Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey.

OBJECTIVES: This analysis uses nationally representative data from the 1988 National Maternal and Infant Health Survey to explore the factors, including employment, associated with breast-feeding initiation and duration. METHODS: Multiple logistic regression was used to model the determinants of breast-feeding initiation among 9087 US women. Multiple linear regression was used to model the duration of breast-feeding among women who breast-fed. RESULTS: Fifty-three percent of mothers initiated breast-feeding in 1988, and the decision to breast-feed was not associated with maternal employment. However, among breast-feeders, returning to work within a year of delivery was associated with a shorter duration of breast-feeding when other factors were controlled. Among employed mothers, the duration of maternity leave was positively associated with the duration of breast-feeding. CONCLUSIONS: The low rates of breast-feeding initiation in the United States are not attributable to maternal participation in the labor force. However, returning to work is associated with earlier weaning among women who breast-feed.     

Maternal education, child immunizations, and public policy: evidence from the US National Immunization Survey

This article measures the independent association of maternal education level and childhood immunization rates in the USA and compares the associations in states that provide free vaccines to all residents (Universal) and those that do not (non-Universal). To do this, the US-based National Immunization Survey data from 1995 to 2003 for children 19-35 months of age were analyzed. Unadjusted estimates of up-to-date status for the 4:3:1:3:3 series and the pneumococcal conjugate vaccine were estimated by the level of maternal education. Linear probability regressions produced adjusted estimates of maternal education effects controlling for covariates. Adjusting for race/ethnicity, income, and other covariates, children of mothers with less than high school education were found to be 7.8% (p<0.05) less likely than children of mothers with college education to be up-to-date for the 4:3:1:3:3 vaccine series. For the newer pneumococcal conjugate vaccine, these children were 4.5% (p<0.05) less likely to be up-to-date. Residence in a Universal state was found to significantly attenuate these effects. As such, higher maternal education, independent of income and race/ethnicity is associated with improved child immunization rates, but subsidizing immunization choices diminishes the disadvantage associated with lower maternal educational achievement.     

中国免疫规划工作面临的挑战和机遇与对策

在总结中国免疫规划工作与分析国内外现状的基础上,剖析了新时期中国免疫规划工作面临的挑战与机遇,并对如何做好中国免疫规划工作提出了若干具体对策。     

The urban American Indian oversample in the 1988 National Maternal and Infant Health Survey.

Although more than two-thirds of American Indians and Alaska Natives (AI) live outside reservations and Tribal lands, few data sets describe social and maternal-child health risk factors among urban AI. The Indian Health Service sponsored a special effort to survey mothers of AI infants as part of the 1988 National Maternal and Infant Health Survey (NMIHS), a comprehensive national study conducted by the National Center for Health Statistics, Centers for Disease Control. The authors analyzed questionnaires completed by mothers residing in selected locations served by urban Indian health programs and compared the data with those for women of other races residing in metropolitan areas. After adjusting the sample for nonparticipating States, the response rate in the Urban Indian Oversample was 60.8 percent (763 of 1,254). More than 45 percent of AI and black respondents, compared with 15 percent of white respondents, reported an annual household income of less than $10,000. About half of AI and black women, compared with nearly three-quarters of white women, reported having insurance or health maintenance organization coverage during pregnancy. Despite having a similarly low rate of health insurance coverage and low household income, AI respondents were far less likely than black respondents to have Medicaid coverage. A higher proportion of AI women than of black or white women reported difficulties in obtaining prenatal care, and AI women were less likely to obtain prenatal care. AI women were also less likely than white women to obtain prenatal care in the first trimester.(ABSTRACT TRUNCATED AT 250 WORDS)     

Young maternal age and depressive symptoms: results from the 1988 National Maternal and Infant Health Survey.

OBJECTIVES: The goal of this study was to provide population-based estimates of the prevalence of depressive symptoms among primiparous US adolescent mothers. METHODS: Data from the live-birth component of the 1988 National Maternal and Infant Health Survey were analyzed. RESULTS: The prevalence of depressive symptoms varied by age and race, from 14% among White adult mothers to 48% among Black mothers 15 to 17 years old. After control for income and marital status, the increased prevalence of depressive symptoms associated with adolescent motherhood was greatly diminished (for 15- to 17-year-old Black women and 18- to 19-year-old White women) or eliminated (for 18- to 19-year-old Black women and 15- to 17-year-old White women). CONCLUSIONS: Adolescent mothers experience high rates of depressive symptoms relative to adult mothers, and mental health and other interventions that alleviate the exacerbating influence of poverty and unmarried status are warranted.     

Preconceptional and prenatal multivitamin-mineral supplement use in the 1988 National Maternal and Infant Health Survey.

This paper examines the prevalence of multivitamin-mineral supplement use before and during pregnancy, as well as predictors of nonuse, in 9953 women who delivered live infants in the 1988 National Maternal and Infant Health Survey. Ninety-seven percent of the women were advised to take multivitamin-mineral supplements in prenatal care. Sixty-seven percent of Black mothers took supplements during pregnancy, as compared with 84% of White mothers. Multivariate analysis revealed that Black mothers; mothers who are less educated, younger, unmarried, and non-smokers; and mothers who participate in Women, Infants, and Children programs are at elevated risk for nonuse. These data help identify groups in need of supplementation guidance.     

Maternal Autonomy and Attitudes Towards Gender Norms: Associations with Childhood Immunization in Nigeria

Globally 2.5 million children under-five die from vaccine preventable diseases, and in Nigeria only 23 % of children ages 12–23 months are fully immunized. The international community is promoting gender equality as a means to improve the health and well-being of women and their children. This paper looks at whether measures of gender equality, autonomy and individual attitudes towards gender norms, are associated with a child being fully immunized in Nigeria. Data from currently married women with a child 12–23 months from the 2008 Nigeria demographic and health survey were used to study the influence of autonomy and gender attitudes on whether or not a child is fully immunized. Multivariate logistic regression was used and several key socioeconomic variables were controlled for including wealth and education, which are considered key inputs into gender equality. Findings indicated that household decision-making and attitudes towards wife beating were significantly associated with a child being fully immunized after controlling for socioeconomic variables. Ethnicity, wealth and education were also significant factors. Programmatic and policy implications indicate the potential for the promotion of gender equality as a means to improve child health. Gender equality can be seen as a means to enable women to access life-saving services for their children.     

Missed Opportunities: Drugs and Drugs Education

Increasing public concern about the extent of adolescent drinking, smoking and illicit drug use has been addressed by a number of Government initiatives. The 1996 Task Force to Review Services for Drug Misusers has recommended the development of services specifically for young people, whilst the White Paper Tackling Drugs Together (1995) recommended that youth services and other agencies aim to reduce experimental behaviour amongst adolescents not yet using drugs, and to encourage cessation and abstinence among those already initiated. Furthermore, drugs education has become a statutory part of the Science Curriculum in both primary and secondary schools, a measure further supported by two guidance documents from the Department for Education and the School Curriculum Assessment Authority. Circular 4/95 Drug Prevention and Schools, (DfE, 1995) and Drug Education: Curriculum Guidance for Schools (SCAA/DfE), essentially set out the expected broader policy and curriculum framework for schools implementing drugs education beyond the minimum statutory requirements.

These policy developments have come about as a consequence of the extensive literature which shows increasing levels of substance experimentation and misuse amongst young people throughout the United Kingdom, and reflect the view evident in the White Paper, that education is a central plank of drugs prevention. This paper describes the outcomes of a collaborative project in three London Boroughs.     

The effect of vaginal bleeding during pregnancy on preterm and small-for-gestational-age births: US National Maternal and Infant Health Survey, 1988

We examined the effects of vaginal bleeding during pregnancy on preterm and small-for-gestational-age (SGA) births using data from the 1988 US National Maternal and Infant Health Survey. We examined the severity of vaginal bleeding and separated the preterm births into subsets by the degree of prematurity (< 32, 32-33, 34-36 weeks' gestation). We also evaluated associations stratified by race. Multiple logistic regression analysis showed that vaginal bleeding was associated with an increased risk of preterm birth, with a more pronounced elevated risk for preterm birth before 34 weeks' gestation and a notably stronger association for more severe bleeding that occurred in both the first and the second half of pregnancy. Odds ratios, but not risk differences, for birth before 34 weeks' gestation were greater for white women with vaginal bleeding than for black women. There was no association between vaginal bleeding during pregnancy and SGA births.     

青海省0～7岁儿童母亲计划免疫知识、态度和行为调查

目的 了解青海省0-7岁儿童母亲对儿童计划免疫的知识态度和行为（KAP）。方法选取青海省共和县2个农业乡和2个牧业乡的8个村作为调查地点．采用自行设计的KAP问卷调查了208名0-7岁儿童母亲．并组织儿童主要看护人参加小组讨论。结果被调查儿童母亲文化水平较低，普遍缺乏计划免疫知识，牧区妇女的计划免疫知识水平低于农区：她们对计划免疫持有正确的态度：在接种行为上，接种的依从性较好，但是接种的主动性较差。被调查儿童母亲现有的计划免疫知识主要来自乡村医生。结论在青海省调查地区开展儿童计划免疫知识教育和传播（Information Educationand Communication．IEC）具有必要性和迫切性。     

Survey of Knowledge,Attitudes, and Practice Management Patterns of Atlanta-Area Obstetricians Regarding Stillbirth

ObjectiveExisting surveillance data on fetal death certificates are suboptimal for conducting reliable epidemiologic studies on stillbirth. The objective of this survey was to better understand the factors potentially affecting the quality of data collected on stillbirths among a defined population.MethodsA survey was mailed to all physicians (n = 661) listed in the July 2007 version of the American Medical Association master file with a primary specialty of obstetrics/gynecology and a mailing address within five counties in metropolitan Atlanta.ResultsA total of 487 physicians met eligibility criteria: 279 returned the survey, 179 did not return the survey, and 29 were returned as unable to locate. Two respondents returned incomplete surveys, leaving 277 participants for the final analysis. Respondents reported seeing an average of six stillbirths per year. A cause of death was not identified in two thirds of cases. Almost half (46.8%) of participants responded that 20 weeks was the minimum gestational age defining stillbirth, whereas 33.1% responded that it was 24 weeks. A majority (92.6%) responded that a standardized definition for stillbirth should be adopted. More than 80% agreed that a comprehensive evaluation was important to identify a cause of death, and 91.9% agreed that the use of a standardized protocol for post-mortem stillbirth evaluation would be helpful. A majority also agreed that ongoing surveillance of stillbirths and a national research agenda on causes of stillbirth are important.ConclusionComprehensive educational and awareness efforts for obstetricians and other related health care personnel are needed to further improve on the data collected for surveillance purposes on stillbirth.     

Comparison of vaccine coverage levels from the National Immunization Survey and the Texas Retrospective Immunization Survey.

The purpose of this study was to compare National Immunization Survey (NIS) vaccine coverage rates with Texas Retrospective Immunization Survey (TRIS) vaccine coverage levels. Up-to-date rates for children 19 through 35 months of age as of October 1, 1994, were calculated for single vaccines and two vaccine combinations. The TRIS weighted statewide up-to-date rates for 4-3-1 and 4-3-1-3 were 66 percent and 60 percent, respectively, versus 71 percent and 68 percent for the NIS. Existing retrospective survey procedures can be modified to produce results that may be compared with the NIS.     

Infant Safe Sleep: A Survey of the Knowledge,Attitudes, and Behaviors of Obstetric Physicians

Obstetricians may be a pregnant woman’s primary professional source of information about her infant prior to the birth, but infant safe sleep knowledge, attitudes and behaviors of this population are unknown. This study explores obstetric physicians’ knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identifies barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. A cross-sectional survey was conducted with obstetric physicians who provide prenatal healthcare to women in Ohio. Surveys were sent to all licensed physicians included in the registry of the State Medical Board of Ohio with “obstetrics,” “obstetrics and gynecology,” or “maternal and fetal medicine” as their primary specialty (n?=?1771). The response rate was 30%, with 418 physicians included in the analysis. Many participants were knowledgeable about infant safe sleep recommendations; however, only 55% indicated that it was important for obstetric physicians to discuss Sudden Infant Death Syndrome and/or infant safe sleep with prenatal patients. Many participants (70%) perceived barriers to providing infant safe sleep education, however most (82%) indicated interest in doing so. Participants’ knowledge and attitudes were significant predictors of whether they discuss this topic with patients. Obstetric physicians can influence the infant safe sleep decisions that women make. Improving obstetricians’ knowledge and attitudes about infant safe sleep and supporting physicians who wish to provide education on this topic may help to ensure that women are receiving frequent and consistent infant safe sleep messaging throughout the prenatal period.     

Racial Differences in the Patterns of Singleton Preterm Delivery in the 1988 National Maternal and Infant Health Survey

Objectives: To determine if the association between race and preterm delivery would persist when preterm delivery was partitioned into two etiologic pathways. Methods: We evaluated perinatal and obstetrical data from the 1988 National Maternal and Infant Health Survey and classified preterm delivery as spontaneous or medically indicated. Discrete proportional hazard models were fit to assess the risk of preterm delivery for Black women compared with White women adjusting for potential demographic and behavioral confounding variables. Results: Preterm delivery occurred among 17.4% of Black births and 6.7% of White births with a Black versus White unadjusted hazard ratio (HR) of 2.8 (95% CI = 2.4–3.3). The adjusted HR for a medically indicated preterm delivery showed no racial difference in risk (HR = 1.0, 95% CI = 0.4–2.6). However, for spontaneous preterm delivery between 20 and 28 weeks gestation, the Black versus White adjusted hazard ratio (HR) was 4.9 (95% CI = 3.4–7.1). Conclusions: Although we found an increased unadjusted HR for preterm delivery among Black women compared with White women, the nearly fivefold increase in adjusted HR for the extremely preterm births and the absence of a difference for medically indicated preterm delivery was unexpected. Given the differences in the risks of preterm birth between Black and White women, we recommend to continue examining risk factors for preterm delivery after separating spontaneous from medically indicated preterm birth and subdividing preterm delivery by gestational age to shed light on the reasons for the racial disparity.     

深圳市食品从业人员艾滋病知识、态度及行为的调查

目的 了解深圳市龙岗区食品从业人员对艾滋病的知识、态度及行为。方法 对深圳市龙岗区684名食品从业人员进行了艾滋病知识、态度及行为的问卷调查。结果 大部分调查对象对艾滋病一般知识的掌握情况较差,平均知晓率为54.8％,不同规模饮食企业和不同年龄段的食品从业人员艾滋病知识知晓率差异有显著性。艾滋病知识来源依次为电视、书刊杂志、广播、宣传栏或宣传小册子、人与人交流。50.7％的被调查者对艾滋病有恐惧感,60.7％表示会给艾滋病患者提供正常的生活和工作环境,49.9％表示艾滋病距离我们很遥远。结论 今后应加强食品从业人员艾滋病知识的教育。     

National Immunization Survey: the methodology of a vaccination surveillance system

The National Immunization Survey (NIS) was designed to measure vaccination coverage estimates for the US, the 50 states, and selected urban areas for children ages 19-35 months. The NIS includes a random-digit-dialed telephone survey and a provider record check study. Data are weighted to account for the sample design and to reduce nonresponse and non-coverage biases in order to improve vaccination coverage estimates. Adjustments are made for biases resulting from nonresponse and nontelephone households, and estimation procedures are used to reduce measurement bias. The NIS coverage estimates represent all US children, not just children living in households with telephones. NIS estimates are highly comparable to vaccination estimates derived from the National Health Interview Survey. The NIS allows comparisons between states and urban areas over time and is used to evaluate current and new vaccination strategies.     

Implementation and applications of bootstrap methods for the National Immunization Survey

In complex probability sample surveys, numerous adjustments are customarily made to the survey weights to reduce potential bias in survey estimates. These adjustments include sampling design (SD) weight adjustments, which account for features of the sampling plan, and non-sampling design (NSD) weight adjustments, which account for non-sampling errors and other effects. Variance estimates prepared from complex survey data customarily account for SD weight adjustments, but rarely account for all NSD weight adjustments. As a result, variance estimates may be biased and standard confidence intervals may not achieve their nominal coverage levels. We describe the implementation of the bootstrap method to account for the SD and NSD weight adjustments for complex survey data. Using data from the National Immunization Survey (NIS), we illustrate the use of the bootstrap (i). for evaluating the use of standard confidence intervals that use Taylor series approximations to variance estimators that do not account for NSD weight adjustments, (ii). for obtaining confidence intervals for ranks estimated from weighted survey data, and (iii). for evaluating the predictive power of logistic regressions using receiver operating characteristic curve analyses that account for the SD and NSD adjustments made to the survey weights.     

Receipt of Recommended Prenatal Interventions and Birth Weight Among African-American Women: Analysis of Data from the 1988 National Maternal and Infant Health Survey

Objectives: While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators. Method: This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data. Results: The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed. Conclusions: Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.     

Ranking states' immunization coverage: an example from the National Immunization Survey

The National Immunization Survey (NIS) provides state-level estimates of preschool immunization coverage. These coverages are frequently presented in ranked lists, and ranks are frequently over-interpreted. In this paper, we highlight the difficulty in interpreting ranked point estimates. To demonstrate the uncertainty of ranks, parametric bootstrap methods were used to derive 90 per cent confidence intervals for ranks of state vaccination coverage levels among preschool children. We graphically compared states to a reference state. If NIS data are used to rank states, one should consider presenting confidence intervals for rank and the results of comparisons of one state with another graphically.