

Increased Risk of Preterm Delivery in Women Residing near Thermal Power Plants in Taiwan

In this article, the researchers studied the prevalence of preterm births for women living near thermal power plants. The prevalence of delivery of preterm birth infants was significantly higher among women living within 3 km of a thermal power plant than among women living within 3–4 km of a plant. After controlling for several possible confounders (including maternal age, season, marital status, maternal education, infant gender, and birth site), the adjusted odds ratio was 1.14 (95% confidence interval, 1.01–1.30) for delivery of preterm infants for women living close to the thermal power plants. These data provide further support for the hypothesis that air pollution can affect the outcome of pregnancy, although a semiecological study cannot confirm a direct causal relationship.     

Increased risk of preterm delivery in women residing near thermal power plants in Taiwan

In this article, the researchers studied the prevalence of preterm births for women living near thermal power plants. The prevalence of delivery of preterm birth infants was significantly higher among women living within 3 km of a thermal power plant than among women living within 3-4 km of a plant. After controlling for several possible confounders (including maternal age, season, marital status, maternal education, infant gender, and birth site), the adjusted odds ratio was 1.14 (95% confidence interval, 1.01-1.30) for delivery of preterm infants for women living close to the thermal power plants. These data provide further support for the hypothesis that air pollution can affect the outcome of pregnancy, although a semiecological study cannot confirm a direct causal relationship.     

Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996

BACKGROUND: Maternal mortality is a sensitive indicator for inequity in health. We describe recent trends in overall and cause-specific maternal mortality ratio among women of German and non-German nationality residing in West Germany. METHODS: Using birth and death register data for 1980-1996 we related 1067 cases of maternal death (ICD 9: 630-676) to 11.2 million live births. We assessed the effects of nationality and of marital status, a proxy for socioeconomic status, controlling for year of death and age of the mother in a Poisson regression model. RESULTS: Maternal mortality ratio in West Germany decreased from 13 per 100000 live births in 1980-1988 to 6.1 in 1989-1996. The crude relative risk for non-German nationality decreased from 1.9 (95% CI: 1.6-2.3) to 1.3 (1.0-1.7); after adjusting for age, year of death and marital status it was 1.7 (95% CI: 1.4-2.1) and 1.6 (95% CI: 1.2-2.1). Unmarried women incurred an adjusted relative risk of 1.8 (95% CI: 1.5-2.3). Non-German women experienced an excess mortality from abortions which largely disappeared in 1989-1996; concurrently, being unmarried no longer conveyed an additional risk to them. The risk status of German mothers developed unfavourably: increasing proportions are unmarried, which continues to be a marker of elevated relative risk in this group. CONCLUSIONS: Our findings suggest continuously improving accessibility and quality of obstetric services, in particular for women of non-German nationality. Still, inequity in maternal risk continues to exist. Maternal risk, however, is not determined by the simple distinction 'German' versus 'non-German'; its association with socioeconomic status extends beyond nationality.     

Socio-economic factors associated with preterm delivery in Greece: a population-based study

Summary. A total population sample of singleton births to mothers with certain last menstrual period dates was identified from the Greek National Perinatal Survey of April 1983. Two groups were considered (3116 primigravidae and 6524 multigravidae) with preterm rates of 5.9% and 8.4% respectively. Of all 17 factors considered, primigravidae showed unadjusted significant associations between preterm delivery and marital status, region of mother's residence, maternal occupation, maternal education and paternal education level. Multigravidae preterm deliveries were associated with marital status, mother's age at marriage, father's age at marriage, mother's age at delivery, mother's education, father's education and maternal smoking at the end of the pregnancy. Logistic regression was used to identify the socio-economic and demographic characteristics independently associated with preterm delivery. For primigravidae, the only significant factors were maternal marital status and region of the country. For multigravidae, significant factors were maternal age at delivery, marital status and smoking habit at the end of pregnancy.     

Socio-economic factors associated with preterm delivery in Greece: a population-based study

A total population sample of singleton births to mothers with certain last menstrual period dates was identified from the Greek National Perinatal Survey of April 1983. Two groups were considered (3116 primigravidae and 6524 multigravidae) with preterm rates of 5.9% and 8.4% respectively. Of all 17 factors considered, primigravidae showed unadjusted significant associations between preterm delivery and marital status, region of mother's residence, maternal occupation, maternal education and paternal education level. Multigravidae preterm deliveries were associated with marital status, mother's age at marriage, father's age at marriage, mother's age at delivery, mother's education, father's education and maternal smoking at the end of the pregnancy. Logistic regression was used to identify the socio-economic and demographic characteristics independently associated with preterm delivery. For primigravidae, the only significant factors were maternal marital status and region of the country. For multigravidae, significant factors were maternal age at delivery, marital status and smoking habit at the end of pregnancy.     

The biocultural context of social networks and depression among the elderly

The association between the size and structure of social networks and the prevalence of depressive symptoms was examined in a population-based study of 1615 men and women age 65 years and older. Age was significantly associated with marital status, social network index quartile, and the social relationship to the primary source of support. Women and men differed with respect to current marital status, number of close friends and relatives, frequency of face-to-face contact, and participation in voluntary associations and religious institutions. Regardless of their marital status, women were also less likely than men to point to a spouse as their primary source of support. Beck Depression Inventory mean scores and rates of depressive symptoms were inversely associated with social network index and participation in voluntary associations and religious institutions for both men and women. Individuals with no primary source of support or who depended on a relative had significantly higher than expected mean scores and rates of depressive symptoms. Both social network index and social distance to primary source of support were independently associated with depression after controlling for age, sex, and number of chronic conditions. Participation in voluntary associations, social distance from primary source of support, church membership, and number of close friends were also significant independent predictors of depressive symptoms. Results indicate that depressive symptoms are inversely associated with the size of social networks. The structure of these networks, in turn, is influenced by biological factors such as age, physical disability, and mortality of network members, and by culturally-determined rules that define the individuals and institutions available for support. However, these rules appear to differ for men and women.     

Paternal age as a risk factor for low birthweight

OBJECTIVES: We examined associations between paternal age and low birth-weight in the US urban population. METHODS: Using a population-based sample of 4621 births, we used multiple logistic regression analysis to estimate associations between paternal age and low birthweight, controlling for maternal age, other demographic factors, and the child's gender. RESULTS: When the child's gender and the mother's race/ethnicity, birthplace, parity, marital status, and health insurance type were controlled, teenaged fathers were 20% less likely and fathers older than 34 years were 90% more likely than fathers aged 20 to 34 years to have low-birthweight babies. The associations were significant when maternal age was also controlled. No racial/ethnic differences in associations between paternal age and low birthweight were found. CONCLUSIONS: We identified paternal age as an independent risk factor for low birthweight in the US urban population, suggesting that more attention needs to be paid to paternal influences on birth outcomes and to the interactive effects of urban environments and individual risk factors on health.     

Marital Quality and Divorce Decisions: How Do Premarital Cohabitation and Nonmarital Childbearing Matter?

This study used the 1979 cohort of the National Longitudinal Survey of Youth (N = 3,481) to test whether the association between marital quality and divorce is moderated by premarital cohabitation or nonmarital childbearing status. Prior research identified lower marital quality as a key explanation for why couples who cohabit or have children before marrying are more likely to divorce than other couples. Using event history and fixed‐effects models, we found that the effect of marital quality on divorce is similar for cohabitors and noncohabitors, with cohabitors more likely to end both high‐ and low‐quality marriages. In contrast, the relationship between marital quality and divorce is weaker for women with nonmarital births; they are less likely than others to dissolve low‐quality marriages. We discuss how commitment norms and self‐efficacy might explain these differences in the association between marital quality and divorce.     

Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences

Adverse pregnancy experiences were examined retrospectively in relation to adult lifetime experience of clinical depression to see whether such experience conferred long-term risk for women. The sample consisted of just under 200 community-based women, half of whom were selected for high depressive-risk on the basis of adverse childhood experience. Over two-thirds of these women had experienced pregnancy. Adverse pregnancies were classified either in terms of loss (adverse non-live pregnancy/births) or in terms of live births in difficult circumstances (adverse live pregnancy/births). Intensive life history interviews collected details of all pregnancies, childhood neglect/abuse, marital adversity and a history of episodes of clinical depression.Both adverse non-live and live pregnancy experiences were significantly related to lifetime depression. The relationship remained for depression in different time periods and for those episodes unrelated to maternity experience. Both types of adverse pregnancy/birth experiences were associated with increased rates of marital problems. While adverse live pregnancy/births related to prior childhood neglect/abuse, this did not hold for those non-live. Logistic regression showed that only adverse non-live pregnancy/births together with marital adversity and childhood neglect/abuse provided the best model for lifetime depression. The findings are discussed in terms of lifetime trajectories linking difficult environments, close relationships and issues of loss.     

不同特征女性人工流产时焦虑、抑郁情绪及影响因素

目的:研究不同特征女性人工流产时焦虑、抑郁情绪评估及影响因素。方法:以2019年1-7月在本院择期行人工流产者105例,其中已婚54例、未婚51例,手术流产62例、药物流产43例。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价并比较不同特征者人工流产前焦虑及抑郁程度,多因素logistic分析可能影响因素。结果:不同婚姻状态、文化程度、孕次、产次、流产方式者发生术前焦虑及抑郁程度存在差异(P<0.05),不同年龄、流产次数者术前焦虑及抑郁程度评分未见差异(P>0.05);未婚及手术流产者术前焦虑及抑郁情况最高(P<0.05)。多因素分析,流产妇女婚姻状态、文化程度、产次、孕次以及流产方式均为产生术前焦虑情绪的独立危险因素。结论:未婚及手术流产者流产前负面情绪较高,提示临床在行人工流产中,及时开展健康教育,做好咨询工作,降低流产妇女的负面情绪,提升生殖健康质量。     

A study of breast cancer in Irish women.

In a study of 100 women with breast cancer and 200 unaffected women the epidemiological characteristic of breast cancer most commonly described--namely, an excess of nonparous women among cases when compared with controls, was not observed. It is suggested that two factors, a dearth of first births born to mothers under 20 years of age and an unusually high proportion of first births when aged 30 years or more, are responsible for this finding. No association was found between breast cancer and socioeconomic status, marital status, age at marriage, age at first pregnancy, parity, or age at menarche. Significant associations with breast cancer included age at natural menopause, hysterectomy, and breast trauma. These findings are discussed.     

A study of breast cancer in Irish women.

In a study of 100 women with breast cancer and 200 unaffected women the epidemiological characteristic of breast cancer most commonly described--namely, an excess of nonparous women among cases when compared with controls, was not observed. It is suggested that two factors, a dearth of first births born to mothers under 20 years of age and an unusually high proportion of first births when aged 30 years or more, are responsible for this finding. No association was found between breast cancer and socioeconomic status, marital status, age at marriage, age at first pregnancy, parity, or age at menarche. Significant associations with breast cancer included age at natural menopause, hysterectomy, and breast trauma. These findings are discussed.     

Diverging associations of maternal age with low birthweight for black and white mothers

BACKGROUND: In the US, the risk of low birthweight appears to increase more quickly with maternal age for black women than it does for white women. Our aim was to investigate correlates and causes of the racial/ethnic divergence in low birthweight by maternal age. METHODS: We analysed birth certificate data from 96 887 singleton births to black and white mothers in Chicago from 1994 to 1996 to determine if the association between maternal age and low birthweight differed by maternal ethnicity, marital status, and socioeconomic disadvantage. The association of maternal age with risk of low birthweight was examined, considering especially the interactions of maternal age with maternal race/ethnicity, marital status, education, and neighbourhood poverty. RESULTS: In unadjusted data, the risk of low birthweight rose steeply with maternal age for black, but not white, mothers. Adjustment for the main effects of maternal education, marital status, adequacy of prenatal care, cigarette smoking, and neighbourhood poverty accounted for some of the age-related excess risk of black mothers. Further adjustment for interactions of maternal age with these risk factors eliminated the ethnic divergence in age slopes. The fully adjusted analysis indicated that the risk of low birthweight rises more quickly with maternal age for disadvantaged women, regardless of race/ethnicity. CONCLUSION: This analysis suggests that hardships act cumulatively to threaten reproductive health. The particularly steep increase in risk of low birthweight with increasing maternal age for black women is explained by the high prevalence of disadvantage in this population.     

Unintended Childbearing and Knowledge of Emergency Contraception in a Population-Based Survey of Postpartum Women

Objectives We examined the relationship between unintended childbearing and knowledge of emergency contraception. Methods The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based survey of postpartum women. We analyzed data from the 2001 PRAMS survey using logistic regression to assess the relationship between unintended childbearing and emergency contraception while controlling for maternal characteristics such as age, race/ethnicity, education, marital status, family income, and insurance coverage before pregnancy. Results In 2001, 1,795 women completed the PRAMS survey (78.1% weighted response proportion). Of the women who completed the survey, 38.2% reported that their birth was unintended and 25.3% reported that they did not know about emergency contraception before pregnancy. Unintended childbearing was associated with a lack of knowledge of emergency contraception (OR 1.43, 95% CI 1.00, 2.05) after controlling for marital status and age. Conclusions Women in Oregon who were not aware of emergency contraception before pregnancy were more likely to have had an unintended birth when their marital status and age were taken into account. Unintended birth was more likely among women who were young, unmarried, lower income, and uninsured. Given that emergency contraception is now available over-the-counter in the US to women who are 18 years of age or older, age- and culturally-appropriate public health messages should be developed to expand women’s awareness of, dispel myths around, and encourage appropriate use of emergency contraception as a tool to help prevent unintended pregnancy and birth. An erratum to this article can be found at     

Trimester of Maternal Gestational Weight Gain and Offspring Body Weight at Birth and Age Five

To investigate associations of trimester-specific GWG with fetal birth size and BMI at age 5?years. We examined 3,015 singleton births to women without pregnancy complications from the Child Health and Development Studies prospective cohort with measured weights during pregnancy. We used multivariable regression to examine the associations between total and trimester gestational weight gain (GWG) and birth weight for gestational age and child BMI outcomes, adjusting for maternal age, race/ethnicity, education, marital status, parity, pre-pregnancy body mass index (BMI), and smoking; paternal overweight, gestational age, and infant sex. We explored differences in associations by maternal BMI and infant sex. GWG in all trimesters was significantly and independently associated with birth weight with associations stronger, though not significantly, in the second trimester. First trimester GWG was associated with child BMI outcomes (OR for child overweight?=?1.05; 95% CI?=?1.02, 1.09). Each kg of first trimester GWG was significantly associated with increased child BMI z-score in women of low (???=?0.099; 95% CI?=?0.034, 0.163) and normal (???=?0.028; 95% CI?=?0.012, 0.044), but not high pre-pregnancy BMI. GWG in all trimesters was associated with birth weight; only first trimester GWG was associated with child BMI. If replicated, this information could help specify recommendations for maternal GWG and elucidate mechanisms connecting GWG to child BMI.     

Depression and occupational injury: results of a pilot investigation

OBJECTIVE: Even mild clinical depression can cause decreased vigilance, attention span, increased irritability, and insomnia-all well-known precursors to occupational injury. This pilot project explores the relationship between occupational injury and depression. METHOD: One hundred twenty-one individuals with recent work-related injuries and 140 without work-related injuries completed a self-administered depression screening instrument (PHQ-9). We compared the two groups using bivariate analyses. The impact of depression on injury was examined using logistic regression analysis controlling for employment history, marital status, age, and sex. RESULTS: Overall, injured workers in this study were not more likely to be depressed than a comparison group of uninjured workers. However, injured women had significantly higher depression scores than non-injured women (P = 0.04); no such difference was found for men. CONCLUSIONS: These data suggest that depression may serve as a precursor to occupational injury for women.     

Relationship Quality and Depressed Affect Among a Diverse Sample of Relationally Unstable Relationship Education Participants

The association between depression and marital satisfaction has been clearly documented. Theoretical approaches describe the direction of effects as depression leading to marital dissatisfaction (stress generation model) and, alternately, marital dissatisfaction leading to depression (marital discord model). Clinical research indicates that treating the relationship of unstable couples can result in improvements in relationship satisfaction and depression. However, many unstable couples may not attend therapy and choose rather to attend Couple and Relationship Education (CRE). Using 250 ethnically diverse couples in community CRE classes, the authors found that relationally unstable participants of CRE report improvements in depressed affect and relationship quality after program participation. Additionally, decreased depressed affect predicted increased relationship quality, not vice versa, and there were no differences by sex. The authors note the potential value of CRE for unstable couples and recommend that interventionists utilize an inclusive approach, devoting attention to the couple relationship as well as individual distress variables.     

Trends in low birth weight infants and changes in Baltimore's childbearing population, 1972–77

Linked birth and death records provided the population for a study of trends in low birth weight (LBW) rates in Baltimore between 1972 and 1977 and of the effect of changes in the characteristics of the childbearing population on these trends. The impact of shifts in the birth weight distribution on neonatal mortality rates was also investigated. Trends were analyzed for unstandardized LBW rates as well as for rates standardized on the distributions of maternal age, education, gravidity, prior pregnancy losses, and marital status.Between 1972 and 1977, the 1,500 and 2,000 gm rates rose significantly by approximately 1 infant per 1,000 live births per year among whites and 2 infants per 1,000 live births among nonwhites. Despite declines in rates for most weights, the effect of these increases was a rise in neonatal mortality rates for both races, but especially for nonwhites.The population of women delivering in Baltimore in 1977 became slightly older, slightly more educated, and of higher gravidity than in 1972, but these changes had little impact on yearly fluctuations in LBW rates. In contrast, increases in births to unmarried women and to women with at least one prior pregnancy loss were related to rising LBW rates. For both races, standardization on marital status and prior pregnancy losses diminishes the increase in the LBW rate over the study period, especially when standardization is performed simultaneously for both variables. These findings hold within maternal age, education, and gravidity groups. However, the LBW rates for nonwhite teenage mothers and for nonwhite women with 12 years of less education increased significantly over the study period, regardless of standardization.