Obesity and contraceptive use among women 20–44 years of age in the United States: results from the 2011–15 National Survey of Family Growth (NSFG)

Objective

Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20–44 years, with body mass index (BMI) and relevant covariates.

Pregnancy Intention and Health Behaviors: Results from the Central Pennsylvania Women’s Health Study Cohort

Objective Our objective was to determine whether intention for future pregnancy affects selected preconception health behaviors that may impact pregnancy outcomes. Methods Analyses are based on data from a population-based cohort study of women ages 18–45 residing in Central Pennsylvania. A subsample of 847 non-pregnant women with reproductive capacity comprise the analytic sample. We determined the associations between intention for future pregnancy and the pattern in the following health behaviors over a 2-year period: nutrition (fruit and vegetable consumption), folic acid supplementation, physical activity, binge drinking, smoking, and vaginal douching. Multivariable analyses controlled for pregnancy-related variables, health status, health care utilization, and sociodemographic variables. Results At baseline, 9% of women were considering pregnancy in the next year, 37% of women were considering pregnancy some other time in the future, and 53% of women were not considering future pregnancy. In multivariable analyses, there were no associations between intention for future pregnancy and maintaining healthy behavior or improving behavior for any of the seven longitudinal health behaviors studied. Conclusions The importance of nutrition, folic acid supplementation, physical activity, avoiding binge drinking, not smoking, and avoiding vaginal douching in the preconception period needs to be emphasized by health care providers and policy makers.     

Contraceptive Method Use by Rural–Urban Residence among Women and Men in the United States, 2006 to 2017

PurposePolicy and reproductive health practice changes in the past decade have affected use of different contraceptive methods, but no study has assessed contraceptive method use over this time by rural–urban residence in the United States.MethodsWe used female and male respondent data (2006–2017) from the National Survey of Family Growth (n = 29,133 women and n = 24,364 men) to estimate contraceptive method use by rural–urban residence over time and contraceptive method use by age, marital status, and parity/number of children.ResultsFrom 2006–2010 to 2013–2017, among urban women, we found increased use of two or more methods (11% to 14%); increased use of intrauterine devices (5% to 11%), implants (0 to 2%), and withdrawal (5 to 8%); and decreased use of sterilization (28% to 22%) and pills (26% to 22%). Among rural women, we found increased use of intrauterine devices (5% to 9%) and implants (1% to 5%). We found increased withdrawal use for urban men, but otherwise no differences among men across time. In data pooled across all survey periods (2006–2017), contraceptive method use varied by rural–urban residence across age, marital status, and parity/number of children.ConclusionsIn a nationally representative sample of reproductive age women and men, we found rural–urban differences in contraceptive method use from 2006–2010 to 2013–2017. Describing contraceptive use differences by rural–urban residence is necessary for tailoring reproductive health services to populations appropriately.     

Provider communication with adolescent and young females during sexual and reproductive health visits: findings from the 2011–2015 National Survey of Family Growth

Objective

This study assesses provider communication with adolescent and young women about birth control, emergency contraception and condoms during sexual and reproductive health visits.

The Association between Parity and Inflammation among Mexican-American Women of Reproductive Age Varies by Acculturation Level: Results of the National Health and Nutrition Examination Survey (1999–2006)

IntroductionParity and acculturation are linked with cardiometabolic risk. Their joint association with cardiometabolic health among Mexican-American women is less established, even though immigrant Mexican-American women have the highest fertility rate in the United States. We examined the modifying role of acculturation on the association of parity with a cardiometabolic risk biomarker, C-reactive protein (CRP).MethodsParticipants (n = 1,002) were women of Mexican background, ages 16 to 39 years, in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2006. The association between parity and elevated CRP was examined using logistic regression adjusted for age, household food security, access to health care, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, waist circumference, physical activity, acculturation, and a product term of parity and acculturation. Acculturation was measured on a 6-point score based on nativity status and duration of residence in the United States (0, Mexico born, U.S. resident <10 years; 1, Mexico born, U.S. resident 10–19 years; 2-Mexico born, U.S. resident ≥20 years; and 3, U.S. born), and language used at home (0, Spanish; 1, bilingual; 2, English). Scores of 0 or 1, 2 or 3, and 4 or 5 represented low, moderate, and high acculturation, respectively.ResultsThe association of parity with elevated CRP varied by acculturation level (p_interaction = 0.10). Parity was associated with elevated CRP among women with low (adjusted odds ratio [OR], 2.26; 95% CI, 1.07–4.80) and moderate acculturation (adjusted OR, 2.79; 95% CI, 1.16–6.73), compared with nulliparous women.ConclusionsHigher odds of elevated CRP associated with parity in immigrant Mexican-American women of reproductive age indicate the need for greater use of maternal/women's health care services for cardiometabolic risk screening and interventions.     

Handgun carrying among White youth increasing in the United States: New evidence from the National Survey on Drug Use and Health 2002–2013

The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12–17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12–17 (n = 197,313) and spanning the years 2002–2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004–2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012–2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.     

Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth

This study examines the alternative implications of the measurements of unintended pregnancy during contraceptive failure in the US. The data from the 1995 National Survey of Family Growth (NSFG) were used to compare levels of unintended pregnancy among contraceptive users based on two definitions: the standard definition based on women's report of contraceptive failure; and the NSFG definition based on pregnancy timing. An attitudinal scale was used to examine women's feeling about their unintended pregnancy. The results of the analysis revealed 68% were unintended pregnancies under the classification of standard definition, while 59% of women with contraceptive failure classified under NSFG definition and reported feeling unhappy or very unhappy about their pregnancy. About 90% of those with contraceptive failure classified as an intended pregnancy reported feeling happy or very happy. Although these results were consistent with one another, it is still unclear why these women feeling happy about their unintended pregnancy are practicing contraception.     

Prevalence of serious mental illness among parents in the United States: results from the National Survey of Drug Use and Health, 2008–2014

PurposeThis brief research report presents findings from a US national household survey on the number and percentage of parents with mental illness.MethodsUsing combined annual data from the 2008–2014 National Survey on Drug Use and Health, parents were defined as having children in the household from birth to 18 years. Prediction models developed in an earlier clinical study using a National Survey on Drug Use and Health subsample were used to estimate serious mental illness (SMI).ResultsA total of 2.7 million parents (3.8%) had a SMI in the past year and 12.8 million parents (18.2%) had any mental illness in the past year. Mental illness was more common among mothers than fathers and least common among Asians compared with other races. SMI was less prevalent in parents who were aged 50 years and older compared with younger age groups.ConclusionsThe burden of mental illness in parents is high in the United States, especially among mothers. Physicians who treat parents should routinely screen for mental illness and discuss its implications for parenting.     

Social Class, Race/Ethnicity and All-Cause Mortality in the US: Longitudinal Results from the 1986–1994 National Health Interview Survey

BACKGROUND: Occupational social class has become a leading indicator of social inequalities in health. In the US, economic sectors are distinct with respect to wages, benefits, job security, promotion ladders and working conditions. The growing economic sector of self-employed workers is characterized by lower wages and benefits, and greater job insecurity. Little attention has been given to the association between economic sector measures of social class and all-cause mortality, and there have been no studies of mortality among the self-employed. METHODS: To determine risk of death associated with economic sector social class, this study entails a longitudinal analysis of the National Health Interview Survey (NHIS), an annual household survey representative of the US population for the period 1986-1994 (n = 377,129). The sample includes 201,566 men and 175,563 women, aged 24-65 years of age, in the civilian labor force. RESULTS: Non- professionals are at higher risk of death than professionals across all sectors and self-employed professionals are at higher risk of death than professionals employed in government and production. Additional social class differences are accounted for by age, race, gender and marital status. Results are also partially explained by income. After controlling for income, Black professionals did not show a lower risk of death than Black non-professionals and self-employed Hispanic professionals had a higher risk of death than Hispanic professionals employed in the private sector. CONCLUSIONS: Given the growth of self-employment in the US, the noted increased risk of death among self-employed professionals merits further investigation and monitoring.     

State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985–2016: Evidence from the Behavioral Risk Factor Surveillance System

BackgroundMost states have at least one policy targeting alcohol use during pregnancy. The public health impact of these policies has not been examined. We sought to examine the relationship between state-level policies targeting alcohol use during pregnancy and alcohol use among pregnant women.MethodsData include state-level alcohol and pregnancy policy data and individual-level U.S. Behavioral Risk Factor Surveillance System data about pregnant women's alcohol use from 1985 to 2016 (N = 57,194). Supportive policies include mandatory warning signs, priority substance abuse treatment, reporting requirements for data and treatment purposes, and prohibitions on criminal prosecution. Punitive policies include civil commitment, Child Protective Services reporting requirements, and child abuse/neglect. Analyses include logistic regression models that adjust for individual- and state-level controls, include fixed effects for state and year, account for clustering by state, and weight by probability of selection.ResultsRelative to having no policies, supportive policy environments were associated with more any drinking, but not binge or heavy drinking. Of individual supportive policies, only the following relationships were statistically significant: mandatory warning signs was associated with lower odds of binge drinking, and priority treatment for pregnant women and women with children was associated with higher odds of any drinking. Relative to no policies, punitive policy environments were also associated with more drinking, but not with binge or heavy drinking. Of individual punitive policies, only child abuse/neglect was associated with lower odds of binge and heavy drinking. Mixed policy environments were not associated with any alcohol outcome.ConclusionsMost policies targeting alcohol use during pregnancy do not seem to be associated with less alcohol consumption during pregnancy.     

Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001–2013

Suicidal ideation and suicide attempts are more common in Latina adolescents than White or African–American adolescents. Several health risk behaviors have been identified as being associated with Latina adolescent suicides. However, to date, no study has identified the consistency and stability of these risk behaviors over time. This study utilized the national Youth Risk Behaviors Survey from 2001 to 2013 to estimate the prevalence of suicidal ideation, suicide attempts, and health risk behaviors associated with suicidal behaviors in Latina adolescents. Our analysis found the prevalence of suicidal ideation and suicide attempts varied significantly over the 13-year study span, decreasing from 2001 to 2009 and increased from 2011 to 2013. The analyses found 11 health risk behaviors that were significantly associated with both suicidal ideation and suicide attempts that did not vary over time. The stability of these 11 health risk behaviors associated with suicidal behaviors could be useful to school personnel to identify early at risk Latina adolescents who may benefit from school and community mental health resources.     

Unmet Need for Therapy Among Children with Autism Spectrum Disorder: Results from the 2005–2006 and 2009–2010 National Survey of Children with Special Health Care Needs

Objectives We examined population-based trends in unmet need for therapy service in children with autism spectrum disorder (ASD) compared to other children with special health care needs (CSHCN), and identified factors associated with unmet need for therapy. Methods A pooled cross-sectional comparison of the 2005–2006 and 2009–2010 waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN) was used. Weighted bivariate analyses were used to compare children ages 3–17 years with ASD (n = 5113) to other CSHCN (n = 71,294) on unmet need for therapy services. Survey weighted multivariate models were used to examine child, family, and contextual characteristics associated with unmet need. Results A greater percentage of children with ASD across both surveys were reported to need therapy than other children with CSHCN. Among children with a reported need, children with ASD were 1.4 times more likely to report an unmet need for therapy compared to other CSHCN (OR 1.42, 95 % CI 1.18–1.71). Variables significantly associated with unmet need for therapy services included not receiving a well-child visit in the past year (OR 5.81, CI 3.83–8.81), surveyed in 2009 (OR 1.42, CI 1.18–1.71), child being female (OR 1.27, CI 1.05–1.53), uninsured (OR 1.72, CI 1.15–2.56), and having greater functional limitation (OR 2.44, CI 1.80–3.34). Conclusions for Practice Children with ASD require supportive services such as occupational, physical, and speech therapy but are less likely to receive such services than other CSHCN. Receiving a well-child visit in the past year was strongly associated with receipt of needed therapy services.     

Family Perceptions of Shared Decision-Making with Health Care Providers: Results of the National Survey of Children with Special Health Care Needs, 2009–2010

The Maternal and Child Health Bureau recently revised its measure of family-provider shared decision-making (SDM) to better align with parents’ views and the intent of SDM. We sought to assess achievements in meeting the revised measure; examine socio-demographic/health correlates; and determine the relationships between SDM and access to quality health care. We analyzed data for 40,242 children with special health care needs (CSHCN) from the 2009–2010 National Survey of CSHCN and assessed the prevalence of SDM and association with other US CSHCN socio-demographic/health characteristics using bivariate and multivariate methods. Logistic regression was used to determine associations between SDM and having a medical home and preventive medical/dental visits. Approximately 70 % of families of CSHCN perceived themselves as shared decision-makers in their child’s care. Families of CSHCN with greater functional limitations had twice the odds of lacking SDM than those never affected. Disparities in attainment rates were noted for families with low versus high income (61 vs. 77 %), less versus more than high school education (59 vs. 73 %), privately insured versus uninsured (76 vs. 57 %), and minority versus white race (63 vs. 74 %). CSHCN with medical homes had 6 times greater odds of perceived SDM and as much as one and a half times the odds of receiving preventive care than CSHCN without a medical home. Major differences in family SDM perceptions are associated with having a medical home, particularly when characterized by family-centered care. Populations of concern are those with more functionally limited children and increased socio-economic challenges.     

Food Sources of Energy and Nutrients among Children in the United States: National Health and Nutrition Examination Survey 2003–2006

Background: Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States. Methods: Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003–2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order. Results: The two top ranked food/food group sources of energy and nutrients were: energy—milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein—milk (13.2%) and poultry (12.8%); total carbohydrate—soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars—soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars—soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber—fruit (10.4%) and yeast bread/rolls (10.3%); total fat—cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids—cheese (16.3%) and milk (13.3%); cholesterol—eggs (24.2%) and poultry (13.2%); vitamin D—milk (60.4%) and milk drinks (8.3%); calcium—milk (33.2%) and cheese (19.4%); potassium—milk (18.8%) and fruit juice (8.0%); and sodium—salt (18.5%) and yeast bread and rolls (8.4%). Conclusions: Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children’s diets.     

How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey

OBJECTIVE: To determine the incidence of self-reported significant hip pain using a nationally representative sample of older adults in the United States. STUDY DESIGN: Subjects were interviewed to determine their leisure time physical activity levels and whether they experienced severe hip pain. Sampling weights were calculated to account for unequal selection probabilities. The impact of race, age, and physical activity status was examined as influential factors affecting hip pain. POPULATION: We interviewed 6596 adults aged 60 years and older as part of the third National Health and Nutrition Examination Survey (NHANES III). OUTCOME MEASURED: We measured the prevalence of hip pain. RESULTS: A total of 14.3% of participants aged 60 years and older reported significant hip pain on most days over the past 6 weeks. Men reported hip pain less frequently than women. Age did not influence self-reported hip pain in men. The lowest prevalence of hip pain was found in women aged 60 to 70 years. Sixteen percent of non-Hispanic white women reported hip pain, compared with 14.8% of black women and 19.3% of Mexican American women. Among non-Hispanic white men, 12.4% reported hip pain, a proportion no different from that of their black and Mexican American male counterparts. Among older US adults, 18.4% of those who had not participated in leisure time physical activity during the previous month reported severe hip pain; 12.6% of those who did engage in physical activity reported hip pain. CONCLUSIONS: Self-reported hip pain has increased since NHANES I (1971-1975). Further studies are needed to identify individuals at highest risk for severe hip pain and to identify optimal treatment of hip pain.     

Vitamin D Status and Acute Respiratory Infection: Cross Sectional Results from the United States National Health and Nutrition Examination Survey, 2001–2006

Vitamin D is a promising, though under-explored, potential modifiable risk factor for acute respiratory infections (ARIs). We sought to investigate the association of vitamin D status with ARI in a large, nationally-representative sample of non-institutionalized individuals from the United States. We analyzed 14,108 individuals over 16 years of age in the National Health and Nutrition Survey (NHANES) 2001–2006 in this cross-sectional study. We used locally weighted scatterplot smoothing (LOWESS) to depict the relationship between increasing 25-hydroxyvitamin D (25OHD) levels and ARI. We then performed a multivariable regression analysis to investigate the association of 25OHD levels with ARI, while adjusting for known confounders. The median serum 25OHD level was 21 (IQR 15–27) ng/mL. Overall, 4.8% (95% CI: 4.5–5.2) of participants reported an ARI within 30 days before their participation in the national survey. LOWESS analysis revealed a near-linear relationship between vitamin D status and the cumulative frequency of ARI up to 25OHD levels around 30 ng/mL. After adjusting for season, demographic factors, and clinical data, 25OHD levels <30 ng/mL were associated with 58% higher odds of ARI (OR 1.58; 95% CI: 1.07–2.33) compared to levels ≥30 ng/mL. Among the 14,108 participants in NHANES 2001–2006, 25OHD levels were inversely associated with ARI. Carefully designed, randomized, controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of ARI.     

Vitamin D status and elevated red cell distribution width in community-dwelling adults: Results from the National Health and Nutrition Examination Survey 2001–2006

Objectives

Elevated red cell distribution width (RDW) is associated with morbidity and mortality in community-dwelling individuals. Although RDW is traditionally used to diagnose anemia, it may also be a marker of systemic inflammation. Since vitamin D is a potent modulator of inflammatory cytokines our goal was to investigate whether 25-hydroxyvitamin D levels (25OHD) are associated with RDW in non-hospitalized adults.

Design

To investigate this association, we conducted a cross-sectional study. Stepwise multivariable linear and logistic regression models were used to assess the independent association of 25OHD with RDW. Elevated RDW was defined as >14.5%.

Setting

Nationwide sample of non-hospitalized adults within the United States.

Participants

Individuals from the National Health and Nutrition Examination Survey from 2001-2006.

Results

15,162 individuals comprised the analytic cohort. Mean 25OHD was 24.9 ng/mL (SE 0.4) and the prevalence of elevated RDW was 6.3%. Linear regression analysis, controlling for age, sex, race, mean corpuscular volume, albumin, and neutropenia, demonstrated that 25OHD was inversely associated with RDW (β=-0.01; 95%CI -0.01 to -0.01). Logistic regression analysis, controlling for the same covariates, also demonstrated an inverse association of 25OHD with elevated RDW (OR 0.96; 95%CI 0.94-0.99). Individuals with 25OHD <30 ng/mL were more likely to have elevated RDW (OR 1.65; 95%CI 1.13-2.40) compared to those individuals with levels ≥30ng/mL.

Conclusions

In a nationwide sample of non-hospitalized adults within the United States, low 25OHD was associated with increased likelihood of elevated RDW. Further studies are needed to determine whether optimizing vitamin D status can reduce the prevalence of elevated RDW, and thereby reduce morbidity and mortality in the general population.