Trends of Parent–Adolescent Drug Talk Styles in Early Adolescence

The present study seeks to understand how parents as prevention agents approach substance use prevention messages during the period of early adolescence. Students (N = 410) in a drug prevention trial completed surveys from 7th to 9th grade. Using longitudinal data, a series of latent transition analyses was conducted to identify major trends of parent–adolescent drug talk styles (i.e., never talked, situated direct, ongoing direct, situated indirect, and ongoing indirect) in control and treatment conditions. Findings demonstrate a developmental trend in drug talk styles toward a situated style of talk as youth transitioned from 7th grade to 9th grade. Findings also show that even though the drug prevention trial did not specifically target parental communication, parents in the treatment condition provide more ongoing substance use prevention messages to their adolescent children than do parents in the control condition. The present study discusses relevant developmental issues, potential intervention effects, and future research directions for communication research in substance use prevention.     

Population-Based Trends in Male Adolescent Obesity in Israel 1967–2003

Obesity increased monotonically from 1.2% to 3.8% of males age 17 (1967–2003). Low socioeconomic status had an independent positive effect on obesity. The likelihood of obesity had risen more steeply over time among the low socioeconomic status group than among other adolescents. Rise in obesity, standard of living, and income inequality (as measured by the Gini index) increased concomitantly.     

Recent Trends in Adolescent Alcohol Use in Hawai‘i: 2005–2011

Monitoring trends in adolescent alcohol use over time is important for planning, allocation of resources, and evaluation of alcohol prevention and treatment programs. This article is an update of previously reported trends in adolescent alcohol use in the State of Hawai‘i utilizing data from the Centers for Disease Control and Prevention''s Youth Risk Behavior Survey. Five alcohol use indicators were investigated between 2005 and 2011 including lifetime use, onset age, current use, binge drinking, and drinking on school property. Youth in Hawai‘i generally reported worse alcohol behaviors in 2009 compared to 2007 but better alcohol use behaviors were observed in 2011 compared to 2009. This trend was not observed on the national level and thus may represent changes unique to Hawai‘i. These apparent changes in alcohol use among adolescents highlight the need for resources and for continued surveillance.     

Early Neonatal Mortality in India, 1990–2006

The increased reach of health programs in India during the past few decades has contributed to a decline in postnatal mortality including infant and child mortality; however, reduction in neonatal mortality remained negligible. About seven out of ten neonatal deaths take place within a week after birth. The progress in reduction as well as dimension along which early neonatal mortality is patterned in India remains unclear. We examine the trend in early neonatal mortality and its possible demographic and socioeconomic predictors using nationally representative data. Data from the three cross-sectional rounds of the National Family Health Survey of India from 1992 to 1993, 1998 to 1999 and 2005 to 2006 were analyzed. Early neonatal mortality rate was estimated for selected demographic and socioeconomic population groups and for major states in India using information on births and deaths during the 3 years preceding the respective surveys. Using the multivariate logistic regression model, we assessed proximate determinants of early neonatal deaths during 1990–2006. Sex of the child, child’s birth size, birth order and interval, type of child’s birth, mother’s age at child’s birth, mother’s educational status, religion, household economic status and region of residence emerged as significant predictors of early neonatal deaths. The adjusted multivariate analysis indicates that majority of the socio-demographic predictors reveal a negligible decline in the probability of early neonatal deaths during 1990–2006. Moreover, based on comprehensive reviews of scientific literature on newborn’s survival we document some of the recommended ways to prevent early neonatal mortality in India.     

Intervention with Adolescent Mother–Child Dyads and Cognitive Development in Early Childhood: a Meta-Analysis

The cognitive development of children of adolescent mothers has often been considered to be at risk. The purpose of this meta-analysis is to examine whether early intervention could help foster more positive cognitive development in the 0- to 4-year-old children of adolescent mothers. Twenty-two studies were reviewed, involving 29 different intervention strategies and 3577 participants. An overall effect size (corrected for publication bias) of d?=?.24 was found (95% CI .11, .36). Intervention strategies that focused specifically on the quality of parent–child interaction (d?=?.89; 95% CI .36, 1.43) or that included parent–child interaction as an important target of intervention (d?=?.53; 95% CI .34, .73) yielded greater effect sizes than those that emphasized maternal support and education (d?=?.23; 95% CI .12, .34). Intervention that was delivered in groups (d?=?.56; 95% CI .36, .74) yielded greater effectiveness than dyadic intervention (d?=?.27; 95% CI .14, .39). Intervention delivered by trained professionals (d?=?.39; 95% CI .22, .56) was more effective than that delivered by paraprofessionals (d?=?.20; 95% CI ?.02, .61). Older studies (slope?=??.015) and those that involved smaller numbers of participants (slope?=??.0008) also yielded greater effect sizes. There was also a marginal tendency for shorter intervention strategies (slope?=??.002), and those that involved younger children (slope?=??.005) and mothers (slope?=??.074) to show greater effects. Discussion focuses on the developmental and practical implications of these results.     

Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments, 2006–2013

Maternal and Child Health Journal - Ectopic pregnancy is an important adverse pregnancy outcome that is under-surveilled. Emergency department (ED) data can help provide insight on the trends of...     

Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003

Background  

The objective of this study was to assess trends in cancer mortality by educational level in Barcelona from 1992 to 2003.     

Temporal Trends in Social Disparities in Maternal Smoking and Breastfeeding in Canada, 1992–2008

A steady decrease in maternal smoking during pregnancy and a steady increase in breastfeeding rates have been observed in Canada in the past two decades. However, the extent to which all socioeconomic classes have benefited from this progress is unknown. Therefore, this study was undertaken to determine: (1) whether progress achieved benefited the entire population or was limited to specific strata; and (2) whether disparities among strata decreased, stayed the same, or increased over time. We used data from the National Longitudinal Survey of Children and Youth, which enrolled children aged 0–3 years between 1994 and 2008. Data collected at entry was analyzed in a cross-sectional manner. Between birth years 1992–1996 and 2005–2008, smoking during pregnancy decreased from 11.5 % (95 % CI 10.0–13.0 %) to 5.2 % (95 % CI 4.1–6.3 %) among mothers with a college or university degree and from 43.0 % (95 % CI 38.8–47.2 %) to 38.6 % (95 % CI 32.9–44.2 %) among those with less than secondary education. During the same period, the rate of breastfeeding initiation increased from 83.8 % (95 % CI 81.9–85.6 %) to 91.5 % (95 % CI 90.2–92.8 %) among mothers with a college or university degree and from 63.1 % (95 % CI 58.9–67.4 %) to 74.7 % (95 % CI 69.8–79.7 %) among those with less than secondary education. The risks of smoking and of not breastfeeding remained significantly higher in the least educated category than in the most educated throughout the study period, and these associations remained statistically significant after controlling for maternal age. Gaps between the least and the most educated mothers narrowed for breastfeeding but widened for smoking during pregnancy.     

Trends in maternal mortality in Switzerland among Swiss and foreign nationals, 1969–2006

Objectives  

To test whether maternal mortality was higher among immigrant women than Swiss women.     

Recent Changes in the Trends of Teen Birth Rates, 1981–2006

PurposeTo explore trends in teen birth rates by selected demographics.MethodsWe used birth certificate data and joinpoint regression to examine trends in teen birth rates by age (10–14, 15–17, and 18–19 years) and race during 1981–2006 and by age and Hispanic origin during 1990–2006. Joinpoint analysis describes changing trends over successive segments of time and uses annual percentage change (APC) to express the amount of increase or decrease within each segment.ResultsFor teens younger than 18 years, the decline in birth rates began in 1994 and ended in 2003 (APC: ?8.03% per year for ages 10–14 years; APC: ?5.63% per year for ages 15–17 years). The downward trend for 18- and 19-year-old teens began earlier (1991) and ended 1 year later (2004) (APC: ?2.37% per year). For each study population, the trend was approximately level during the most recent time segment, except for continuing declines for 18- and 19-year-old white and Asian/Pacific Islander teens. The only increasing trend in the most recent time segment was for 18- and 19-year-old Hispanic teens. During these declines, the age distribution of teens who gave birth shifted to slightly older ages, and the percentage whose current birth was at least their second birth decreased.ConclusionsTeen birth rates were generally level during 2003/2004–2006 after the long-term declines. Rates increased among older Hispanic teens. These results indicate a need for renewed attention to effective teen pregnancy prevention programs in specific populations.     

Trends in food availability in Portugal in 1966–2003

BACKGROUND: Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown. AIM OF THE STUDY: To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003. METHODS: Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression. RESULTS: The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 +/- 2.2 kcal (slope +/- standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 +/- 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 +/- 0.1 kcal/year and 2.5 +/- 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products. CONCLUSIONS: Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countries.     

Trends in Birth Rates: New York City 1970–1995

Traditional means of assessing the problem of teen pregnancy have relied on national or state statistics. By using large geographic areas, usually comprised of a heterogeneous population, it is impossible to tell which subareas have more of a problem than others. This study focused on trends in teen birth rates at the health district level in New York City over a 25-year period to illustrate variations among ethnic groups. Teen birth rates were calculated based on vital statistics published by the New York City Department of Health. They were calculated as the number of births per 1,000 females in each of three age groups: under age 15, 15–17, and 18–19. Rates were calculated for the entire City, for four boroughs, and for selected health center districts. The decline in the birth rate among New York City teens is most significant in health districts populated by blacks. An exception is the noted increases in birth rates in districts populated predominantly by Hispanics. Data show substantial decreases among older teens compared to younger teens. Birth trends in small areas of New York City mirror trends seen nationwide. As migration changes the ethnic composition of small areas, it is important to monitor trends so that policies and programs can be targeted to those in need.     

Five-year Trends in Women Veterans' Use of VA Maternity Benefits, 2008–2012

BackgroundAn increasing number of young women veterans are returning from war and military service and are seeking reproductive health care from the Veterans Health Administration (VHA). Many of these women seek maternity benefits from the VHA, and yet little is known regarding the number of women veterans utilizing VHA maternity benefits nor the characteristics of pregnant veterans using these benefits. In May 2010, VHA maternity benefits were expanded to include 7 days of infant care, which may serve to entice more women to use VHA maternity benefits. Understanding the changing trends in women veterans seeking maternity benefits will help the VHA to improve the quality of reproductive care over time.ObjectiveThe goal of this study was to examine the trends in delivery claims among women veterans receiving VHA maternity benefits over a 5-year period and the characteristics of pregnant veterans utilizing VHA benefits.DesignWe undertook a retrospective, national cohort study of pregnant veterans enrolled in VHA care with inpatient deliveries between fiscal years (FY) 2008 and 2012.ParticipantsWe included pregnant veterans using VHA maternity benefits for delivery.Main MeasuresMeasures included annualized numbers and rates of inpatient deliveries and delivery-related costs, as well as cesarean section rates as a quality indicator.Key ResultsDuring the 5-year study period, there was a significant increase in the number of deliveries to women veterans using VHA maternity benefits. The overall delivery rate increased by 44% over the study period from 12.4 to 17.8 deliveries per 1,000 women veterans. A majority of women using VHA maternity benefits were age 30 or older and had a service-connected disability. From FY 2008 to 2012, the VHA paid more than $46 million in delivery claims to community providers for deliveries to women veterans ($4,993/veteran).ConclusionsOver a 5-year period, the volume of women veterans using VHA maternity benefits increased by 44%. Given this sizeable increase, the VHA must increase its capacity to care for pregnant veterans and ensure care coordination systems are in place to address the needs of pregnant veterans with service-connected disabilities.     

Trends in Warfarin Monitoring Practices Among New York Medicare Beneficiaries, 2006–2011

Anticoagulation with warfarin requires frequent evaluation of the international normalized ratio (INR), and less invasive testing devices are available for use by clinicians at the point-of-care (POC) and by patients who self-test (PST). Despite commercial availability and positive results of published studies, evidence suggests that adoption of less invasive (POC/PST) testing in the United States is slow. Considering the equivalence of results and logistical advantages of POC/PST testing, slow uptake may indicate a gap in quality of care warranting evaluation and possibly intervention. This study used Medicare fee for service claims data to explore the uptake of POC/PST INR monitoring across New York State over a 6 year time frame (2006–11), with additional analyses based on beneficiary age, sex, race and ethnicity and income by county. In 2006, only 28.3 % of 103,410 analyzable beneficiaries presumed to be chronic warfarin users based on INR testing patterns were monitored by POC/PST, and increased to only 37.6 % by 2011. Utilization of POC/PST testing varied widely by county (baseline range 1.2–89.4 %), and uptake of these testing modalities in New York State was significantly lower among the very elderly, women, and ethnic minorities. We hypothesize that poor penetration of these less invasive INR testing modalities into highly populated New York City and barriers to POC utilization in long term care facilities may account for a portion of the variability in INR testing patterns observed in this study. However, additional research is needed to further explore whether disparities in warfarin monitoring practices exist.     

Trends in Racial and Ethnic Disparities in Infant Mortality Rates in the United States, 1989–2006

Objectives. We sought to measure overall disparities in pregnancy outcome, incorporating data from the many race and ethnic groups that compose the US population, to improve understanding of how disparities may have changed over time.Methods. We used Birth Cohort Linked Birth–Infant Death Data Files from US Vital Statistics from 1989–1990 and 2005–2006 to examine multigroup indices of racial and ethnic disparities in the overall infant mortality rate (IMR), preterm birth rate, and gestational age–specific IMRs. We calculated selected absolute and relative multigroup disparity metrics weighting subgroups equally and by population size.Results. Overall IMR decreased on the absolute scale, but increased on the population-weighted relative scale. Disparities in the preterm birth rate decreased on both the absolute and relative scales, and across equally weighted and population-weighted indices. Disparities in preterm IMR increased on both the absolute and relative scales.Conclusions. Infant mortality is a common bellwether of general and maternal and child health. Despite significant decreases in disparities in the preterm birth rate, relative disparities in overall and preterm IMRs increased significantly over the past 20 years.In the United States, differences in infant mortality by race and ethnicity have been noted since at least the early 1900s. In particular, the large and persistent disparity in mortality between Black and White infants has been thoroughly examined (though remains largely unexplained), and the “Mexican American paradox”—surprisingly low mortality rates when one considers the seemingly unfavorable sociodemographic profile among those infants—has also been much studied.1–8 Higher rates of poor outcome also are generally more frequent among American Indians/Alaska Natives (AIAN) and certain Hispanic subpopulations.4,8 Although infant mortality rates (IMRs) have decreased considerably over the past several decades, it is unclear if much progress has been made in reducing overall disparities in infant mortality across multiple groups.7 Reducing these disparities is a foundation of the national US health objectives.9Most disparity analyses rely on pairwise comparisons—comparing the rate of adverse outcome in one group (e.g., mortality among Black infants) to that of a reference group (e.g., mortality among White infants)—on either a relative or absolute scale, depending on the purpose of the analysis. Pairwise comparisons have suggested that, at least in relative terms, the Black–White disparity in infant mortality has widened over the past several decades.10,11 However, pairwise comparisons such as relative risk ratios (RRs) or risk differences (RDs) do not allow for assessment of the overall degree of disparity in the entire population comprising more than 2 groups, and are not weighted by population size to account for demographic distributions and changes in population size over time.12–14 The choice of disparity metric (e.g., absolute vs relative, population-weighted vs equally weighted, pairwise vs multigroup) reflects various value judgments that are often not explicated; it is important to note that different metrics can lead to different conclusions about whether disparities are increasing or decreasing.12–14Measurement of the degree of, and trends in, overall disparities in pregnancy outcome, incorporating data from the many racial and ethnic groups that compose the US population, will improve understanding of how disparities may have changed as a consequence of factors such as demographic changes or changes in perinatal care (e.g., changes in perinatal regionalization,15,16 use of surfactant,11 or medically induced preterm birth [PTB]17). Social and medical advances have not benefited all racial and ethnic subgroups to the same degree.7,8,11,18,19 As a consequence, it is unclear how population-based disparities across multiple different racial and ethnic subpopulations may have changed in the United States, or if there are differences when one is looking at disparities on an absolute or relative scale.Ongoing methodological work in the assessment of health disparities has led to the development of several measures that incorporate data from multiple groups to calculate overall population-level disparity indices on the absolute and relative scale.20 The objectives of this analysis were to examine how disparities in infant mortality in the United States have changed from 1989 to 2006, and to explore differential patterns across the major components of infant mortality: PTB rates and gestational age–specific infant mortality.21 In addition, we calculated both population-weighted and equally weighted disparity measures to enable determination of how demographic changes may have influenced overall disparity in infant mortality.     

Use of Density-Equalizing Cartograms to Visualize Trends and Disparities in State-Specific Prevalence of Obesity: 1996–2006

Objectives. We used cartograms to visually communicate the state-specific prevalence of obesity and its association with socioeconomic variables over time to benefit and inform decisions by national health policymakers who address geographic and social inequities in health.Methods. We generated density-equalizing maps, known as cartograms (in which geographic regions are sized in proportion to some variable), that illustrate indicators of population and educational attainment. We also provide an innovative presentation of the obesity choropleth map (which presents values for areas by shading).Results. The maps depict the absolute burden of obesity, the inverse association between obesity and education, and geographic patterns in the prevalence of obesity over time.Conclusions. The prevalence of obesity in the United States continues to increase. These cartograms can help stakeholders interpret surveillance data and their relation to demographic and socioeconomic characteristics to inform decisions.Several national surveys have shown that prevalence rates for obesity continue to increase.^1,2 Not surprisingly, this prevalence is not uniformly distributed; obesity disproportionately affects some groups in the United States.^3,4 Among adult men, no significant differences in obesity prevalence are seen among racial/ethnic groups.^1,5,6 However, both non-Hispanic Black and Mexican American women have a higher prevalence of obesity.^1,5,6 Among adult women, poverty and low educational levels are also associated with a higher prevalence of obesity.⁵Data from public health surveillance, often summarized in large, traditional tables, can be difficult to interpret and may not show the information in a meaningful way. One common solution is to display trends in the prevalence of obesity via maps. For instance, researchers have used choropleth maps (which present percentages for areas through the use of color, saturation, and lightness) to show changes in state-specific prevalence of obesity over time.⁷ Several limitations and critiques have been noted for choropleth maps, however.^8,9 For example, large areas (often sparsely populated) tend to visually dominate smaller (often densely populated) areas,^10–14 leading to potential misinterpretation of the burden of obesity. Moreover, obesity is most highly concentrated among certain subpopulations, not only minorities but also the poor,¹⁵ and these related factors are difficult to depict on choropleth maps.The use of density-equalizing maps, or cartograms, minimizes such limitations by transforming the size and sometimes the shape of political areas (in this case, states) so they are proportional to another variable; traditionally, the variable is population, but other variables could be used. Cartograms are relatively new to public health but have been used successfully to map patterns of chronic disease, including the distribution of Wilms tumors in New York State,¹⁶ mortality patterns of cerebrovascular disease in North Carolina,¹⁷ and associations between both lung cancer and leukemia and the Rocky Flats plant site in Colorado.¹⁰ Other successful cartograms have been developed to analyze the spatial distribution of cryptosporidiosis among AIDS patients in San Francisco, California,¹⁸ and to characterize the spatial distribution of late-state and in situ breast cancer among women in the San Francisco Bay Area.¹⁹ Innovative mapping applications, including cartograms, can be used in public health to improve understanding of health problems and for exploratory analysis of data.^20,21For our exploratory study, we used cartograms and other cartographic techniques to visually communicate the pattern of obesity prevalence and its association with socioeconomic variables over time. Our density-equalizing cartograms of population and education indicators show the prevalence of obesity, and an innovative presentation of the choropleth map shows change in obesity prevalence over time.