Barriers to adolescent prenatal care.

It is estimated that over one-half of all adolescent mothers receive inadequate prenatal care. Our objectives were to explore the barriers to care as perceived by adolescents and to develop a model to identify adolescents at risk for inadequate care. Structured interviews were conducted with 101 adolescents less than 17 years of age who delivered infants at an urban university hospital between September 1988 and January 1989. All the interviews were conducted within 48 hr of delivery by a single investigator. The Maternal Health Services Index was used to divide subjects into those who received inadequate care (Group 1, n = 37) and those who received intermediate or adequate care (Group 2, n = 64). Both groups were predominantly black (99%), poor (mean Hollingshead score = 2), and unmarried (99%). Groups 1 and 2 differed (p less than 0.05) in 12 variables pertaining to beliefs about prenatal care and course during the pregnancy. Of the 12 variables, 7 comprised a stepwise logistic regression model designed to maximally differentiate Groups 1 and 2--negative attitudes towards physicians (20% vs 6%), perceived importance of first trimester care (78% vs 94%), confusion about available prenatal services (24% vs 5%), lack of health insurance (41% vs 16%), exposure to pregnant friends (76% vs 95%), mean gestational age at recognition of pregnancy (15 wks vs 11 wks), and desire for an adolescent-only prenatal clinic (78% vs 58%). The adjusted odds ratios of the variables ranged in declining order from 15.4 to 4.7. The attributable risks, or etiologic fractions, of the variables ranged in increasing order from 0.19 to 0.49. Receiver-operating characteristic curve analysis of the model demonstrated a curve area of 0.89 +/- 0.04, significantly better than chance. We conclude that the model clarifies the barriers to care and helps identify pregnant adolescents who are likely to receive inadequate prenatal care.     

Pregnant African-American teens are less likely than their nonpregnant peers to use condoms

OBJECTIVE: The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition. METHODS: Sexually active African-American females (N = 522), ages 14-18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded. RESULTS: Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%). CONCLUSIONS: Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.     

Pregnancy weight gain in adolescents and young adults

We examined whether adolescents required greater prenatal weight gains than nonadolescents to deliver equal weight babies following a low-risk pregnancy. Maternal characteristics and monthly weight gains were collected from medical records obtained from a private health maintenance organization (n = 423). Maternal weight gain, gestational age, parity, and cigarette use during pregnancy were significant predictors of infant birth weight in our regression models. Subjects were nonsmokers with a gestational age greater than 37 weeks and a parity equal to 0 who entered prenatal care during the first trimester of pregnancy. Mean total weight gains for the adolescents (16.2 +/- 4.8 kg; n = 51) and adults (15.2 +/- 5.4 kg; n = 65), and infant birth weights were similar. Mean infant birth weight was 3473 +/- 394 g for the adolescents and 3339 +/- 453 g for the young adults, whereas the optimal weight range for newborns is about 3500-3999 g. Modifiable risks are the important predictors of infant birth weight, and adolescents do not appear to require a greater weight gain than young adults to deliver similar weight babies.     

Mental health problems among pregnant and non-pregnant youth

OBJECTIVE: To estimate the prevalence of mental health problems in primiparous adolescents and to compare their mental health profile with the profile of sexually active adolescents who have never gotten pregnant. METHODS: Cross-sectional study that compared two groups of adolescents aged 13 to 17 years from a city in Southern Brazil, 2003-2004. The sample included 207 primiparous who attended prenatal care programs in urban public services, and 308 sexually active students from state public schools who had never gotten pregnant. A screening instrument to identify mental health problems in adolescents (Brazilian version of the Youth Self-Report) was applied to the participants together with a questionnaire on risk factors for pregnancy in adolescence. Statistical analysis included Chi-square tests, Fisher's exact test, Mann Whitney's U and logistic regression models. RESULTS: Pregnant and non-pregnant adolescents did not differ in the prevalence of total mental health problems (24.6% vs. 27.3%; p=0.50). Compared to the group of never pregnant adolescents, the group of primiparous presented higher prevalence of anxious/depressive symptoms (24.2% vs. 15.3%; p=0.01) and withdrawn/depressed symptoms (13.0% vs., 4.5%; p<0.001) and there was a greater number of tobacco users (21.3% vs. 11.0%; p=0.002). These differences were confirmed by logistic regression models controlled for maternal education. CONCLUSIONS: Anxiety and depression symptoms and tobacco use were more frequent in pregnant adolescents in comparison to non-pregnant. These problems require special attention from prenatal care services in order to avoid potential damages for the health of mothers and their children.     

AIDS/HIV knowledge level and perceived chance of having HIV among rural adolescents.

Behaviors that increase the risk of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) among adolescents living in rural areas have been reported to be as frequent as those of lower socioeconomic minority youth living in large urban areas. Little is known, however, about whether rural adolescents possess adequate knowledge upon which to make responsible decisions to avoid exposure to HIV. In order to address this deficit, we administered the Centers for Disease Control (CDC) 1989 Secondary School Health Risk Survey to 294 sixth, seventh, and eighth grade students (30.2% sample) from a rural county with significant social problems including epidemic sexually transmitted diseases STDs, sex-for-drugs, poverty, and drug abuse. The sample was 65% African-American, 50% female, with a mean age of 12.9 +/- 1.3 years. Although 68% reported having received school-based AIDS education, a lower proportion (greater than or equal to 10%) the students were found to correctly answer 8 of 17 AIDS/HIV knowledge questions than those from a national comparison group. The mean was 12.8 +/- 3.1 of 17 items answered correct. Lower AIDS/HIV knowledge was associated with lower school grade (rho = 0.46, p less than or equal to 0.0001); being African-American, Hispanic, or Native American (p less than or equal to 0.043); and never receiving school-based AIDS/HIV education (p less than or equal to 0.0001). Based on multivariate analysis of variance (ANOVA), only school-based AIDS/HIV education was a significant predictor (p less than or equal to 0.0001) of knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)     

Personal values and sexual decision-making among virginal and sexually experienced urban adolescent girls.

PURPOSE: To guide the development of an intervention to reduce the incidence of sexually transmitted diseases (STDs) in urban, adolescent girls, we investigated such girls' reasons for deciding to have or not to have sexual intercourse. METHODS: Consecutive girls >or=14 years of age attending an urban adolescent clinic were invited to complete an anonymous survey about sexual decision-making. In this pilot study, girls were asked: (a) whether they agreed with a statement that they had or had not had sexual intercourse "because of my values and beliefs"; and (b) to select from a list one or more specific reasons why they had or had not had intercourse. The girls were categorized by self-report as either "virgins," "currently inactive" (no intercourse in the preceding 3 months), or "currently active" (had intercourse during the preceding 3 months). RESULTS: Usable surveys were obtained from 197 adolescents whose age (18.2 +/- 2.6 years) and race (69% black) were comparable to those of clinic attendees in general. Forty girls (20%; age 16.1 +/- 2.1 years) were virgins, 25 girls (13%; age 17.8 +/- 2.3 years) were inactive, and 132 girls (67%; age 18.9 +/- 2.5 years) were currently active. "Values and beliefs" were cited as the reason for decisions about sexual behavior by 53% of the virgins, but only by 24% of the sexually inactive and 24% of the sexually active girls (p = .002). Virgins were more likely than inactive girls to cite three specific reasons for not having sex: "not the right thing for me now" (82% vs. 50%, p = .007), "waiting until I am older" (69% vs. 8%, p = .001), and "waiting until I am married" (67% vs. 38%, p = .02). The reason "against my religious beliefs" was cited by 23% of virgins and 13% of inactive girls (p = not significant). Personal values were implicit in the two specific reasons for having sex that active girls chose most frequently, namely, "I like/love the person" (86%) and "I like having sex" (37%), although only 24% of these girls had explicitly cited "values and beliefs" as their reason for having sex. CONCLUSIONS: Our data indicate that urban girls, both those who have had sexual intercourse and those who have not, view their sexual behavior as being based on personal (although infrequently religious) values. Many of the virginal urban, adolescent girls we surveyed hold abstinence as a personal value. The sexually active adolescents perceive the decision to have sexual intercourse as being based affirmatively on their personal values rather than on the chance occurrence of opportunities to have intercourse. These data may be useful in the development of new strategies for reducing urban adolescent girls' risk of acquiring sexually transmitted diseases.     

Truth Be Told: Adolescents’ Disclosure of Sexual Activity to Healthcare Providers

PurposeThe purpose of this study was to describe whether adolescent and young adult patients truthfully disclose sexual activity to providers during a sexual history and explore associations between disclosure and receipt of recommended services.MethodsData from the 2018 National Survey of Sexual Health and Behavior were used to describe self-reported disclsoure of sexually active 14- to 24-year-olds who had a health care visit in the previous year where a sexual history was taken (n = 196). We examined bivariate associations between disclosure and age, race/ethnicity, sex, sexual identity, and receipt of sexual health services.ResultsMost (88%) respondents reported telling their provider the truth about sexual activity. A higher proportion of the younger adolescents (14- to 17-year-olds) did not disclose compared with the 18- to 24-year-old respondents (25.4% vs 3.9%; p < .001). A higher proportion of patients who disclosed reported having a sexually transmitted disease test (69.6% vs 26.7%; p < .001); being offered a sexually transmitted disease test (44.3% vs 4.5%; p < .001); and being asked by providers about number of partners (54.3% vs 15.4%; p < .01).ConclusionsMost young patients disclose their sexual history to their provider, but younger patients might be less likely to do so. Positive patient-provider relationships may encourage disclosure of sexual activity and support receipt of indicated sexual and reproductive health services.     

Infrequency of sexually transmitted disease screening among sexually experienced U.S. female adolescents

CONTEXT: Since 1993, the Centers for Disease Control and Prevention and professional medical organizations have recommended that all sexually experienced female adolescents receive annual screening for Chlamydia trachomatis. Whether adolescents receive this care is largely unknown. METHODS: Reports of receipt of testing or treatment for a sexually transmitted disease (STD) in the past year, as well as sites of care, were obtained from 3,987 sexually experienced females in grades 7-12 who participated in Wave 1 of the National Longitudinal Study of Adolescent Health, conducted in 1995. Logistic regression was used to determine predictors of reporting care. RESULTS: Eighteen percent of all participants reported having received STD services in the past year. Of those who reported having had a routine physical examination in the past year, 22% reported receipt of STD services. The proportion reporting STD care increased linearly with age from 9% of 12-13-year-olds to 25% of those 19 or older. In adjusted analyses, the odds of reporting testing or treatment were elevated among participants who had had a physical examination in the past year (odds ratio, 2.1), those with Medicaid or Medicare insurance (1.9), black women (1.5) and older adolescents (1.2). Adolescents most often reported having received STD care at a community health center (44%) or a private physician's office (31%). CONCLUSIONS: Continued inadequate screening may contribute to persisting high prevalence of chlamydia infection among adolescents. Future research is needed to determine whether the proportions of adolescents receiving recommended STD screening have increased over time.     

Obstetric care and payment source: do low-risk Medicaid women get less care?

OBJECTIVES: This study examined whether Medicaid-insured women at low risk receive less adequate obstetrical care than privately insured women. METHODS: Low-risk women who were cared for by a random sample of obstetrical providers in Washington State were randomly selected. Information on all prenatal and intrapartum services was abstracted from medical records. Service information was aggregated into standardized resource-use units. Results compared Medicaid-insured women with those who were privately insured. RESULTS: Medicaid-insured women were significantly younger (22.5 years vs 26.9 years) and averaged 6% fewer visits than privately insured women. Nonetheless, Medicaid status had no meaningful association with prenatal, intrapartum, or overall resource use. Some variation occurred in individual resources received. Medicaid-insured women had 38.8% more resources expended on testing for sexually transmitted diseases. Privately insured women had more resources expended on alpha-fetoprotein testing and on amniocentesis. There were no meaningful differences in birthweight or gestational age at delivery. CONCLUSIONS: In this study of women who entered obstetrical care at low risk, similar care and resources were expended on Medicaid-insured and on privately insured women.     

Teenage Pregnancy in the Texas Panhandle

PURPOSE: This study compares rural and small-city teenage and adult pregnancies, with respect to complication rates and pregnancy outcomes. METHODS: Chart review of Medicaid patients (513 teenage [under 20 years] and 174 adult controls [ages 25-34]) delivered (excluding multiple gestation) in Amarillo, Texas, from January 1999 to April 2001. Demographic data collected included maternal race, gravidity, parity, smoking status, drug usage, presence of antenatally diagnosed sexually transmitted disease(s), county type (rural vs small city) and number of prenatal visits. Outcomes included mode of delivery, primary cesarean section rates, preterm birth (<34 or <37 weeks), birth weight, birth weight <2500 g, preeclampsia, total maternal weight gain, hemoglobin changes after delivery, Apgar scores, and neonatal intensive care unit admissions. Statistical comparisons between groups were made for a number of factors and outcomes (P < .05). RESULTS: Teenagers did not have a significantly higher frequency of either illicit drug or tobacco usage, but teenagers <17 years had a greater incidence of sexually transmitted diseases (19.8% vs 10.4%, P < .008) and preeclampsia (7.1% vs 2.3%, P < .025, odds ratio 3.2 [1.1 to 9.9]) when compared with adults. The total weight gain was highest for teens < or =17 years (36.4 pounds vs adults: 28.2, P < .001). The primary cesarean section rate was higher in adults (all teens 18.5% vs adults 38.6%, P < 001). County rurality had no impact on any of the observed findings or variables tested. CONCLUSIONS: Young teenagers have a higher incidence of sexually transmitted diseases and preeclampsia and also gain significantly more weight with pregnancy than young adults. However, the pregnancy outcomes were no different for rural vs small city teens.     

Pelvic inflammatory disease in the adolescent

We studied 171 women, 106 young adults, and 65 adolescents, with a clinical diagnosis of pelvic inflammatory disease (PID) to determine whether differences existed in the presentation in these two groups. The study population was an age-stratified, random sample obtained from 1162 women with this condition. Demographic characteristics, sexual history, physical findings, severity of illness, and laboratory findings were compared between the two groups. The most significant findings were that the adolescents sought health care later in the course of the illness (7.8 vs. 5.6 days; p < 0.02) and were more commonly infected with the gonococcus (42% vs. 28%; p < 0.05). No statistically significant differences were found in the other parameters evaluated. Implications of these findings regarding the health care for sexually transmitted diseases (STDs) and the education of adolescents are discussed.     

Health care seeking behaviors related to sexually transmitted diseases among adolescents.

OBJECTIVES: This study identified social, cognitive, and behavioral factors associated with how adolescents seek health care for sexually transmitted diseases. METHODS: Data for male and female adolescents (n = 208) attending a clinic specializing in sexually transmitted diseases were examined. RESULTS: Symptomatic female adolescents required greater time to obtain care than asymptomatic female adolescents or symptomatic male adolescents. Factors affecting duration of care seeking interval included perception of barriers to care, lower self-efficacy for response to a sexually transmitted disease, greater perceived seriousness of sexually transmitted diseases, previous history of sexually transmitted diseases, and stigma. CONCLUSIONS: Improved secondary sexually transmitted disease prevention efforts among adolescents require reductions in barriers to care and improved symptom recognition by adolescents.     

Obesity and overweight in young adults: the CARDIA study

The associations of body size with age, race, sex, and education in young adults were examined in 5,115 black and white, men and women ages 18-30 years. Black women were more obese than white women with greater mean levels of body mass index (25.8 vs 23.1 kg/m2), subscapular skinfold thickness (19.9 vs 15.2 mm), and waist girth (76.7 vs 72.0 cm), all P less than 0.0001. Black women were more likely to exceed 20% of ideal body weights (black women 23.7%, white women 9.1%, P less than 0.0001). No similar differences were found in men. Associations of measures of body size with age and education differed among race/sex groups. Body mass index and skinfolds increased with age among white and black men and black women, but not among white women. The association of education with obesity was negative among white women and positive among black men with no significant association noted among white men and black women. These data show a complex relationship between age, sex, race, education, and obesity in young adulthood.     

A comparison of sexual behaviour and attitudes of healthy adolescents in a Danish high school in 1982, 1996, and 2001

AIM: To assess changes in sexual behaviour among students at a high school in Denmark from 1982 to 2001. METHODS: An anonymous self-administered questionnaire was used to compare data from three identical cross-sectional surveys performed in 1982, 1996, and 2001. RESULTS: Girls: More girls reported their first sexual intercourse before their 16th birthday in 2001 (42%) than in 1996 (29%) In 1982 it was also 42% (Chi-square for trend: p = 0.003). Fewer girls with no regular partner used condoms for their personal protection in 2001 (2%) than in 1996 (9%) and 1982 (0%) (Chi-square for trend p = 0.016). The proportion of girls with no regular partner who considered protection from sexually transmitted disease important for their choice of contraception was 39% in 2001 compared with 71% in 1996 and only 10% in 1982 (Chi-square for trend: p < 0.0001).Boys: More boys reported sexual debut before their 16th birthday in 2001 (40%) than in 1996 (37%) and 1982 (24%) (Chi-square for trend: p = 0.023). For boys with no regular partner, condom was preferred for personal protection by 85% in 2001, 91% in 1996 and 61% in 1982 (Chi-square for trend p = 0.007). Protection against sexually transmitted infection declined, especially among boys with no regular partner, from 51% in 2001 to 72% in 1996 and 21% in 1982 Chi-square for trend: p < 0.0001).The tendency towards earlier sexual debut and less use of safe sex practices to protect against sexually transmitted infections (STI) was accompanied by a rise in the number of detected STIs during this period. CONCLUSIONS: The period from 1982 to 1996 during which sexual attitudes were directed toward safer sex seems to have given way to a reverse trend in the period from 1996 to 2001. These findings may have significant implications for health care authorities organising preventive strategies for healthy adolescents.     

Adolescent suicide attempters: do physicians recognize them?

The single most important risk factor for adolescent suicide is a previous attempt. It is unclear if physicians can identify adolescents who have attempted suicide. Our objectives were to determine the prevalence of previous attempts in an adolescent clinic population, if physicians identify attempters, and if attempters demonstrate persistent distress. Of 332 patients aged 12-19 years attending a medical clinic, 48 (14.5%) reported a previous attempt. The physician's visit note documented that only 8 (16.7%) of the 48 attempters were asked about suicidal behavior. Attempters were more likely than nonattempters (p less than 0.05) to be female; to come to clinic without a guardian; to give a chief complaint pertaining to sexually transmitted disease, obstetrics-gynecology, or mental health; and to report previous mental health care. Attempters had poorer mean scores (p less than 0.05) on validated subscales for family relationships, social competence, depression, unpopularity, somatic complaints, thought disorders, delinquency, aggression, and identity. We conclude that suicide attempts are common among adolescent clinic patients, that physicians may not recognize attempters, and that attempters remain distressed and in need of care. Physicians who see adolescents for routine medical problems must consider the potential for self-destructive behavior, regardless of the presenting complaint.     

Very-low-calorie diets with high and low protein content: impact on triiodothyronine, energy expenditure, and nitrogen balance

Optimal composition of reducing diets remains controversial. Seventeen obese inpatients received 440 kcal/d, either 41% protein plus 55% carbohydrate (CD) or 95% protein (PP), for 3 wk. There were no significant diet effects (all data CD vs PP) in weight loss (8.88 +/- 1.01 vs 8.74 +/- 0.79 kg), loss of lean mass (2.10 +/- 0.35 vs 1.61 +/- 0.39 kg), metabolic rate reduction (15.3 +/- 2.8 vs 13.0 +/- 5.2%), or meal-stimulated thermogenesis (26.6-37.9 vs 29.0-26.1 net kcal/3 h [time NS also]). Triiodothyronine (T3) responses differed (2.35 +/- 0.11 to 1.57 +/- 0.14 vs 2.43 +/- 0.11 to 1.47 +/- 0.12 nmol/L, p less than 0.01) as did free T3 (3.4 +/- 0.2 to 2.6 +/- 0.2 vs 3.2 +/- 0.2 to 2.0 +/- 0.2 pmol/L, (p less than 0.01]; thyroxine declined similarly in both groups. Subjects fed CD gained no advantage over subjects fed PP. Regression analyses revealed no relationship between thyroid hormones, energy deficit, or lean mass with nitrogen losses, suggesting that other or more complex processes govern endogenous protein metabolism during weight loss.     

Older, but not wiser: how men get information about AIDS and sexually transmitted diseases after high school

CONTEXT: As they reach adulthood, young men are less likely to use condoms and are at increased risk for exposure to AIDS and other sexually transmitted diseases (STDs). Little is known about which prevention efforts reach men in their 20s. METHODS: Longitudinal data from the 1988, 1990-1991 and 1995 waves of the National Survey of Adolescent Males are used to identify sources of information about AIDS and STDs among 1,290 young men aged 22-26. Information receipt from four main sources, the topics covered by each source and the personal characteristics associated with getting more information are all explored. RESULTS: Twenty-two percent of men surveyed discussed disease prevention topics with a health provider in the last year, 48% attended a lecture or read a brochure, 51% spoke to a partner, friend or family member, and 96% heard about AIDS or STDs from the media (e.g., television advertisements, radio or magazine). Excluding media sources, 30% of young men reported getting no STD or AIDS prevention messages in the last year. Being black or Hispanic, having had a physical exam or an AIDS test in the last year, and having discussions about AIDS or STDs with parents or a health care provider in the past were associated with receiving more information. CONCLUSIONS: Although young men who are at higher risk for STD or HIV infection are more likely than other young men to get information about disease prevention, young adult men are much less likely than adolescents to receive AIDS or STD prevention education. More prevention efforts need to be aimed at young adults.     

Longitudinal prediction of sexually transmitted diseases among adolescents: results from a national survey

BACKGROUND: Although adolescent use of condoms has been increasing, incidence of sexually transmitted diseases (STDs) among young people remains high. To identify adolescent behavioral risk factors for acquiring STDs, this study assessed adolescent self-reports of acquired chlamydia, gonorrhea, syphilis, and trichomoniasis within 1 year after a baseline interview. METHODS: We used data from the National Longitudinal Survey of Adolescent Health for this study. Data were collected in the homes of survey respondents, using audio-computer-assisted self-interview (audio-CASI) technology and interviews. Participants were enrolled in grades 7-11 from 134 U.S. schools. A cohort of 4593 sexually experienced adolescents was followed for 1 year. We conducted separate analyses for both genders. RESULTS: About 3.1% of the male adolescents and nearly 4.7% of the female adolescents reported having had at least one STD after the baseline interview. For both genders, self-reported STD infection before baseline interview was the best predictor of self-reported STD infection 1 year after baseline interview. Female adolescents were more likely to report diagnosis with an STD after baseline if they self-identified as a minority race (other than Asian) and perceived that their mother did not disapprove of their having sex. Female adolescents were less likely to report STDs if they perceived that adults care about them. No additional variables predicted STD diagnosis after baseline for male adolescents. CONCLUSIONS: We conclude that past history of STD infection is the most important indicator of subsequent STD infection among adolescents. Thus, this study suggests the benefit of specific clinical efforts designed to promote preventive behavior among adolescents newly diagnosed with an STD.     

Racial Differences in Perceived Barriers to Prenatal Care

Objectives: It is well known that black women are less likely to receive adequate prenatal care than white women. This study examines whether there are differences in barriers to prenatal care reported by black and white mothers. Method: Data from the 1988 National Maternal and Infant Health Survey were used to measure relationships between race and reported financial, service, and personal barriers to prenatal care use, adjusting for maternal age, parity, education, poverty level, and insurance coverage during pregnancy. All analyses were stratified by marital status because of substantial effect modification. Results: Among married women, 12.1% of black women reported at least one barrier to prenatal care compared to 9.8% of white women. However, after adjustment for demographic and socioeconomic factors, black women were less likely to report a barrier odds ratio [OR] of 0.8; 0.6–1.0). Unmarried black women were less likely to report any barriers to care than white unmarried women (17.9% vs. 25.6%). After adjustment, the OR was 0.4 (0.3–0.5). Conclusions: This study suggests that though black women are less likely to receive prenatal care than white women, they are less likely to report barriers to such care. This may be due to differing expectations from the health system. The investigation of perceived barriers to care is important to the consequent understanding of what steps must be taken to assure that pregnant women do not experience obstacles to the receipt of prenatal care.     

The use of bicycle helmets in a western Canadian province without legislation

INTRODUCTION: This study examined the use of helmets in adults, adolescents, and children in a western Canadian province that has no helmet legislation. METHODS: A prospective survey of cyclists in two urban Alberta regions was completed. Cyclist demographics, helmet wearing and helmet use were recorded. RESULTS: Helmets were observed in 2,259 (55%; 99% CI: 52-57) of 4,141 cyclists; however, only 75% (CI 71, 78) were wearing the helmet properly. Patterns of use varied according to age: 75% (CI 71, 78) of children, 29% (CI 23, 34) of adolescents, and 52% (CI 49, 55) of adults wore helmets. Percentages were higher in Calgary than Edmonton (63% vs. 45%; p < 0.0001) and females wore helmets more often (64% vs. 50%; p < 0.0001). DISCUSSION: These results identify large within- and between-region variation in the use of cycling helmets in Alberta. Injury prevention planners need to use these data to adopt interventions that are focused on age groupings, gender, and place of residence.