Does Maternal Birth Outcome Differentially Influence the Occurrence of Infant Death Among African Americans and European Americans?

The United States continues to have one of the highest infant mortality rates (IMR). Although studies have examined the association between maternal and infant birth outcomes, few studies have examined the impact of maternal birth outcome on infant mortality. This study was designed to examine the influence of maternal low birth weight and preterm birth on infant mortality. The 1997–2007 Virginia birth and infant death registry was analyzed. The infant birth and death data was linked to maternal birth registry data using the mother’s maiden name and date of birth. From the mother’s birth registry data, the grandmother’s demographic and pregnancy history was obtained. Logistic regression modeling was used to estimate adjusted odds ratios and their 95% confidence intervals. There was a statistically significant association between maternal birth outcome and subsequent infant mortality. Infants born from a mother who was low birth weight were 2.3 times more likely to have an infant die within the first year of life. Similarly, infants born from a mother born preterm were 2.2 times more likely to have an infant die. Stratification by race showed that there was no statistical association between maternal birth weight and infant death among Whites. However, a strong association was observed among Blacks. Maternal birth outcomes may be an important indicator for infant mortality. Future longitudinal studies are needed to understand the underlying cause of these associations.     

Community Stakeholders’ Perceptions of Major Factors Influencing Childhood Obesity,the Feasibility of Programs Addressing Childhood Obesity,and Persisting Gaps

Prior research has identified numerous factors contributing to increased rates of childhood obesity. However, few studies have focused explicitly on the experience of community stakeholders in low-income communities. This study sought to capture the perspectives of these on-the-ground experts regarding major factors contributing to childhood obesity as well as gaps in current prevention and control efforts. We conducted semi-structured interviews with 39 stakeholders from different community sectors (e.g., healthcare providers, childcare providers, teachers). Data were drawn from the Massachusetts Childhood Obesity Research Demonstration project, a multi-level, multi-sector intervention designed to reduce childhood obesity being implemented in two low-income communities in Massachusetts. Interviews were conducted at baseline, transcribed, coded using grounded theory approach, and analyzed in NVivo 10.0. The vast majority of stakeholders had recently participated in obesity prevention strategies, and nearly all of them identified gaps in prevention efforts either within their organizations or in the broader community. In addition to factors previously identified in the literature, several themes emerged including the need to change policies to increase physical activity during school, offer healthier snacks in schools and afterschool programs, and increase communication and collaboration within the community in prevention efforts. Community stakeholders can impact the success of interventions by bridging the gap between science and lived experience. The results of this study can guide future research by highlighting the importance of including stakeholders’ frontline experiences with target populations, and using information on identified gaps to augment intervention planning efforts.     

Optimizing Assessment of Risk and Protection for Diverse Adolescent Outcomes: Do Risk and Protective Factors for Delinquency and Substance Use Also Predict Risky Sexual Behavior?

Prevention Science - Assessments of youth risk and protective factors (RPFs) for substance use, delinquency, and violence have been used by communities to identify priorities and target them with...     

Which Risk Factors for Child Maltreatment Predict Mothers’ Enrollment in a Parenting Support Program?

Parenting support programs are an effective means of preventing child maltreatment. However, these programs are often criticized for their limited ability to enroll and engage the parents who need them most. The present study aimed to determine which risk factors associated with child maltreatment predicted mothers’ enrollment in the Triple P—Positive Parenting Program in Quebec. To this end, 240 mothers of children aged 6 months to 8 years enrolled in Triple P were compared with 834 mothers randomly selected from the general population. The results suggest that mothers who perceived their child to be more difficult, used fewer positive parenting practices, and reported a lower parenting sense of competence were more likely to enroll in the program. Being unemployed, having a lower income, and being a single parent or part of a stepfamily also increased the mothers’ likelihood of participating in Triple P. These results suggest that Triple P was implemented in such a way as to attract families presenting various risk factors, which is promising in a child maltreatment prevention context.

     

Do Risk Factors Explain the Increased Prevalence of Type 2 Diabetes Among California Asian Adults?

Asian subgroup-specific information on type 2 diabetes mellitus (DM) is scarce. Using the California Health Interview Survey 2007 data, we examined Chinese, Korean, Japanese, Filipinos, and Vietnamese adults (n = 3,688) and Caucasian adults (n = 33,981) for the prevalence of DM and risk factors. The age-adjusted prevalence of DM was the highest among Filipinos (8.05%) followed by Japanese (7.07%), Vietnamese (7.03%), and Koreans (6.3%). Chinese (5.93%) was the only Asian group studied whose prevalence was lower than Caucasians (5.94%). From multiple logistic regression, after adjusting for risk factors, Japanese had the highest likelihood of DM (OR = 1.75, CI = [1.12–2.73], P < 0.05), followed by Filipinos (1.66, [1.13–2.43], P < 0.01), and Koreans (1.59, [1.00–2.52], P < 0.05), relative to Caucasians. Our results suggest that even after accounting for lifestyle and other risk factor differences between Caucasians and key Asian subgroups in California, Japanese, Filipinos, and Koreans have a 1.6–1.75 greater likelihood of DM compared to Caucasians.     

Risk Factors for Obesity and High Blood Pressure in Chinese American Children: Maternal Acculturation and Children’s Food Choices

The objective of this study is to explore risk factors associated with overweight and high blood pressure in Chinese American children. Students and their parents were recruited from Chinese language schools in the San Francisco Bay Area. Data were collected on 67 children and their mothers, and included children’s weight, height, waist and hip circumferences, blood pressure, level of physical activity, dietary intake, usual food choice, knowledge about nutrition and physical activity, and self-efficacy regarding diet and physical activity. Mothers completed questionnaires on demographic data and acculturation. About 46% of children had a body mass index exceeding the 85th percentile. Lower level of maternal acculturation is a risk factor for overweight and higher waist to hip ratio. Children’s unhealthy food choices were predictive of high body mass index and high systolic blood pressure, whereas older age and less physical activity in children were predictors of high diastolic blood pressure. Developing culturally sensitive and developmentally appropriate interventions to reduce overweight and high blood pressure is critical to reduce health disparities among minority children.     

Early Initiatives for Children at Risk—Development of a Program for the Prevention and Treatment of Behavior Problems in Primary Services

During the past decade, Norwegian authorities have initiated and funded a project to scale up the use of evidence-based programs for the prevention and treatment of conduct problems in children. The first step in this process was to increase treatment competence by implementing the Parent Management Training-Oregon Model (PMTO) in specialist services for children. The second step was to develop the program Early Initiatives for Children at Risk (Norwegian acronym, TIBIR), designed to identify children with possible conduct problems as early as possible and to offer tailored interventions as part of the ordinary primary services for children in individual municipalities. The theoretical rationale and practical considerations leading to the design of TIBIR are presented, together with the program modules and current research activities. Some of the challenges concerning the program’s ability to reach various risk groups are discussed, as are the challenges encountered regarding quality assurance and fidelity maintenance. Finally, some future research questions are presented and discussed.     

Do Maternal Factors and Milk Expression Patterns Affect the Composition of Donor Human Milk?

A primary role of Human Milk Banks (HMBs) is to provide human milk (HM) for preterm infants and to support the mothers of these infants as they establish their own milk supply. A better understanding of the variation in the energy and macronutrients contents of donor human milk (DHM) potentiates targeted nutrition for preterm babies. Therefore, the aim of this study was to assess the variability of energy and macronutrients content in DHM and to investigate the impact of maternal factors and feeding practices on the nutritional value of DHM. The study involved 49 donors registered in the HMB in the Holy Family Hospital in Warsaw, Poland. Samples from each donor were pooled within a maximum of two weeks. The composition of DHM, including energy content, protein, fat, and carbohydrate concentrations, was analyzed using the Miris Human Milk Analyzer. The analyses were performed before the pasteurization process. The mean time of milk donation to HMB was 13.2 ± 6.0 weeks. There were no significant differences in energy and macronutrients contents of DHM in the beginning and at the end of milk donation to HMB, however, HM fat concentration was positively correlated with afternoon feedings (r = 0.289, p = 0.044). The method of feeding (breastfeeding vs. feeding only expressed milk) also did not impact the nutritional value of DHM. Future research for the DHM should include a further cross-sectional observational study with the collection of detailed donor information and characteristics of milk expression and feeding practices to further evaluate the pooling processes and the effect on DHM composition.     

Prevalence of and Risk Factors for Substance Use Among Perinatally Human Immunodeficiency Virus–Infected and Perinatally Exposed but Uninfected Youth

PurposeThis study examined risk factors associated with recent substance use (SU) among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compared SU lifetime prevalence with the general population of United States (U.S.) adolescents.MethodsWe conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry, 13.2 years; 51% female; 69% PHIV+; and 72% African-American) enrolled in a U.S. multisite prospective cohort study between 2007 and 2009. Substance use data were collected by audio computer–assisted self-interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence with U.S. samples.ResultsPerinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver or others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys.ConclusionsAlthough SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status.     

Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans

A discrete-choice logit model was applied to study the determinants of mental health provider choice using data from a large urban county in the Northeast US. The study subjects were 9,544 adult Medicaid recipients who received outpatient treatment from the 20 Community Mental Health Center (CMHC) programs in 2001. In addition to a conventional set of variables representing client and provider characteristics, the regression model included several interaction terms to examine whether racial concordance level among patients influences the choice of an outpatient program. The results revealed that racial concordance among the clients seems to be a factor in choosing a program. In particular, Caucasian clients are much more likely to select a program with a higher percentage of Caucasian clients, even though they have to travel further. More generally, our results suggest that program choice may be driven more by the racial composition of the clients served than by spatial proximity to the program.     

Which Type of Risk Information to Use for Whom? Moderating Role of Outcome-Relevant Involvement in the Effects of Statistical and Exemplified Risk Information on Risk Perceptions

The extant empirical research examining the effectiveness of statistical and exemplar-based health information is largely inconsistent. Under the premise that the inconsistency may be due to an unacknowledged moderator (O’Keefe, 2002), this study examined a moderating role of outcome-relevant involvement (Johnson & Eagly, 1989) in the effects of statistical and exemplified risk information on risk perception. Consistent with predictions based on elaboration likelihood model (Petty & Cacioppo, 1984), findings from an experiment (N = 237) concerning alcohol consumption risks showed that statistical risk information predicted risk perceptions of individuals with high, rather than low, involvement, while exemplified risk information predicted risk perceptions of those with low, rather than high, involvement. Moreover, statistical risk information contributed to negative attitude toward drinking via increased risk perception only for highly involved individuals, while exemplified risk information influenced the attitude through the same mechanism only for individuals with low involvement. Theoretical and practical implications for health risk communication are discussed.     

Should We Activate Risk Perceptions in the Context of Suicide Prevention? Examining Fear Appeals,Help-Seeking Determinants,and Help-Seeking Sources Among University Employees Who Suffer from Depression

Prevention Science - Health promotion strategies have largely focused on activating risk perceptions for health conditions in resistant at-risk populations in order to induce behavior change. Yet,...     

Is LARC for Everyone? A Qualitative Study of Sociocultural Perceptions of Family Planning and Contraception Among Refugees in Ethiopia

Objective Ethiopia is home to an increasingly large refugee population. Reproductive health care is a critical issue for these groups because refugee women are at high risk for unmet family planning needs. Efforts to expand contraceptive use, particularly long acting reversible contraceptive (LARC) methods are currently underway in several Ethiopian refugee camps. Despite availability of LARC methods, few refugee women opt to use them. The purpose of this study was to explore how culture influences contraceptive attitudes and behaviors, particularly towards LARC methods, among Ethiopia’s refugee populations. Methods Focus group discussions and individual interviews were conducted with Eritrean and Somali refugees living in Ethiopia. The qualitative data was analyzed to identify important themes highlighting the relationship between cultural values and contraceptive attitudes and behaviors. Results Childbearing was highly valued among participants in both study groups. Eritreans reported desire to limit family size and attributed this to constraints related to refugee status. Somalis used cultural and religious faith to deal with economic scarcity and were less likely to feel the need to adapt contraceptive behaviors to reduce family size. Participants held overall positive views of the contraceptive implant. Attitudes toward the intrauterine device (IUD) were overwhelmingly negative due to its long-acting nature. Conclusions Culture, religion and refugee status form a complex interplay with family planning attitudes and behaviors among Eritrean and Somali refugees. For these populations, the three-year implant appears to be a more acceptable contraceptive method than the longer-acting IUD because it is in line with their reproductive plans.     

Does the “Stages of Change” Construct Predict Cross-Sectional and Temporal Variations in Dietary Behavior and Selected Indicators of Diabetes Risk Among Norwegian-Pakistani Women?

The aim of this study is to explore the association between motivational “stage” and intake of selected foods, and risk factors for diabetes; and what degree of attendance in an intervention that was necessary to show movements across the motivational “stages of change”. Participants (n = 198, aged 25–62 years) were randomly assigned into intervention and control. Data collection: Interviews with a structured questionnaire, anthropometric and biochemical assessments. Intake of several food items and blood parameters at baseline differed according to motivational stage. Those who participated in at least four group sessions in the intervention were more likely to show a positive move through the “stages of change”. Those in low motivational stages at baseline had benefitted just as much from the intervention as those in higher stages. Intake of several food items corresponded to the motivational “stage”. High attendance in the intervention was necessary for a positive move through “stages of change”.     

Do Early Career Indicators of Clinical Skill Predict Subsequent Career Outcomes and Practice Characteristics for General Internists?

Objective

To study relationships between clinical skill measures assessed at the beginning of general internists'' careers and their career outcomes and practice characteristics.

Data Sources

General Internist Community Tracking Study Physician Survey respondents (2000–2001, 2004–2005) linked with residency program evaluations and American Board of Internal Medicine board certification examination score records; n = 2,331.

Study Design

Cross-sectional regressions of career outcome and practice characteristic measures on board examination scores/success, residency evaluations interacted with residency type, and potential confounding variables.

Principal Findings

Failure to achieve board certification was associated with $27,206 (18 percent, p < .05) less income and 14.9 percent more minority patients relative to physicians scoring in the bottom quartile on their initial examination who eventually became certified (p < .01). Other skill measures were not associated with income. Scoring in the top rather than bottom quartile on the board certification examination was associated with 9 percent increased likelihood of reporting high career satisfaction (p < .05). Among physicians trained in community hospital residency programs, lower evaluations were associated with 14.5 percent higher share of minority patients (p < .05). Both skill measures were associated with practice type.

Conclusions

There are associations between early career skill measures and career outcomes. In addition, minority patients are more likely to be treated by physicians with lower early career clinical skills measures than nonminority patients.     

Prevalence of Coronary Heart Disease Risk Factors and Screening for High Cholesterol Levels Among Young Adults,United States, 1999–2006

PURPOSE Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults.METHODS National estimates were obtained using results for 2,587 young adults (men aged 20 to 35 years; women aged 20 to 45 years) from the 1999–2006 National Health and Nutrition Examination Surveys. We defined high low-density lipoprotein cholesterol (LDL-C) as levels higher than the goal specific for each CHD risk category outlined in the National Cholesterol Education Program Adult Treatment Panel III guidelines.RESULTS About 59% of young adults had CHD or CHD equivalents, or 1 or more of the following CHD risk factors: family history of early CHD, smoking, hypertension, or obesity. In our study, the overall screening rate in this population was less than 50%. Moreover, no significant difference in screening rates between young adults with no risk factors and their counterparts with 1 or more risk factors was found even after adjustment for sociodemographic and health care factors. Approximately 65% of young adults with CHD or CHD equivalents, 26% of young adults with 2 or more risk factors, 12% of young adults with 1 risk factor, and 7% with no risk factor had a high level of LDL-C.CONCLUSIONS CHD risk factors are common in young adults but do not appear to alter screening rates. Improvement of risk assessment and management for cardiovascular disease among young adults is warranted.