Why do foreign-born blacks have lower infant mortality than native-born blacks? New directions in African-American infant mortality research.

OBJECTIVE: This study focuses attention on maternal nutrition and stress as possible reasons for excess black infant mortality after exploring lower infant mortality for the infants of foreign-born black mothers compared to native-born black mothers. METHODS: All births to non-Hispanic black women in New York City from 1988-1992 were examined and infant mortality for the infants of native-born women was compared to infant mortality for the infants of foreign-born women. RESULTS: Before controlling for potential confounders on the birth certificate, the infants of native-born black women had a greater risk of infant mortality than the infants of foreign-born black women: OR = 1.48 (95% confidence interval [CI] = 1.38, 1.58). After controlling for potential confounders, the infants of native-born black women still had a greater risk of infant mortality than the infants of foreign-born black women: OR(a) = 1.32 (95% Cl = 1.21, 1.43). CONCLUSIONS: Maternal nutrition and stress are possible causes of excess black infant mortality. They should be topics for research and program development.     

The effect of parental race on fetal and infant mortality in twin gestations

Previous work has found that singleton birth outcomes are better if the father is black and the mother is white than if the father is white and the mother is black. We sought to examine the effects of parental race on fetal and infant mortality in twins. We analyzed the fetal and infant mortality rates in four groups [both parents white (W-W), both parents black (B-B), father black and mother white (FB-MW), and father white and mother black (FW-MB)], using the 1995--1997 U.S. twin registry data (249,221 twins). Compared to W-W, the infant mortality for B-B, FW-MB, and FB-MW (respectively, relative risk [RR] 1.84, 95% confidence interval [CI] 1.73-1.95; RR 1.39, 95% CI 1.03-1.51; and RR 1.49, 95% CI 1.26-1.77) were all significantly different from W-W but not from each other. When fetal mortality was added to infant mortality, the combined mortality was highest for B-B (RR 1.66, 95% CI 1.58-1.75), intermediate for FW-MB (RR 1.18, 95% CI 0.92-1.51) and FB-MW (RR 1.37, 95% CI 1.19-1.58) and lowest for W-W. Thus, twin infants born to black parents have higher risk of fetal and infant mortality compared with twin infants born to white parents and infants of mixed race parents generally have intermediate outcomes.     

Bias in online recruitment and retention of racial and ethnic minority men who have sex with men

Background

The Internet has become an increasingly popular venue for men who have sex with men (MSM) to meet potential sex partners. Given this rapid increase in online sex-seeking among MSM, Internet-based interventions represent an important HIV (human immunodeficiency virus) prevention strategy. Unfortunately, black and Hispanic MSM, who are disproportionately impacted by the HIV epidemic in the United States, have been underrepresented in online research studies.

Objective

Our objective was to examine and quantify factors associated with underrecruitment and underretention of MSM of color in an online HIV behavioral risk research study of MSM recruited from an online social networking site.

Methods

Internet-using MSM were recruited through banner advertisements on MySpace.com targeted at men who reported in their MySpace profile their age as at least 18 and their sexual orientation as gay, bisexual, or unsure. Multivariable logistic regression models were used to estimate the odds stratified by race and ethnicity of the MySpace user clicking through the banner advertisement. To characterize survey retention, Kaplan-Meier survival curves and multivariable Cox proportional hazards models identified factors associated with survey dropout.

Results

Over 30,000 MySpace users clicked on the study banner advertisements (click-through rate of 0.37%, or 30,599 clicks from 8,257,271 impressions). Black (0.36% or 6474 clicks from 1,785,088 impressions) and Hispanic (0.35% or 8873 clicks from 2,510,434 impressions) MySpace users had a lower click-through rate compared with white (0.48% or 6995 clicks from 1,464,262 impressions) MySpace users. However, black men had increased odds of click-through for advertisements displaying a black model versus a white model (adjusted odds ratio [OR] = 1.83, 95% confidence interval [CI] 1.72 - 1.95), and Hispanic participants had increased odds of click-through when shown an advertisement displaying an Asian model versus a white model (adjusted OR = 1.70, 95% CI 1.62 - 1.79). Of the 9005 men who consented to participate, 6258 (69%) completed the entire survey. Among participants reporting only male sex partners, black non-Hispanic and Hispanic participants were significantly more likely to drop out of the survey relative to white non-Hispanic participants (hazard ratio [HR] = 1.6, 95% CI 1.4 - 1.8 and HR = 1.3, 95% CI 1.1 - 1.4, respectively). Men with a college-level of education were more likely to complete the survey than those with a high-school level of education (HR = 0.8, 95% CI 0.7 - 0.9), while men who self-identified as heterosexual were more likely to drop out of the survey compared with men who self-identified as gay (HR = 2.1, 95% CI 1.1 - 3.7).

Conclusions

This analysis identified several factors associated with recruitment and retention of MSM in an online survey. Differential click-through rates and increased survey dropout by MSM of color indicate that methods to recruit and retain black and Hispanic MSM in Internet-based research studies are paramount. Although targeting banner advertisements to MSM of color by changing the racial/ethnic composition of the advertisements may increase click-through, decreasing attrition of these study participants once they are engaged in the survey remains a challenge.     

Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe

OBJECTIVE: To investigate the effect of isolated or concomitant infection with malaria and HIV on pregnancy and neonatal outcome. METHODS: Data were collected on pregnant women admitted during the rainy seasons in the obstetric division of a district referral hospital in northern Zimbabwe in 2000 and 2001. The effects of malaria and HIV infection were determined by multivariate analysis. RESULTS: The prevalence of HIV seropositivity and symptomatic malaria in 986 pregnant women was 8.3% and 14.7%, respectively. HIV-infected women were more likely to develop malaria attacks during pregnancy than seronegative women (odds ratio [OR] = 3.96, 95% confidence interval (CI): 2.42-6.46). Malaria and HIV infections were associated with increased risk of stillbirth (OR = 4.74, 95% CI: 1.34-16.78) and preterm delivery (OR = 4.10, 95% CI: 2.17-7.75), respectively. They were independently associated with increased risk of low birth weight (malaria: OR = 10.09, 95% CI: 6.50-15.65; HIV: OR = 3.16, 95% CI: 1.80-5.54) and very low birth weight (malaria: OR = 5.04, 95% CI: 1.00-25.43; HIV: OR = 10.74, 95% CI: 2.12-54.41), low Apgar score (malaria: OR = 4.45, 95% CI: 1.42-13.94; HIV: OR = 5.94, 95% CI: 1.66-21.30), and fetal growth restriction (malaria: OR = 3.98, 95% CI: 2.51-6.30; HIV: OR = 4.07, 95% CI: 2.40-6.92). Dual infection with malaria and HIV was associated with increased risk of maternal, perinatal, and early infant death. CONCLUSIONS: Women with single HIV or malaria infection have a significantly increased risk of adverse outcomes of pregnancy and childbirth. Dual infection has additional detrimental effects on maternal and infant survival in an area where HIV and malaria coexist.     

Understanding the role of reactions to race-based treatment in breast and cervical cancer screening

Racial and ethnic disparities in breast and cervical cancer mortality persist despite effective screening methods. We examined associations between race/ethnicity and Pap testing within three years or mammography within two years, controlling for a composite reactions-to-race-based-treatment variable created using data from the 2002 and 2004 Behavioral Risk Factor Surveillance System Reactions to Race module, which assessed respondents experiences based on one's race. We calculated prevalence of Pap testing (for women aged > or = 18) and mammography (for women aged > or = 40) by race, and fit logistic regression models to estimate the strength of association of reactions to race-based treatment with screening and race--before and after controlling for demographics, socioeconomic status, health status, smoking and healthcare access. In the reduced model, black women were more likely (2.03: 95% CI: 1.55-2.65) to be screened for cervical cancer than whites. Reactions to race-based treatment did not impact the odds of black women receiving Pap tests or mammograms. Given current racial and ethnic disparities in breast and cervical cancer mortality, we suggest that more attention needs to be focused on follow-up of abnormal results and state-of-the art treatment for black and Hispanic women.     

Disclosure of HIV status: the role of ethnicity among people living with HIV in London

OBJECTIVE: To examine HIV disclosure among people living with HIV in London. METHODS: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving medical care in National Health Service (NHS) clinics in northeast London completed a confidential, self-administered questionnaire. Respondents were asked whether they had told anyone else that they had HIV, and if so, whom. RESULTS: The analysis included 1407 people: 667 black African heterosexual respondents (453 women, 214 men) and 740 gay men (633 white, 107 ethnic minority). The majority of respondents (88.0%) had told at least 1 other person about their HIV infection, but this varied between groups: white gay men, 95.0%; ethnic minority gay men, 93.5%; black African heterosexual women, 84.8%; black African heterosexual men, 76.6% (P < 0.001). Black African heterosexual men (65.3%) and women (60.4%) were less likely to have told their current partner about their HIV infection than white (86.2%) or ethnic minority gay men (85.2%): black African men, adjusted odds ratio (AOR) 0.25, 95% confidence interval (CI) 0.14, 0.44, P < 0.001; black African women, AOR 0.24, 95% CI 0.15, 0.39, P < 0.001 (reference group, white gay men). Only 1 in 5 respondents (21.6%) had disclosed their HIV status to their employer (white gay men, 30.5%; ethnic minority gay men, 15.8%; black African heterosexual women, 10.5%; black African heterosexual men, 8.8%; P < 0.001). CONCLUSIONS: In this London study there were striking differences, by ethnicity, in the extent to which people with HIV disclosed their infection. This has important implications in light of the 2005 Disability Discrimination Act and recent prosecutions in the UK for the reckless transmission of HIV.     

Variation in symptoms of sleep-disordered breathing with race and ethnicity: the Sleep Heart Health Study

STUDY OBJECTIVES: To examine the relation of sleep-related symptoms to race and ethnicity in a diverse sample of middle-aged and older men and women. DESIGN: Cross-sectional questionnaire survey. SETTING: In the initial phase of the Sleep Heart Health Study, men and women enrolled in participating epidemiologic cohort studies were surveyed. PARTICIPANTS: 13,194 men and women 40 years of age and older, including 11,517 non-Hispanic white, 648 black, 643 American Indian, 296 Hispanic, and 90 Asian-Pacific Islander. INTERVENTIONS: Not applicable. MEASUREMENTS AND RESULTS: After adjustment for BMI and other factors, frequent snoring was more common among Hispanic women (odds ratio (OR) = 2.25, 95% confidence interval (CI) = 1.48, 3.42) and black women (OR = 1.55, 95% Ci = 1.13, 2.13) than among non-Hispanic white women. Hispanic men were significantly more likely to report frequent snoring than non-Hispanic white men (OR = 2.30, 95% CI = 1.43, 3.69). Black, American Indian, and Asian men did not differ significantly from white men in snoring prevalence. American Indian women were significantly more likely to report breathing pauses during sleep than their white, non-Hispanic counterparts (OR = 1.52, 95% CI 1.03, 2.24), although polysomnography data on a subset of the sample suggested that the association between this symptom reported on questionnaire and objective evidence of sleep-disordered breathing may be weaker among American Indians than among other groups. Mean Epworth Sleepiness Scale scores were slightly higher in black men and women than in their white, non-hispanic counterparts. CONCLUSIONS: Frequent snoring was more common among black and Hispanic women and Hispanic men than among their white non-Hispanic counterparts, even after adjusting for BMI and other factors. Further research including polysomnography and objective measurements of sleepiness is needed to assess the physiologic and clinical significance of these findings.     

Characteristics of HIV infection among Hispanics, United States 2003-2006

BACKGROUND: Hispanic subgroups of varied national origin differ culturally; overall, Hispanics in the United States are disproportionately affected by HIV infection. METHODS: We analyzed cases of HIV infection that were diagnosed among Hispanics in 33 states and US-dependent areas during 2003-2006 and reported to the Centers for Disease Control and Prevention through June 2007. We used Poisson regression to calculate the estimated annual percent change in the number and rate of HIV diagnoses and used logistic regression to analyze the association between birthplace and a short (<12 months) HIV-to-AIDS interval. RESULTS: HIV infection was diagnosed among 30,415 Hispanics. Of 24,313 with reported birthplace, 61% were born outside the continental United States. The annual number of diagnoses increased among Mexican-born males [estimated annual percent change = 8.8%; 95% confidence interval (CI) = 3.5 to 14.5] and Central American-born males (18.6%; 95% CI = 9.4 to 28.6) and females (24.6%; 95% CI = 8.8 to 42.7) but decreased among US-born Hispanic females (-8.2%; 95% CI = -13.3 to -2.8). A short HIV-to-AIDS interval was more common among Mexican-born Hispanics than among US-born Hispanics. DISCUSSION: Diagnosis trends and HIV-to-AIDS intervals varied by place of birth. To decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural differences.     

Prevalence of breastfeeding at four months in general practices in south London.

BACKGROUND: Successive quinquennial National Infant Feeding Surveys have provided a valuable picture of national and regional variations in infant feeding practices within the United Kingdom. Social variation in breastfeeding has been recognised to be an important source of health inequalities in childhood by the Independent Inquiry into Inequalities in Health Report. AIM: To determine the prevalence of breastfeeding at birth and at four months in a sample of women from urban general practices, its variation between practices, and relation to practice population deprivation scores. To report the timing of introduction of solid feeds. DESIGN OF STUDY: Cross-sectional questionnaire survey based on a random cluster sample. SETTING: Women with infants aged four months in general practices in South London. METHOD: Mode of infant feeding at birth and four months, and time of introduction of solids. Jarman score as a measure of practice population deprivation. Housing tenure, maternal ethnic group, and maternal age at leaving full-time education. RESULTS: Twenty-five general practices were sampled. Median practice Jarman score was 15.0 (interquartile range [IQR] = 12.6-21.9). Responses were received from 1053 out of 1532 mothers approached (69%). Of these, 87% (897) had breastfed at birth, while 59% (609) were still breastfeeding their babies at four months. Mothers in rented accommodation were less likely to breastfeed than owner-occupiers (odds ratio [95% CI] = 0.52 [0.37-0.74]), as were women of white, compared with those of black, ethnic origin (odds ratio [95% CI] = 0.55 [0.36-0.82]). Those who completed up to two years and more than two years education after the age of 16 were 2.94 (95% CI = 1.85-4.66) and 9.25 (95% CI = 6.02-14.21) more likely to breastfeed at four months, respectively, than mothers whose formal education was completed at or before 16 years. Practice-specific rates of breastfeeding ranged from 71% to 100% at birth (median 87%; IQR = 79-93%) and 22% to 83% at four months (median 61%; interquartile range = 47-66%). The intra-practice correlation coefficient for breastfeeding at four months was 0.052 (within-cluster variance = 0.23, between-cluster variance = 0.013). There was no association between breastfeeding at four months and practice-specific Jarman score. Median age of starting solids was 16 weeks (IQR = 15-17 weeks). CONCLUSIONS: Housing tenure, maternal education, and ethnic group are significantly associated with breastfeeding prevalence at four months. Between-practice variation in breastfeeding prevalence is not associated with measures of practice population deprivation, as assessed by Jarman scores. Consideration should be given to including information on maternal ethnic group and housing tenure in future National Infant Feeding Surveys. Current weaning practices fall short of the recommendation of the World Health Assembly.     

Risk factors for incident HIV infection among anonymous HIV testing site clients in Santos,Brazil: 1996-1999

OBJECTIVES: To determine temporal trends in HIV infection and risk factors among persons seeking anonymous HIV testing in Santos, Brazil. METHODS: Data and sera from persons testing for HIV from 1996 to 1999 were used. Exposures were abstracted from HIV testing risk assessments. Stored HIV-positive sera were tested to identify recently acquired HIV infection using a serologic testing algorithm for detecting recent HIV seroconversion (STARHS). Independent associations between exposures and recently acquired HIV infection were determined using multivariate analyses. RESULTS: Overall, estimated HIV incidence was 2.0% (95% CI: 1.1-3.5) for the 4-year period: 1.2% (95% CI: 0.5-2.6) in women and 2.7% (95% CI: 1.3-5.0) in men. Incidence increased among women but remained stable among men. Exposures independently associated with incident infection included a history of sex work (OR= 5.4, 95% CI: 1.5-18.7), concurrent syphilis infection (OR =4.1, 95% CI: 1.4-11.9), anal sex (OR = 3.0, 95% CI: 1.3-7.1), and having an HIV-positive sexual partner (OR= 1.4, 95% CI: 1.1-1.9). CONCLUSIONS: This study further demonstrates the public health utility of using the STARHS for the assessment of emerging trends in the HIV epidemic. Results from this study will help to target appropriate prevention strategies directed toward at-risk populations in Santos.     

Secular trends in congenital anomaly-related fetal and infant mortality in Canada, 1985-1996.

Prenatal diagnosis of major congenital anomalies and subsequent termination of affected pregnancies has been widely available as part of routine obstetric care in recent years. In this study, vital statistical data on stillbirths, live births, and infant deaths were used to examine secular trends in gestational age-specific and category-specific fetal and infant mortality due to congenital anomalies in Canada (excluding Ontario and Newfoundland) from 1985-1996. Comparisons of the rates between 1985-1987 and 1994-1996 were made using relative risks and 95% confidence intervals (CI). The overall fetal mortality rate due to congenital anomalies increased significantly, from 68.0 per 100,000 total births in 1985-1987 to 78.6 per 100,000 total births in 1994-1996, while the overall infant mortality rate due to congenital anomalies decreased significantly over the same period, from 2.47 to 1.79 per 1,000 live births. The fetal death rate due to congenital anomalies at 20-21 weeks of gestation increased approximately five-fold (relative risk [RR] = 4.83, 95% CI = 3.28-7.11) from 4.5 to 21.5 per 100,000 fetuses at risk, while the rate at 37-41 weeks decreased by 30% (RR = 0.70, 95% CI = 0.50-0.97). Fetal death rates among pregnancies at 20-25 weeks of gestation increased in all categories of congenital anomaly except anencephaly and respiratory system anomalies. Congenital anomaly-related fetal and infant deaths have increased at early gestation but declined at later gestation in Canada. These changes suggest an increase in prenatal diagnosis and selective termination of pregnancies with congenital anomalies in recent years.     

Age at natural menopause and factors associated with menopause state among Puerto Rican women aged 40-59 years, living in Puerto Rico

OBJECTIVE: The timing of menopause is associated with multiple health outcomes in female populations including all-cause mortality, heart disease, breast cancer, and osteoporosis. Although research suggests that age at menopause varies in different ethnic groups, data on age at menopause among Hispanic women are limited. DESIGN: The present cross-sectional study estimates age at natural menopause among a sample of 1,272 Puerto Rican women aged 40 to 59 years who participated in health fairs held in 22 municipalities of Puerto Rico between May 2000 and November 2001. Cox proportional hazard regression analysis was used to characterize age at natural menopause and its association with relevant covariates. RESULTS: The overall adjusted median age at natural menopause was 51.3 years. Current employment (hazard ratio = 0.75, 95% CI: 0.59-0.95) and parity of two or three children as compared with having no children or one child (hazard ratio = 0.73, 95% CI: 0.54-0.98) were associated with a later menopause. CONCLUSIONS: This study provides a robust estimate of age at menopause for Puerto Rican women, which is similar to overall estimates previously reported for US populations, but higher than estimates for other Hispanic populations. Our results confirm attributes associated with age at menopause and provide information relevant to understanding the potential chronic disease burden of Puerto Rican women as they age.     

Mortality in a cohort of HIV-infected adults started on a protease inhibitor-containing therapy: standardization to the general population

Death rates in the APROCO cohort of 1,157 HIV-1 infected adults starting for the first time a protease inhibitor-containing therapy were standardized to the 1996 French general population mortality rates stratified by age and gender. Median follow-up was 23 months and mortality rate was 2.2% person-years (95% confidence interval [CI] = 1.6-2.9). Overall mortality was 7.8 times higher than in the general population (95% CI = 5.7-10.4), 4.7 in men and 19.5 in women. Among the 144 patients considered complete responders, the death rate was 1.2% person-years (95% CI = 0.2-3.5) and mortality remained 5.1 times higher (95% CI = 1.0-14.9) than in the general population. Failure of treatment, long-term adverse effects, or less favorable socio-demographic status could explain these trends.     

Pregnancy outcomes in HIV-infected and uninfected women in rural and urban South Africa

OBJECTIVE: To describe pregnancy outcomes among clade C HIV-infected and uninfected women in South Africa. DESIGN: A longitudinal cohort study. METHODS: Pregnant women attending 9 rural/urban antenatal clinics were prospectively recruited and followed up. Women were seen at the clinic or at home after delivery on 4 occasions after enrollment: 2 times within the first 2 weeks of the newborn's life at home, and every 2 weeks thereafter until their first health clinic visit when the infant was 6 weeks old. RESULTS: A total of 3465 women were enrolled; 615 withdrew after delivery, moved away, or had a missing or indeterminate HIV status, leaving 2850 women (1449 HIV-infected women). Six women died after delivery and there were 17 spontaneous abortions and 104 stillbirths. An adverse pregnancy outcome was independently associated with HIV infection (adjusted odds ratio [AOR] = 1.63; P = 0.015), urban enrollment (AOR = 0.39; P = 0.020), and nonhospital delivery (AOR = 13.63; P < 0.001) as well as with a CD4 count <200 cells/mL among HIV-infected women (AOR = 1.86; P = 0.127). Among 2529 singleton liveborn babies, birth weight was inversely associated with maternal HIV (AOR = 1.45; P = 0.02) and maternal middle upper arm circumference (AOR = 0.93; P < 0.001). Early infant mortality was not significantly associated with maternal HIV (hazard ratio [HR] = 1.18; P = 0.52) but was with urban sites (HR = 0.34; P = 0.045). Low birth weight substantially increased mortality (AOR = 8.3; P < 0.001). HIV status of infants by 8 weeks of age (14.6%, 95% confidence interval: 12.5% to 17.0%) was inversely associated with maternal CD4 cell count and birth weight. CONCLUSIONS: HIV-infected women are at a significantly increased risk of adverse pregnancy outcomes. Low-birth-weight infants of HIV-infected and uninfected women are at substantially increased risk of dying.     

Regional adipose tissue and lipid and lipoprotein levels in HIV-infected women

BACKGROUND: HIV infection and antiretroviral therapy are associated with dyslipidemia, but the association between regional body fat and lipid levels is not well described. METHODS: Multivariable linear regression analyzed the association between magnetic resonance imaging-measured regional adipose tissue and fasting lipids in 284 HIV-infected and 129 control women. RESULTS: Among African Americans, HIV-infected women had higher triglyceride (116 vs. 83 mg/dL; P < 0.001), similar high-density lipoprotein (HDL; 52 vs. 50 mg/dL; P = 0.60), and lower low-density lipoprotein (LDL; 99 vs. 118 mg/dL; P = 0.008) levels than controls. Among whites, HIV-infected women had higher triglyceride (141 vs. 78 mg/dL; P < 0.001), lower HDL (46 vs. 57 mg/dL; P < 0.001), and slightly lower LDL (100 vs. 107 mg/dL; P = 0.059) levels than controls. After adjustment for demographic and lifestyle factors, the highest tertile of visceral adipose tissue (VAT) was associated with higher triglyceride (+85%, 95% confidence interval [CI]: 55 to 121) and lower HDL (-9%, 95% CI: -18 to 0) levels in HIV-infected women; the highest tertile of leg subcutaneous adipose tissue (SAT) was associated with lower triglyceride levels in HIV-infected women (-28%, 95% CI: -41 to -11) and controls (-39%, 95% CI: -5 to -18). After further adjustment for adipose tissue, HIV infection remained associated with higher triglyceride (+40%, 95% CI: 21 to 63) and lower LDL (-17%, 95% CI: -26 to -8) levels, whereas HIV infection remained associated with lower HDL levels (-21%, 95% CI: -29 to -12) in whites but not in African Americans (+8%, 95% CI: -2 to 19). CONCLUSIONS: HIV-infected white women are more likely to have proatherogenic lipid profiles than HIV-infected African American women. Less leg SAT and more VAT are important factors associated with adverse lipid levels. HIV-infected women may be at particular risk for dyslipidemia because of the risk for HIV-associated lipoatrophy.     

Racial and ethnic disparities in perinatal mortality: applying the perinatal periods of risk model to identify areas for intervention

OBJECTIVES: To determine the feto-infant mortality rate for New York City, assess racial/ethnic variations and identify areas for intervention using the Perinatal Periods of Risk (PPOR) approach. METHODS: The PPOR model examines fetal and infant deaths by age at death (fetal, neonatal, postneonatal) and birthweight (500-1499, > or =1500 g). It groups age at death and birthweight into four categories to identify problems hypothesized to lead to the death: factors related to Maternal Health and Prematurity, Maternal Care, Newborn Care and Infant Health. The model was applied to fetal and infant deaths occurring in New York City using Vital Records data from 1996-2000. Analysis was completed for the entire city and by race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Asians/Pacific Islander). RESULTS: The overall feto-infant mortality rate was 11.5/1,000 live births plus fetal deaths. This rate varied by race/ethnicity; black non-Hispanics had a higher rate than other racial/ethnic groups. Conditions related to maternal health and prematurity were the largest contributing factors to feto-infant mortality (5.9/1000) in New York City. Among blacks and Hispanics, problems related to maternal health and prematurity contributed a larger share than among whites and Asians/Pacific Islanders. CONCLUSION: The use of the PPOR approach shows that the racial/ethnic disparities in feto-infant mortality that exist in New York City are largely related to maternal health and prematurity. Interventions to reduce the feto-infant mortality rate should include preconception care and improvements in women's health.     

A case-control study of factors associated with HIV infection among black women

OBJECTIVE: To identify social, behavioral and epidemiologic factors associated with HIV infection among HIV-infected and HIV-uninfected black women residing in North Carolina. DESIGN: A case-control study conducted in August 2004 in North Carolina. METHODS: Cases were 18-40-year-old women with HIV infections diagnosed from 2003-2004. Controls were 18-40-yearold, HIV-negative heterosexually active women recruited from HIV testing sites. Five focus group discussions were also conducted with women not participating in the case-control study. RESULTS: Multivariate analyses of 31 cases and 101 controls showed that HIV-positive women were more likely to receive public assistance [adjusted odds ratio (aOR) 7.3; 95% confidence interval (CI) 2.1, 26.0], to report a history of genital herpes infection (aOR 10.6; 95% CI 2.4, 47.2), and were less likely to have discussed a variety of sexual and behavioral issues relevant to risk of HIV infection with their male partners (aOR 0.6; 95% CI 0.4, 0.8). Focus group participants indicated that financial and social demands created competing challenges for making HIV prevention a priority. CONCLUSIONS: Inadequate communication between black women and their sexual partners may create barriers to sexual and behavioral risk reduction. A multidimensional approach that addresses both biological factors such as herpes infection and socioeconomic factors may be needed to reduce HIV transmission in this population.     

Maternal, perinatal and infant outcome of spontaneous pregnancy in the sixth decade of life

Pregnancy in the older woman is a well-known risk factor for perinatal morbidity and mortality. OBJECTIVE: To evaluate perinatal and infant morbidity and mortality in women 50 or more years old. METHODS: A retrospective population based study (1990-2004) evaluating spontaneously pregnant Chilean women more than 50 years old (217 live or stillbirths) compared to women 20-34 years old (2,817,742 neonates, control group). The comparison was performed using Chi Square with Yates's correction or exact Fisher test as appropriate. The risk analysis was performed by odds ratio (OR) and confidence interval of 95% (CI 95%). RESULTS: Women over 50 had a significantly greater risk of fetal (OR: 3.7; CI 95%: 1.2-10.5), neonatal (OR: 10.4; CI 95%: 5.7-18.7), post-neonatal (OR: 9.5; CI 95%: 4.6-19.1) and infant death (OR: 10.5; CI 95%: 6.6-16.7). There were no differences between groups in the incidences of low and very low birth weight. CONCLUSION: Pregnancy over 50 years of age entails a very high risk of fetal, neonatal and early childhood death. Unprotected sexual life for these women should be considered only after evaluation of their potential fertility.