The environmental history in pediatric practice: a study of pediatricians' attitudes,beliefs, and practices

We conducted a mail survey of practicing pediatricians in Georgia to assess their knowledge, attitudes, and behaviors regarding recording patients' environmental histories. Of 477 eligible pediatricians, 266 (55.8%) responded. Fewer than one in five reported having received training in environmental history-taking. Pediatricians reported that they strongly believe in the importance of environmental exposures in children's health, and 53.5% of respondents reported experience with a patient who was seriously affected by an environmental exposure. Pediatricians agreed moderately strongly that environmental history-taking is useful in identifying potentially hazardous exposures and in helping prevent these exposures. Respondents reported low self-efficacy regarding environmental history-taking, discussing environmental exposures with parents, and finding diagnosis and treatment resources related to environmental exposures. The probability of self-reported history-taking varied with the specific exposure, with environmental tobacco smoke and pets most frequently queried and asbestos, mercury, formaldehyde, and radon rarely queried. The pediatricians' preferred information resources include the American Academy of Pediatrics, newsletters, and patient education materials. Pediatricians are highly interested in pediatric environmental health but report low self-efficacy in taking and following up on environmental histories. There is considerable opportunity for training in environmental history-taking and for increasing the frequency with which such histories are taken.     

Evaluating the utility and accuracy of a reverse telephone directory to identify the location of survey respondents

PURPOSE: To investigate the utility and positional accuracy of a reverse telephone directory to enhance geocoding using self-reported street addresses. METHODS: This cross-sectional study used 2001 self-reported survey data from 2636 participants in three Missouri areas. When available, street addresses were appended to participant telephone numbers using a reverse telephone directory. The odds of finding a telephone number in the reverse directory and the positional accuracy between self-reported addresses and those obtained from the reverse directory were calculated. We also determined the quality of self-reported address information and that obtained by means of the reverse telephone directory. RESULTS: Rural respondents, younger respondents, women, African Americans, and respondents with less than a high school education were less likely to have their telephone number present in the reverse directory. Using the reverse directory increased the overall percentage of respondents whose addresses were geocoded from 51.5% to 72.0%. Eighty-one percent of addresses were geocoded to the same US Census Block Group and 89% were geocoded to the same Census Tract as the self-reported addresses. CONCLUSIONS: The street address of survey participants obtained through the reverse directory can be used to augment the unknown location of telephone survey respondents but specific groups of people are less likely to be found in the directory.     

Neighborhood contributions to psychological distress among Latino New York City adults

Objective: Neighborhood-level factors such as ethnic densities and social cohesion have been negatively associated with psychological distress among Latino Americans. Yet, existing evidence is based on either specific neighborhood factors or particular Latino subgroups. The objective of the study was to assess difference in psychological distress between each of four Latino subgroups (Puerto Ricans, Dominicans, Mexicans, other Latinos) and non-Latino white adults in New York City, and quantify total neighborhood-level influence on these differences.

Design: We used the combined Community Health Survey data from 2009, 2010, and 2012 surveys. We estimated the odds ratios (ORs) for self-reported non-specific psychological distress (Kessler-6 questions scale ≥ 13) by race/ethnicity using logistic regression models. We further adjusted these estimates for both observed and unobserved neighborhood-level confounding using the conditional pseudolikelihood method for complex survey data.

Results: Puerto Ricans were more likely to be psychologically distressed (OR?=?1.58, 95% CI?=?1.18, 2.12) compared with non-Latino whites, whereas the opposite was seen in other Latino subgroups. Accounting for full neighborhood-level confounding increased the disparity for Puerto Ricans (OR?=?1.79, 95% CI?=?1.26–2.54). For the other subgroups, lower odds of psychological distress were no longer observed or attenuated after accounting for neighborhood-level confounding. Overall neighborhood-level factors were associated with lower psychological distress at greater extent among all Latinos subgroups versus non-Latino whites in New York City.

Conclusion: Despite substantial variations of psychological distress across Latino subgroups, the study shows evidence that neighborhood-level factors might play a protective role in all Latino subgroups.     

Self-reported medical history was generally accurate among Japanese workplace population

ObjectiveTo assess the validity of self-reported medical history of several diseases among the Japanese population, and to clarify to what extent the self-reported year of diagnosis for chronic diseases is different from the physician's reports.Study Design and SettingSubjects were 8,947 persons who responded to questions about medical history in a self-administered questionnaire. Of them, 854 subjects reported one or more medical histories and gave permission to contact their physician. The physicians were then requested to provide information on 809 subjects. Valid responses of 714 subjects were collected. We compared the self-reported medical histories with those reported by the physician.ResultsOf 15 persons who reported myocardial infarction, 13 (87%) were confirmed. Angina pectoris was verified in eight out of the 11 (73%). The confirmation proportions of hypertension, diabetes, hyperlipidemia, and hyperuricemia were 97%, 96%, 95%, and 95%, respectively. The self-reported year of diagnosis was 1.70–2.49 years earlier than the physician-reported year for chronic diseases. Agreement between the self-reported and the physician-reported years was higher, the more recent the self-reported year was.ConclusionSelf-reported medical histories were generally accurate, especially for diseases with clear diagnostic criteria. However, investigators should be aware of the errors in reporting the year of diagnosis.     

Residential mobility during pregnancy and the potential for ambient air pollution exposure misclassification

Studies of environmental exposures and adverse birth outcomes often rely on maternal address at birth obtained from the birth certificate to classify exposure. Although the gestational age of interest is often early pregnancy, maternal addresses are not available for women who move during pregnancy when using maternal addresses abstracted from birth certificates. The aim of this study was to explore the extent of ambient air pollutant exposure misclassification due to maternal residential mobility during pregnancy among the subgroup of a New York birth cohort. The authors obtained the maternal addresses at birth from the New York Birth Certificate, and the maternal addresses by gestational age from the National Birth Defect Prevention Study for New York participants for the study period 1997-2002. Among the 1324 mothers, 172 (13.0%) moved once during pregnancy and 46 (3.5%) moved at least twice. When accounting for multiple addresses among some individuals, of the 218 mothers who moved, 38 (2.9%) moved in the 3rd to 8th weeks after conception (critical period, not exclusive from the 1st trimester), 80 (6.0%) moved in the 1st trimester, 112 (8.5%) in the 2nd trimester, and 51 (3.9%) in the 3rd trimester. Air monitoring data from the New York Department of Environmental Conservation were used as surrogates to compute the ambient ozone and PM₁₀ exposures for mothers with complete residential data. This study estimates exposure using maternal address at birth obtained from birth certificates, compared to exposure estimates when using maternal addresses by gestational age obtained from maternal interview, the gold standard. Average exposures during pregnancy were similar when using interview based versus birth certificate addresses (0.035 vs. 0.035 ppm for ozone, and 20.11 vs. 20.09 μg/m³ for PM₁₀, respectively). Kappa statistics and percent agreement were calculated to measure the degree of agreement for dichotomous exposure measurements (<median vs.>=median) and weighted kappa for quartile exposure measurements by gestational age. All the statistics indicated a high agreement between the two measurements. For mothers who moved, the majority maintained their address in the same exposure region. Given the low mobility during pregnancy and the short distance moved, the exposure assignment did not change substantially when using the more accurate interview based addresses in this study. However, the level of observed agreement may decrease for studies that require smaller geographic zones for exposure assignments or with more mobile study populations.     

Outdoor Air Quality Awareness,Perceptions, and Behaviors Among U.S. Children Aged 12–17 Years, 2015–2018

PurposeThis study aimed to assess U.S. adolescents' perceptions and knowledge about air quality and their behaviors aimed to reduce air pollution exposure and whether they vary by demographic characteristics.MethodsWe analyzed data from the Porter Novelli Public Services YouthStyles survey, a nationally representative survey of U.S. adolescents aged 12–17 years. In survey years 2015–2018, a total of 3,547 adolescents self-reported awareness, perceptions, and behaviors related to air pollution. We calculated weighted percentages of respondents reporting each aspect of air quality awareness, perception, and behaviors overall and by categories of age, gender, parental education, metropolitan status, region, and survey year.ResultsOverall, an estimated 81% of U.S. adolescents thought outdoor air pollution could impact health, 52% thought there were things they could do to limit their or their family's exposure, 19% were aware of air quality alerts, 46% of those who thought or were informed air quality was bad did something differently, and 19% always or usually avoided busy roads to reduce air pollution exposure; differences were reported by some demographic variables.ConclusionsAmong U.S. adolescents, awareness that air pollution could impact health was relatively high. However, gaps were found in the awareness of the potential impacts and other aspects of awareness and perceptions related to air pollution and the engagement in behaviors to reduce exposure, some of which varied by demographic characteristics. These results can be used to inform interventions that increase awareness and behaviors to reduce air pollution exposures among U.S. adolescents.     

Evaluating the Health Information Technology Regional Extension Center in South Carolina

ObjectiveTo determine the impact of the South Carolina Regional Extension Center, Center for Information Technology Implementation Assistance (CITIA-SC), on physician practices engaged in the process of electronic medical record (EMR) adoption.Data sourcesData from a cross-sectional survey distributed in March 2011 to 1310 primary care practice groups throughout South Carolina was used to determine the degree of EMR adoption throughout the state (n=452 respondents; 34.5% response rate). Participation in CITIA-SC was determined by obtaining a list of practices from CITIA-SC.Study designA posttest-only design with nonequivalent groups was used to estimate the degree of EMR implementation, plans for and perceived barriers to implementation based on CITIA-SC participation.ResultsCITIA-SC practice sites faced similar barriers to EMR implementation as non-CITIA-SC participants, including initial or recurring cost of an EMR, low staff expertise with EMRs or computers, and productivity disruption. Additionally, CITIA-SC practice sites had fewer IT personnel on staff (p=0.0358) and were considering EMR implementation without a plan (p=0.0125). Despite these barriers, more practices participating in the CITIA-SC program were preparing to invest in an EMR system within one year when compared to nonparticipants (75.9% versus 28.3%, p<0.0001).ConclusionOur results indicated that the practice sites that participate in the REC had fewer IT resources and more perceived barriers to implementation. These results suggest that REC participant practice sites intend to implement an EMR, but recognize the need for technical assistance in the preparation and implementation of an EMR system.     

孕产期母亲用药、环境接触及分娩方式与婴幼儿过敏性疾病的关联性研究

目的 探讨孕产期母亲用药、环境接触及分娩方式对婴幼儿过敏性疾病的影响。方法 基于横断面调查的病例对照研究。按我国的地理和人口分布,在全国范围内选择33个城市,采用整群抽样方法在各城市的城区随机选择一个社区作为样本区,调查对象为0~24月龄婴幼儿母亲,进行面对面问卷调查。调查对象分为两组,曾出现过敏性疾病症状且被诊断为过敏性疾病的婴幼儿为过敏组（2 113例）和从未发生过敏性疾病症状的婴幼儿为对照组（6 303例）。结果 父母双方有过敏史和父母单方有过敏史均为婴幼儿发生过敏的危险因素,父母双方均有过敏史（OR=3.950）的危险关联强度高于父母单方有过敏史者（OR=2.277）;孕期使用抗生素（OR=1.396）、孕期接触消毒剂及清洁剂（OR=1.386）、孕期吸烟或接触吸烟环境（OR=1.301）、剖宫产（OR=1.255）是婴幼儿发生过敏性疾病的危险因素,各因素组间差异均有统计学意义（P<0.05）。结论 婴幼儿过敏预防重点在孕产期的一级预防,应避免无临床指征情况下剖宫产、孕期滥用抗生素和消毒剂以及接触烟草。     

Exposure misclassification due to residential mobility during pregnancy

ObjectivesPregnant women are a highly mobile group, yet studies suggest exposure error due to migration in pregnancy is minimal. We aimed to investigate the impact of maternal residential mobility on exposure to environmental variables (urban fabric, roads and air pollution (PM10 and NO₂)) and socio-economic factors (deprivation) that varied spatially and temporally.MethodsWe used data on residential histories for deliveries at ≥24 weeks gestation recorded by the Northern Congenital Abnormality Survey, 2000–2008 (n = 5399) to compare: (a) exposure at conception assigned to maternal postcode at delivery versus maternal postcode at conception, and (b) exposure at conception assigned to maternal postcode at delivery versus mean exposure based on residences throughout pregnancy.ResultsIn this population, 24.4% of women moved during pregnancy. Depending on the exposure variable assessed, 1–12% of women overall were assigned an exposure at delivery >1SD different to that at conception, and 2–25% assigned an exposure at delivery >1SD different to the mean exposure throughout pregnancy.ConclusionsTo meaningfully explore the subtle associations between environmental exposures and health, consideration must be given to error introduced by residential mobility.     

Taking action on developmental toxicity: Scientists’ duties to protect children

Background

Few epidemiological studies of air pollution have used residential histories to develop long-term retrospective exposure estimates for multiple ambient air pollutants and vehicle and industrial emissions. We present such an exposure assessment for a Canadian population-based lung cancer case-control study of 8353 individuals using self-reported residential histories from 1975 to 1994. We also examine the implications of disregarding and/or improperly accounting for residential mobility in long-term exposure assessments.

Methods

National spatial surfaces of ambient air pollution were compiled from recent satellite-based estimates (for PM_2.5 and NO₂) and a chemical transport model (for O₃). The surfaces were adjusted with historical annual air pollution monitoring data, using either spatiotemporal interpolation or linear regression. Model evaluation was conducted using an independent ten percent subset of monitoring data per year. Proximity to major roads, incorporating a temporal weighting factor based on Canadian mobile-source emission estimates, was used to estimate exposure to vehicle emissions. A comprehensive inventory of geocoded industries was used to estimate proximity to major and minor industrial emissions.

Results

Calibration of the national PM_2.5 surface using annual spatiotemporal interpolation predicted historical PM_2.5 measurement data best (R² = 0.51), while linear regression incorporating the national surfaces, a time-trend and population density best predicted historical concentrations of NO₂ (R² = 0.38) and O₃ (R² = 0.56). Applying the models to study participants residential histories between 1975 and 1994 resulted in mean PM_2.5, NO₂ and O₃ exposures of 11.3 ??g/m³ (SD = 2.6), 17.7 ppb (4.1), and 26.4 ppb (3.4) respectively. On average, individuals lived within 300 m of a highway for 2.9 years (15% of exposure-years) and within 3 km of a major industrial emitter for 6.4 years (32% of exposure-years). Approximately 50% of individuals were classified into a different PM_2.5, NO₂ and O₃ exposure quintile when using study entry postal codes and spatial pollution surfaces, in comparison to exposures derived from residential histories and spatiotemporal air pollution models. Recall bias was also present for self-reported residential histories prior to 1975, with cases recalling older residences more often than controls.

Conclusions

We demonstrate a flexible exposure assessment approach for estimating historical air pollution concentrations over large geographical areas and time-periods. In addition, we highlight the importance of including residential histories in long-term exposure assessments. For submission to: Environmental Health     

Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: A comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data

ObjectiveWe assessed the extent to which self-reported exposure to SHS underestimates the actual exposure to SHS and what factors are associated with a tolerance for SHS exposure in the Korean setting where the smoke-free policy is incomplete.MethodsInformation on socio-demographic characteristics, alcohol drinking and smoking was collected for 7948 nonsmokers aged ≥ 19 years from the fourth Korea National Health and Nutrition Examination Survey, 2008–2009. Self-reported and cotinine verified SHS exposures were compared. Potential factors associated with cotinine verified but not self-reported SHS exposures were assessed using a logistic regression model.ResultsSelf-reported SHS exposure significantly underestimated the actual SHS exposure as determined by cotinine verification (kappa coefficient: 0.1066). At younger age, frequent alcohol drinking in females and a longer smoking duration in males were positively associated with cotinine verified exposure but not with the self-reported SHS exposure; they were also positively associated with cotinine verified exposure irrespective of self-reported SHS exposure.ConclusionsOur findings show a tolerance for smoking in Korea. The current partial ban on smoking does not fully protect people from exposure to SHS. Smoking should be banned in all public places. In addition, efforts to de-normalize smoking in the Korean culture need to be strengthened.     

Does the workplace-smoking ban eliminate differences in risk for environmental tobacco smoke exposure at work?

ObjectivesA workplace-smoking ban in the Netherlands was introduced on January 1, 2004. Before the ban male and low educated employees were at higher risk for exposure to environmental tobacco smoke (ETS). Effective implementation of the ban should result not only in an overall decline of exposure, but also in the disappearance of systematic differences in exposure between subgroups of employees.MethodsData from a Dutch continuous Internet survey were used. From July 2003 through June 2005, 200 respondents were randomly selected each week. The sample consisted of 11,291 non-smoking, working respondents, aged 16–65 years.ResultsETS exposure decreased among all employees and among subgroups at higher risk before the ban. However, also after the ban, males and low educated employees were still most likely to be exposed to ETS.ConclusionsThe workplace-smoking ban was effective in reducing ETS exposure among employees. However, after the ban still 52.2% of non-smoking workers reported to be exposed. We did not find the expected stronger effect among employees who were at higher risk. Both before and after implementation of the ban, males and lower educated employees were about two times more likely to be exposed to ETS.     

Longitudinal exposure assessments of neighbourhood effects in health research: What can be learned from people's residential histories?

Health research into neighbourhood effects has generally examined neighbourhoods cross-sectionally, ignoring the fact that neighbourhood exposures might accumulate over people's lives and affect health outcomes later in life. Using longitudinal Dutch register data with complete 15-year residential address histories, we examined whether health effects of neighbourhood socioeconomic characteristics differ between cumulative and current exposures. We illustrated these differences between exposure assessments using suicide mortality among middle-aged adults. All suicides aged 40–64 years between 2012 and 2016 were matched with 10 random controls in a nested case-control design. We measured neighbourhood exposures longitudinally for circular buffers around residential addresses at the current address and through three accumulative measures, each incorporating the residential address history with increasing detail. Covariate-adjusted conditional logistic regressions were used to assess associations between suicide and neighbourhood social fragmentation, population density and unemployment rate. Our results showed that total and male suicide mortality was significantly lower in highly fragmented neighbourhoods when using accumulative exposures, but not when using the current residential address. However, we observed few differences in coefficients between exposures assessments for neighbourhood urbanicity and unemployment rate. None of the neighbourhood characteristics showed evidence that detailed cumulative exposures were a stronger predictor of suicide compared to more crude measures. Our findings provide little evidence that socioeconomic neighbourhood characteristics measured cumulatively along people's residential histories are stronger predictors of suicide mortality than cross-sectional exposures.     

Hypersensitivity pneumonitis with Mycobacterium avium complex among spa workers

Abstract

Background: The New Mexico Department of Health (NMDOH) investigated the cause of two cases of hypersensitivity pneumonitis (HP) in spa maintenance workers with laboratory confirmed Mycobacterium avium complex (MAC). The investigation occurred in tandem with worker protection and swimming pool regulatory investigations by the New Mexico Environment Department at the spa where the workers were employed.

Objectives: The investigation was conducted in order to identify unreported cases, exposure source(s), and to prevent further worker exposure.

Methods: NMDOH surveyed 57 spa employees about symptoms and exposures, categorized jobs according to self-reported exposure to water, and computed odds ratios for symptom reporting by exposure category. Environmental isolates from spa water and filter swabs were cultured and compared to patient isolates by the Environmental and Applied Microbiology Team, Centers for Disease Control and Prevention (CDC).

Results: Workers with the highest exposure reported more HP-like symptoms (OR?=?9·6), as did intermediate exposure workers (OR?=?6·5), compared to workers with no aerosolized water exposure. Two of 13 environmental isolates were closely related to one of the patient isolates.

Conclusions: Workers were likely exposed during spray cleaning of cartridge filters in a poorly ventilated work space. Recommendations include inhibiting organism growth in spa systems, assuring the use of respiratory protection, and adequately ventilating work spaces where filters and equipment are cleaned.     

Residential mobility during pregnancy for mothers of infants with or without congenital cardiac anomalies: a reprint.

Maternal residence at time of delivery is sometimes used as a proxy for residence during early pregnancy to estimate environmental exposures. Residential addresses during time of conception through the first trimester were obtained from mothers of 152 infants with congenital cardiac anomalies and 175 controls, and they were compared with the addresses at delivery abstracted from birth certificates. An estimated 24.8% (95% CI = 20.3, 29.9) of women moved between the time of conception and delivery, and the percentage of cases and controls who moved was similar. Use of address at time of delivery may reduce the likelihood of finding an association between a congenital malformation and a maternal environmental exposure.     

Residential Mobility during Pregnancy for Mothers of Infants with or without Congenital Cardiac Anomalies: A Reprint

Maternal residence at time of delivery is sometimes used as a proxy for residence during early pregnancy to estimate environmental exposures. Residential addresses during time of conception through the first trimester were obtained from mothers of 152 infants with congenital cardiac anomalies and 175 controls, and they were compared with the addresses at delivery abstracted from birth certificates. An estimated 24.8% (95% CI = 20.3, 29.9) of women moved between the time of conception and delivery, and the percentage of cases and controls who moved was similar. Use of address at time of delivery may reduce the likelihood of finding an association between a congenital malformation and a maternal environmental exposure.     

Comparability of data obtained from migrant farmworkers and their spouses on occupational history.

BACKGROUND: Epidemiologic studies, particularly case-control studies, often rely on proxy respondents to provide information about subjects' occupational histories. The quality of proxy-reported information in occupational histories has never been evaluated for migrant farmworkers. METHODS: We compared occupational histories self-reported by 31 farmworkers with those reported by their wives. The work histories were obtained using an icon/calendar-based questionnaire that was designed to facilitate recall for migrant farmworkers, who typically have complex work histories. RESULTS: The work histories provided by proxy respondents contained 32% fewer jobs and accounted for 24% fewer years than the self-reported histories. Correlations for lifetime duration of employment in different types of jobs were moderate to good for general agricultural jobs in Washington (0.70) and apple-related jobs (0.65), which were held by virtually all of the farmworkers; correlations were moderate to poor for less common jobs and for specific types of tasks. Agreement was better after marriage than before, and for jobs held in the current year compared to other time frames. Overall, the ability of the spouses to provide occupational histories for farmworkers was within the range observed in studies involving other occupations and industries. CONCLUSIONS: In studies involving farmworkers, when study subjects cannot be interviewed, spouses can provide useful information on occupational histories. However, the information should be used only for more generalized exposure assessments; it is most appropriate for estimating cumulative duration of agricultural work, or recent work, by place or for common crops.     

Long-term air pollution exposure and lung function in 15 year-old adolescents living in an urban and rural area in Germany: The GINIplus and LISAplus cohorts

IntroductionThe impact of outdoor air pollution exposure on long-term lung development and potential periods of increased lung susceptibility remain unknown. This study assessed associations between early-life and current residential exposure to air pollution and lung function at 15-years of age in two German birth cohorts.MethodsFifteen year-old participants living in an urban and rural area in Germany underwent spirometry before and after bronchodilation (N = 2266). Annual average (long-term) exposure to nitrogen dioxide (NO₂), particles with aerodynamic diameters less than 2.5 μg/m³ (PM_2.5) mass and less than 10 μg/m³ (PM₁₀) mass, PM_2.5 absorbance and ozone were estimated to each participant's birth-, 10- and 15-year home address using land-use regression and kriging (ozone only) modelling. Associations between lung function variables and long-term pollutant concentrations were assessed using linear regression models adjusted for host and environmental covariates and recent short-term air pollution exposures.ResultsLong-term air pollution concentrations assessed to the birth-, 10- and 15-year home addresses were not associated with lung function variables, before and after bronchodilation, in the complete or study area specific populations. However, several lung function variables were negatively associated with long-term NO₂ concentrations among asthmatics. For example, NO₂ estimated to the 15-year home address was associated with the ratio of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC) and the mean flow rate between 25% and 75% of FVC (−3.5%, 95% confidence interval [−6.0, −1.0] and −297.4 ml/s [−592.6, −2.1] per 5.9 μg/m³ increase in NO₂, respectively). Nearly all effect estimates for the associations between the short-term PM_2.5 mass, PM₁₀ mass and ozone concentrations and the lung function variables were negative in the complete population.ConclusionsEarly-life and current long-term air pollution exposures and lung function at the age of 15 years were not associated in the complete study population. Asthmatics may represent a vulnerable group.     

Offenders who are mothers with and without experience in prostitution: differences in historical trauma, current stressors, and physical and mental health differences

BackgroundWomen offenders are a growing population in the criminal justice system; most are mothers. A subset of these women have a history of prostitution. Despite more recent research identifying the needs of women offenders who are mothers, those with and without experience in prostitution are still generally represented in the literature as a homogenous group.MethodsThis study examined the differences between mothers who indicated that they had engaged in prostitution with those who had not. The data were from a survey of offending mothers in a Midwestern city and was based on 889 respondents. Approximately 20% of the women indicated that they had engaged in prostitution at some point in their lives.FindingsMothers with histories of prostitution reported more exposure to violence, witnessing crime, living in areas with high drug activity, and having a higher rate of physical and mental health problems.ConclusionsHealth care professionals who interact with mothers in the criminal justice system who have histories of prostitution should be careful to assess for a history of trauma and its psychological consequences. Along with increased health care needs, interventions are needed to help these women obtain basic needs such as stable housing outside of high crime and high drug-use areas and to receive targeted psychological services that respond to the unique trauma suffered by this subpopulation of offenders.