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Rao L, Rocca CH, Muñoz I, Chambers BD, Devaskar S, Asiodu IV, Stern L, Blum M, Comfort AB, Harper CC. "She should support me, she's my doctor:" Patient perceptions of agency in contraceptive decision-making in the clinical encounter in Northern California. Perspect Sex Reprod Health 2023; 55:94-103. [PMID: 37216964 PMCID: PMC10537387 DOI: 10.1363/psrh.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Agency in contraceptive decision-making is an essential aspect of reproductive autonomy. We conducted qualitative research to investigate what agency means to patients seeking contraceptive care to inform the development of a validated measure of this construct. METHODOLOGY We held four focus group discussions and seven interviews with sexually-active individuals assigned female at birth, ages 16-29 years, recruited from reproductive health clinics in Northern California. We explored experiences in contraceptive decision-making during the clinic visit. We coded data in ATLAS.ti and by hand, compared codes across three coders, and used thematic analysis to identify salient themes. RESULTS The sample mean age was 21 years, with 17% of participants identifying as Asian, 23% as Black, 27% as Latinx, 17% as Multiracial/other, and 27% as white. Overall, participants reported active and engaged decision-making in their recent contraceptive visit but noted experiences that had undermined their agency in the past. They described how non-judgmental care allowed them to communicate openly, affirming their ability to make their own decisions. However, several mentioned how unexpected contraceptive side effects after the visit had reduced their sense of agency over their decision in retrospect. Several participants, including those who identified as Black, Latinx, and/or Asian, described prior experiences where pressure to use a contraceptive method had undermined their agency and where they had switched providers to regain agency over their contraceptive decisions. DISCUSSION Most participants were aware of their agency during contraceptive visits and how it varied in different experiences with providers and the healthcare system. Patient perspectives can help to inform measurement development and ultimately the delivery of care that supports contraceptive agency.
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Affiliation(s)
- Lavanya Rao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Corinne H. Rocca
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Isabel Muñoz
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Brittany D. Chambers
- Department of Human Ecology, University of California, Davis, School of Agricultural and Environmental Sciences, Davis, California, USA
| | - Sangita Devaskar
- Planned Parenthood Northern California, Santa Rosa, California, USA
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Lisa Stern
- Coalition to Expand Contraceptive Access (CECA), San Francisco, California, USA
| | - Maya Blum
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Alison B. Comfort
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Cynthia C. Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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Chambers BD, Fontenot J, McKenzie-Sampson S, Blebu BE, Edwards BN, Hutchings N, Karasek D, Coleman-Phox K, Curry VC, Kuppermann M. "It was just one moment that I felt like I was being judged": Pregnant and postpartum black Women's experiences of personal and group-based racism during the COVID-19 pandemic. Soc Sci Med 2023; 322:115813. [PMID: 36881972 PMCID: PMC9968447 DOI: 10.1016/j.socscimed.2023.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Racial inequities in maternal and child health outcomes persist: Black women and birthing people experience higher rates of adverse outcomes than their white counterparts. Similar inequities are seen in coronavirus disease (COVID-19) mortality rates. In response, we sought to explore the intersections of racism and the COVID-19 pandemic impact on the daily lives and perinatal care experiences of Black birthing people. METHODS We used an intrinsic case study approach grounded in an intersectional lens to collect stories from Black pregnant and postpartum people residing in Fresno County (July-September 2020). All interviews were conducted on Zoom without video and were audio recorded and transcribed. Thematic analysis was used to group codes into larger themes. RESULTS Of the 34 participants included in this analysis, 76.5% identified as Black only, and 23.5% identified as multiracial including Black. Their mean age was 27.2 years [SD, 5.8]. Nearly half (47%) reported being married or living with their partner; all were eligible for Medi-Cal insurance. Interview times ranged from 23 to 96 min. Five themes emerged: (1) Tensions about Heightened Exposure of Black Lives Matter Movement during the pandemic; (2) Fear for Black Son's Safety; (3) Lack of Communication from Health Care Professionals; (4) Disrespect from Health Care Professionals; and (5) Misunderstood or Judged by Health Care Professionals. Participants stressed that the Black Lives Matter Movement is necessary and highlighted that society views their Black sons as a threat. They also reported experiencing unfair treatment and harassment while seeking perinatal care. CONCLUSIONS Black women and birthing people shared that exposure to racism has heightened during the COVID-19 pandemic, increasing their levels of stress and anxiety. Understanding how racism impacts Black birthing people's lives and care experiences is critical to reforming the police force and revising enhanced prenatal care models to better address their needs.
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Affiliation(s)
- Brittany D Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA; California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Jazmin Fontenot
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bridgette E Blebu
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brittany N Edwards
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | | | - Deborah Karasek
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Venise C Curry
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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3
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Blebu BE, Kuppermann M, Coleman-Phox K, Karasek D, Lessard L, Chambers BD. A qualitative exploration of experiences accessing community and social services among pregnant low-income people of color during the COVID-19 pandemic. Womens Health (Lond) 2023; 19:17455057231156792. [PMID: 36939097 PMCID: PMC9988620 DOI: 10.1177/17455057231156792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased social and economic stressors among pregnant individuals. While community and social services have been available to mitigate stressors in pregnancy (e.g. food insecurity and financial hardship) and reduce the risk of adverse maternal outcomes, it is unclear how the pandemic impacted access to these resources, particularly in communities of color with lower incomes. OBJECTIVE To examine the experiences accessing community and social service resources during the COVID-19 pandemic among pregnant people of color with low incomes. DESIGN Participants for this COVID-related qualitative study were recruited from two sources-a prospective comparative effectiveness study of two models of enhanced prenatal care and the California Black Infant Health Program between August and November of 2020. METHODS We conducted 62 interviews with Medicaid-eligible participants in California's Central Valley. During their interviews, study participants were asked to share their pregnancy-related experiences, including how they felt the pandemic had affected those experiences. RESULTS We identified two broad themes: challenges with accessing community and social service resources during the pandemic and opportunities for improving access to these resources. Sub-themes related to challenges experienced included difficulty with remote access, convoluted enrollment processes for community and social services, and problems specific to accessing COVID-19 resources (e.g. testing). Sub-themes related to opportunities to improve access included leveraging instrumental support from perinatal staff and informational (e.g. practical) support from other community programs and pregnant peers. Participant recommendations included leveraging opportunities to improve client experiences through increased transparency and better patient-provider communication. CONCLUSION This study highlights some important trends that emerged with the rollout of remote service delivery for social services among a vulnerable population. Many participants were able to leverage support through other programs and perinatal staff. These individuals identified additional opportunities to improve client experiences that can inform the future implementation of support services for pregnant people.
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Affiliation(s)
- Bridgette E Blebu
- Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah Karasek
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Lessard
- Institute for Circumpolar Health Studies, University of Alaska, Anchorage, Anchorage, AK, USA
| | - Brittany D Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA
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4
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Chambers BD, Taylor B, Nelson T, Harrison J, Bell A, O'Leary A, Arega HA, Hashemi S, McKenzie-Sampson S, Scott KA, Raine-Bennett T, Jackson AV, Kuppermann M, McLemore MR. Clinicians' Perspectives on Racism and Black Women's Maternal Health. Women's Health Reports 2022; 3:476-482. [PMID: 35651994 PMCID: PMC9148644 DOI: 10.1089/whr.2021.0148] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/13/2022]
Abstract
Objective: Materials and Methods: Results: Conclusion:
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Affiliation(s)
- Brittany D. Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, California, USA
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brianne Taylor
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tamara Nelson
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Harrison
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Arielle Bell
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Allison O'Leary
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Helen A. Arega
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sepehr Hashemi
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Karen A. Scott
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Andrea V. Jackson
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Monica R. McLemore
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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5
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Lessard LN, Wiemann A, Oberholtzer C, Coleman-Phox K, Chambers BD, Kuppermann M. In pursuit of a community-informed group prenatal care model for telehealth use. The JHD 2022. [DOI: 10.21853/jhd.2022.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Group prenatal care is increasingly being used to improve maternal and infant physical and mental health outcomes. We assessed COVID-19–related changes in prenatal care, economic circumstances, and social needs of low-income pregnant and parenting persons to inform adapting a group prenatal care program enhanced with education, care coordination, and other support for use with telehealth. This study offers tangible ways to design and enhance telehealth group prenatal care to address the priorities identified by low-income families while incorporating limitations and requirements of medical care delivery systems. Telehealth group prenatal care programs can be implemented to increase access to health care, resources, and social connection during and after the pandemic.
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6
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Dyer L, Chambers BD, Crear-Perry J, Theall KP, Wallace M. The Index of Concentration at the Extremes (ICE) and Pregnancy-Associated Mortality in Louisiana, 2016-2017. Matern Child Health J 2022; 26:814-822. [PMID: 34148221 PMCID: PMC8684557 DOI: 10.1007/s10995-021-03189-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana. METHODS Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders. RESULTS Analyses resulted in an estimated 1.73 (95% CI 1.02-2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors. CONCLUSIONS FOR PRACTICE In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
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Affiliation(s)
- Lauren Dyer
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
| | - Brittany D Chambers
- School of Medicine, Epidemiology and Biostatistics, University of San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Joia Crear-Perry
- National Birth Equity Collaborative, 4747 Earhart Blvd, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
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7
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Baer RJ, Chambers BD, Coleman-Phox K, Flowers E, Fuchs JD, Oltman SP, Scott KA, Ryckman KK, Rand L, Jelliffe-Pawlowski LL. Risk of early birth by body mass index in a propensity score-matched sample: A retrospective cohort study. BJOG 2022; 129:1704-1711. [PMID: 35133077 DOI: 10.1111/1471-0528.17120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/20/2021] [Accepted: 01/22/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Evaluate the risk of preterm (<37 weeks) or early term birth (37 or 38 weeks) by body mass index (BMI) in a propensity score-matched sample. DESIGN Retrospective cohort analysis. SETTING California, USA. POPULATION Singleton live births from 2011-2017. METHODS Propensity scores were calculated for BMI groups using maternal factors. A referent sample of women with a BMI between 18.5 and <25.0 kg/m2 was selected using exact propensity score matching. Risk ratios for preterm and early term birth were calculated. MAIN OUTCOME MEASURES Early birth. RESULTS Women with a BMI <18.5 kg/m2 were at elevated risk of birth of 28-31 weeks (relative risk [RR] 1.2, 95% CI 1.1-1.4), 32-36 weeks (RR 1.3, 95% CI 1.2-1.3), and 37 or 38 weeks (RR 1.1, 95% CI 1.1-1.1). Women with BMI ≥25.0 kg/m2 were at 1.2-1.4-times higher risk of a birth <28 weeks and were at reduced risk of a birth between 32 and 36 weeks (RR 0.8-0.9) and birth during the 37th or 38th week (RR 0.9). CONCLUSION Women with a BMI <18.5 kg/m2 were at elevated risk of a preterm or early term birth. Women with BMI ≥25.0 kg/m2 were at elevated risk of a birth <28 weeks. Propensity score-matched women with BMI ≥30.0 kg/m2 were at decreased risk of a spontaneous preterm birth with intact membranes between 32 and 36 weeks, supporting the complexity of BMI as a risk factor for preterm birth.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA
| | - Brittany D Chambers
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Elena Flowers
- Departments of Nursing and Institute for Human Genomics, University of California, San Francisco, California, USA
| | - Jonathan D Fuchs
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,San Francisco Department of Public Health, San Francisco, California, USA
| | - Scott P Oltman
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Karen A Scott
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Larry Rand
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Laura L Jelliffe-Pawlowski
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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8
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McKenzie-Sampson S, Baer RJ, Blebu BE, Karasek D, Oltman SP, Pantell MS, Rand L, Rogers EE, Torres JM, Jelliffe-Pawlowski LL, Scott KA, Chambers BD. Maternal nativity and risk of adverse perinatal outcomes among Black women residing in California, 2011-2017. J Perinatol 2021; 41:2736-2741. [PMID: 34282261 PMCID: PMC8939260 DOI: 10.1038/s41372-021-01149-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine the risk of adverse perinatal outcomes among the United States (US)-born and foreign-born Black women in California. STUDY DESIGN The study comprised all singleton live births to Black women in California between 2011 and 2017. We defined maternal nativity as US-born or foreign-born. Using Poisson regression, we computed risk ratios (RR) and 95% confidence intervals (CI) for three adverse perinatal outcomes: preterm birth, small for gestational age deliveries, and infant mortality. RESULTS Rates of adverse perinatal outcomes were significantly higher among US-born Black women. In adjusted models, US-born Black women experienced an increased risk of preterm birth (RR 1.51, 95% CI 1.39, 1.65) and small for gestational age deliveries (RR 1.52, 95% CI 1.41, 1.64), compared to foreign-born Black women. CONCLUSIONS Future studies should consider experiences of racism across the life course when exploring heterogeneity in the risk of adverse perinatal outcomes by nativity among Black women in the US.
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Affiliation(s)
- Safyer McKenzie-Sampson
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA. .,UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | - Rebecca J. Baer
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine,Department of Pediatrics, University of California San Diego School of Medicine
| | - Bridgette E. Blebu
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine
| | - Deborah Karasek
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine
| | - Scott P. Oltman
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine,UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine
| | - Matthew S. Pantell
- Department of Pediatrics, University of California San Francisco School of Medicine
| | - Larry Rand
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine
| | - Elizabeth E. Rogers
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine,Department of Pediatrics, University of California San Francisco School of Medicine
| | - Jacqueline M. Torres
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine,UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine
| | - Laura L. Jelliffe-Pawlowski
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine,UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine
| | - Karen A. Scott
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine,Department of Humanities and Social Sciences, University of California San Francisco School of Medicine
| | - Brittany D. Chambers
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine,UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine
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Scott KA, Chambers BD, McKenzie‐Sampson S, Camara TL, VanGompel EW, Davis D, Lyndon A. The Virtual Perinatal Quality Improvement Prioritization By Affected Communities (
V‐QPAC
) Protocol. Health Serv Res 2021. [DOI: 10.1111/1475-6773.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Brittany D. Chambers
- UCSF School of Medicine San Francisco California USA
- California Preterm Birth Initiative, UCSF San Francisco California USA
| | - Safyer McKenzie‐Sampson
- UCSF School of Medicine San Francisco California USA
- California Preterm Birth Initiative, UCSF San Francisco California USA
| | | | | | - Dána‐Ain Davis
- Queens College and Graduate Center City University of New York New York California USA
| | - Audrey Lyndon
- New York University Rory Meyers College of Nursing New York New York USA
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10
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Karvonen KL, Baer RJ, Rogers EE, Steurer MA, Ryckman KK, Feuer SK, Anderson JG, Franck LS, Gano D, Petersen MA, Oltman SP, Chambers BD, Neuhaus J, Rand L, Jelliffe-Pawlowski LL, Pantell MS. Correction: Racial and ethnic disparities in outcomes through 1 year of life in infants born prematurely: a population based study in California. J Perinatol 2021; 41:1782. [PMID: 33782533 DOI: 10.1038/s41372-021-01004-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Rebecca J Baer
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Martina A Steurer
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Kelli K Ryckman
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Sky K Feuer
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - James G Anderson
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Linda S Franck
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Dawn Gano
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Mark A Petersen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Scott P Oltman
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Brittany D Chambers
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - John Neuhaus
- Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Larry Rand
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
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11
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Goin DE, Gomez AM, Farkas K, Duarte C, Karasek D, Chambers BD, Jackson AV, Ahern J. Occurrence of fatal police violence during pregnancy and hazard of preterm birth in California. Paediatr Perinat Epidemiol 2021; 35:469-478. [PMID: 33689194 PMCID: PMC8243783 DOI: 10.1111/ppe.12753] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exposure to fatal police violence may play a role in population-level inequities in risk for preterm delivery. OBJECTIVE To evaluate whether exposure to fatal police violence during pregnancy affects the hazard of preterm delivery and whether associations differ by race/ethnicity and fetal sex. METHODS We leveraged temporal variation in incidents of fatal police violence within census tracts to assess whether occurrence of fatal police violence in a person's tract during pregnancy was associated with increased hazard of extremely (20-27 weeks), early (28-31 weeks), moderate (32-33 weeks), and late (32-36 weeks) preterm delivery in California from 2007 to 2015. We used both death records and the Fatal Encounters database to identify incidents of fatal police violence. We estimated hazard ratios (HR) using time-varying Cox proportional hazard models stratified by census tract, controlling for age, race/ethnicity, educational attainment, health insurance type, parity, and the year and season of conception. We further stratified by race/ethnicity and infant sex to evaluate whether there were differential effects by these characteristics. RESULTS Exposure to an incident of fatal police violence was associated with a small increase in the hazard of late preterm birth using both the death records (N = 376,029; hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.00, 1.10) and the Fatal Encounters data (N = 938,814; HR 1.03, 95% CI 1.00, 1.06). We also observed an association for moderate preterm birth in the Fatal Encounters data (HR 1.06, 95% CI 0.98, 1.15). We did not observe associations for early or extremely preterm birth in either data source. Larger relative hazards of moderate (HR 1.25, 95% CI 0.93, 1.68) and late preterm delivery (HR 1.18, 95% CI 1.05, 1.33) were observed among Black birth parents with female births in the Fatal Encounters data. CONCLUSIONS Preventing police use of lethal force may reduce preterm delivery in communities where such violence occurs.
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Affiliation(s)
- Dana E. Goin
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley
| | - Kriszta Farkas
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Catherine Duarte
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Deborah Karasek
- Preterm Birth Initiative, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Brittany D. Chambers
- Preterm Birth Initiative, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Andrea V. Jackson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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12
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Calthorpe LM, Baer RJ, Chambers BD, Steurer MA, Shannon MT, Oltman SP, Karvonen KL, Rogers EE, Rand LI, Jelliffe-Pawlowski LL, Pantell MS. The association between preterm birth and postpartum mental healthcare utilization among California birthing people. Am J Obstet Gynecol MFM 2021; 3:100380. [PMID: 33932629 DOI: 10.1016/j.ajogmf.2021.100380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While mental health conditions such as postpartum depression are common, little is known about how mental healthcare utilization varies after term versus preterm delivery. OBJECTIVE This study aimed to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. STUDY DESIGN The study sample was obtained from a database of live-born neonates delivered in California between the years of 2011 and 2017. The sample included all people giving birth to singleton infants between the gestational age of 20 and 44 weeks. Preterm birth was defined as <37 weeks' gestation. Emergency department visits and hospitalizations with a mental health diagnosis within 1 year after birth were identified using International Classification of Diseases codes. Logistic regression was used to compare relative risks of healthcare utilization among people giving birth to preterm infants vs term infants, adjusting for the following covariates: age, race or ethnicity, parity, previous preterm birth, body mass index, tobacco use, alcohol or drug use, hypertension, diabetes mellitus, adequacy of prenatal care, education, insurance payer, and the presence of a mental health diagnosis before birth. Results were then stratified by mental health diagnosis before birth to determine whether associations varied based on mental health history. RESULTS Of our sample of 3,067,069 births, 6.7% were preterm. In fully adjusted models, compared with people giving birth to term infants, people giving birth to preterm infants had a 1.5 times (relative risk; 95% confidence interval, 1.4-1.7) and 1.3 times (relative risk; 95% confidence interval, 1.2-1.4) increased risk of being hospitalized with a mental health diagnosis within 3 months and 1 year after delivery, respectively. People giving birth to preterm infants also had 1.4 times (95% confidence interval, 1.3-1.5) and 1.3 times (95% confidence interval, 1.2-1.4) increased risk of visiting the emergency department for a mental health diagnosis within 3 months and 1 year after birth, respectively. Stratifying by preexisting mental health diagnosis, preterm birth was associated with an elevated risk of mental healthcare utilization for people with and without a previous mental health diagnosis. CONCLUSION We found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. Our findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
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Affiliation(s)
- Lucia M Calthorpe
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon).
| | - Rebecca J Baer
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Brittany D Chambers
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Martina A Steurer
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Maureen T Shannon
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Scott P Oltman
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Kayla L Karvonen
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Elizabeth E Rogers
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Larry I Rand
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Laura L Jelliffe-Pawlowski
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
| | - Matthew S Pantell
- University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon)
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13
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Bell A, Oltman SP, Baer R, Blebu B, Chambers BD, Rand L, Jelliffe-Pawlowski LL, Swartz A, Scott K. 990 Factors associated with preterm birth among california youth. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Karvonen KL, Baer RJ, Rogers EE, Steurer MA, Ryckman KK, Feuer SK, Anderson JG, Franck LS, Gano D, Petersen MA, Oltman SP, Chambers BD, Neuhaus J, Rand L, Jelliffe-Pawlowski LL, Pantell MS. Racial and ethnic disparities in outcomes through 1 year of life in infants born prematurely: a population based study in California. J Perinatol 2021; 41:220-231. [PMID: 33514879 DOI: 10.1038/s41372-021-00919-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/08/2020] [Accepted: 01/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate racial/ethnic differences in rehospitalization and mortality rates among premature infants over the first year of life. STUDY DESIGN A retrospective cohort study of infants born in California from 2011 to 2017 (n = 3,448,707) abstracted from a California Office of Statewide Health Planning and Development database. Unadjusted Kaplan-Meier tables and logistic regression controlling for health and sociodemographic characteristics were used to predict outcomes by race/ethnicity. RESULTS Compared to White infants, Hispanic and Black early preterm infants were more likely to be readmitted; Black late/moderate preterm (LMPT) infants were more likely to be readmitted and to die after discharge; Hispanic and Black early preterm infants with BPD were more likely to be readmitted; Black LMPT infants with RDS were more likely to be readmitted and die after discharge. CONCLUSIONS Racial/ethnic disparities in readmission and mortality rates exist for premature infants across several co-morbidities. Future studies are needed to improve equitability of outcomes.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Rebecca J Baer
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Martina A Steurer
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Kelli K Ryckman
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Sky K Feuer
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - James G Anderson
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Linda S Franck
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Dawn Gano
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Mark A Petersen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
| | - Scott P Oltman
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Brittany D Chambers
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - John Neuhaus
- Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Larry Rand
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, San Francisco, CA, USA.,Department of Epidemiology and Statistics, University of California San Francisco, San Francisco, CA, USA
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,California Preterm Birth Initiative, San Francisco, CA, USA
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15
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Burgess A, Mckenzie-Sampson S, Kuppermann M, Chambers BD. 774 Development of an obstetric discrimination scale for examining impact of racism on pregnancy outcomes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Baer RJ, Nidey N, Bandoli G, Chambers BD, Chambers CD, Feuer S, Karasek D, Oltman SP, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study. AJP Rep 2021; 11:e5-e14. [PMID: 33489437 PMCID: PMC7813589 DOI: 10.1055/s-0040-1721668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy. Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa. Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1-1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated). Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.
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Affiliation(s)
- Rebecca J. Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Nichole Nidey
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Brittany D. Chambers
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Sky Feuer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Deborah Karasek
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Scott P. Oltman
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Laura L. Jelliffe-Pawlowski
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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17
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Thorpe S, Tanner AE, Kugler KC, Chambers BD, Ma A, Jenkins Hall W, Ware S, Milroy JJ, Wyrick DL. First-year college students' alcohol and hookup behaviours: sexual scripting and implications for sexual health promotion. Cult Health Sex 2021; 23:68-84. [PMID: 31805826 DOI: 10.1080/13691058.2019.1688868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
This study used a sexual scripting framework to analyse data from the Online College Social Life Survey to examine the role of individual, (e.g. gender, race and alcohol use), relational (partner type, condom use behaviours), and contextual factors (sex ratios and fraternity/sorority affiliation) influencing 4,292 first-year college students' hookup experiences. Results suggest that hookups are relatively "safe", with the the majority involving non-penetrative sexual behaviour, condom use, and familiar partners. However, alcohol use affected hookup behaviours and lower levels of condom use were associated with heavy alcohol use, even with less well known partners. Findings point to the importance of interventions that reinforce first-year students' positive behaviours and present them with protective behavioural strategies to use in the context of alcohol, and with repeat or well-known partners to reduce risk and have enjoyable, consensual sexual experiences.
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Affiliation(s)
- Shemeka Thorpe
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Kari C Kugler
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Brittany D Chambers
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | | | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Jeffrey J Milroy
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - David L Wyrick
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
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18
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McLemore MR, Berkowitz RL, Oltman SP, Baer RJ, Franck L, Fuchs J, Karasek DA, Kuppermann M, McKenzie-Sampson S, Melbourne D, Taylor B, Williams S, Rand L, Chambers BD, Scott K, Jelliffe-Pawlowski LL. Risk and Protective Factors for Preterm Birth Among Black Women in Oakland, California. J Racial Ethn Health Disparities 2020; 8:1273-1280. [PMID: 33034878 DOI: 10.1007/s40615-020-00889-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
This project examines risk and protective factors for preterm birth (PTB) among Black women in Oakland, California. Women with singleton births in 2011-2017 (n = 6199) were included. Risk and protective factors for PTB and independent risk groups were identified using logistic regression and recursive partitioning. Having less than 3 prenatal care visits was associated with highest PTB risk. Hypertension (preexisting, gestational), previous PTB, and unknown Women, Infant, Children (WIC) program participation were associated with a two-fold increased risk for PTB. Maternal birth outside of the USA and participation in WIC were protective. Broad differences in rates, risks, and protective factors for PTB were observed.
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Affiliation(s)
- Monica R McLemore
- Department of Family Health Care Nursing, UCSF School of Nursing, 2 Koret Way, N431H, San Francisco, CA, 94134, USA.
| | - Rachel L Berkowitz
- School of Public Health, UC Berkeley, 2121 Berkeley Way, #5302, Berkeley, CA, 94704, USA
| | - Scott P Oltman
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
| | - Rebecca J Baer
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- Department of Pediatrics, UCSD, San Diego, CA, USA
| | - Linda Franck
- Department of Family Health Care Nursing, UCSF School of Nursing, 2 Koret Way, N431H, San Francisco, CA, 94134, USA
| | - Jonathan Fuchs
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, 94102, USA
| | - Deborah A Karasek
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF School of Medicine, San Francisco, CA, USA
| | - Daphina Melbourne
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, 94102, USA
| | - Briane Taylor
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, 94102, USA
| | - Shanell Williams
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, 94102, USA
| | - Larry Rand
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, 94102, USA
| | - Brittany D Chambers
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, 94102, USA
| | - Karen Scott
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, UCSF, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF School of Medicine, San Francisco, CA, USA
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Scott KA, Chambers BD, Baer RJ, Ryckman KK, McLemore MR, Jelliffe-Pawlowski LL. Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:593. [PMID: 33023524 PMCID: PMC7541301 DOI: 10.1186/s12884-020-03290-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background Despite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with GDM. Specifically, the relationship between PTB by subtype (defined as indicated PTB and spontaneous PT labor) and severity, GDM, and nativity has not been well characterized. Here we examine the risk of PTB by severity (early < 34 weeks, late 34 to 36 weeks) and early term birth (37 to 38 weeks) by nativity among Black women with GDM in California. Methods This retrospective cohort study used linked birth certificate and hospital discharge data for 8609 of the 100,691 self-identifying non-Hispanic Black women with GDM who had a singleton live birth between 20 and 44 weeks gestation in California in 2013–2017. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were examine risks for PTB, by severity and subtype, and early term birth using multivariate regression modeling. Results Approximately, 83.9% of Black women with GDM were US-born and 16.1% were foreign-born. The overall prevalence of early PTB, late PTB, and early term birth was 3.8, 9.5, and 29.9%, respectively. Excluding history of prior PTB, preeclampsia was the greatest overall risk factor for early PTB (cOR = 6.7, 95%, CI 5.3 to 8.3), late PTB (cOR = 4.3, 95%, CI 3.8 to 5.0), and early term birth (cOR = 1.8, 95%, CI 1.6 to 2.0). There was no significant difference in the prevalence of PTB by subtypes and nativity (p = 0.5963). Overall, 14.2% of US- compared to 8.9% of foreign-born women had a PTB (early PTB: aOR = 0.56, 95%, CI 0.38 to 0.82; late PTB: aOR = 0.57, 95%, CI 0.45 to 0.73; early term birth: aOR = 0.67, 95%, CI 0.58 to 0.77). Conclusions Foreign-born status remained protective of PTB, irrespective of severity and subtype. Preeclampsia, PTB, and GDM share pathophysiologic mechanisms suggesting a need to better understand differences in perinatal stress, chronic disease, and vascular dysfunction based on nativity in future epidemiologic studies and health services research.
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Affiliation(s)
- Karen A Scott
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA
| | - Rebecca J Baer
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.,California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, Building 3, La Jolla, CA, 92161, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Office S435 CPHB, Iowa City, IA, 52242, USA
| | - Monica R McLemore
- Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, N431H, San Francisco, San Francisco, CA, 94143, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA
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20
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Flaherman VJ, Afshar Y, Boscardin J, Keller RL, Mardy A, Prahl MK, Phillips C, Asiodu IV, Berghella WV, Chambers BD, Crear-Perry J, Jamieson DJ, Jacoby VL, Gaw SL. Infant Outcomes Following Maternal Infection with SARS-CoV-2: First Report from the PRIORITY Study. Clin Infect Dis 2020; 73:e2810-e2813. [PMID: 32947612 PMCID: PMC7543372 DOI: 10.1093/cid/ciaa1411] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022] Open
Abstract
Infant outcomes after maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not well described. In a prospective US registry of 263 infants, maternal SARS-CoV-2 status was not associated with birth weight, difficulty breathing, apnea, or upper or lower respiratory infection through 8 weeks of age.
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21
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Chambers BD, Arabia SE, Arega HA, Altman MR, Berkowitz R, Feuer SK, Franck LS, Gomez AM, Kober K, Pacheco-Werner T, Paynter RA, Prather AA, Spellen SA, Stanley D, Jelliffe-Pawlowski LL, McLemore MR. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health 2020; 36:213-219. [PMID: 31919987 PMCID: PMC7269549 DOI: 10.1002/smi.2922] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/13/2019] [Accepted: 12/17/2019] [Indexed: 11/12/2022]
Abstract
Research supports that exposure to stressors (e.g., perceived stress and racism) during pregnancy can negatively impact the immune system, which may lead to infection and ultimately increases the risk for having a preterm or low-birthweight infant. It is well known that Black women report higher levels of stressors at multiple timepoints across pregnancy compared with women of all other racial and ethnic groups. This study addresses gaps in the literature by describing pregnant and early post-partum Black women's exposures to structural racism and self-reported experiences of racial discrimination, and the extent to which these factors are related. We used a cross-sectional study design to collect data related to exposures to racism from pregnant and early post-partum Black women residing in Oakland, California, from January 2016 to December 2017. Comparative analysis revealed that living in highly deprived race + income neighborhoods was associated with experiencing racial discrimination in three or more situational domains (p = .01). Findings show that Black women are exposed to high levels of racism that may have negative impacts on maternal health outcomes.
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Affiliation(s)
- Brittany D. Chambers
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
| | - Silvia E. Arabia
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Helen A. Arega
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Molly R. Altman
- Family and Child Nursing Department, School of Nursing, University of Washington, Seattle, Washington
| | - Rachel Berkowitz
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Sky K. Feuer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
- Obstetrics, Gynecology, and Reproductive Sciences Department, University of California, San Francisco, San Francisco, California
| | - Linda S. Franck
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Anu M. Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Kord Kober
- Physiological Nursing Department, University of California, San Francisco, San Francisco, California
| | - Tania Pacheco-Werner
- Central Valley Health Policy Institute, California State University, Fresno, California
| | - Randi A. Paynter
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Aric A. Prather
- Center for Health and Community, Psychiatry Department, University of California, San Francisco, San Francisco, California
| | - Solaire A. Spellen
- Expecting Justice, San Francisco Department of Public Health, San Francisco, California
| | - Darcy Stanley
- LifeLong Medical Care Brookside, San Pablo, California
| | - Laura L. Jelliffe-Pawlowski
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
| | - Monica R. McLemore
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
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Baer RJ, Chambers BD, Coleman-Phox K, Feuer SK, Oltman SP, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. 196: Odds of early birth by class of obesity in a propensity matched sample. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Chambers BD, Baer RJ, Bandoli G, Felder J, Feuer SK, Flowers E, Franck L, Gomez AM, Karasek D, Nidey NL, Oltman SP, Rogers E, Scott K, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. 855: Risk of adverse birth outcome among Black women with post-traumatic stress disorder. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Coyle KK, Chambers BD, Anderson PM, Firpo-Triplett R, Waterman EA. Blended Learning for Sexual Health Education: Evidence Base, Promising Practices, and Potential Challenges. J Sch Health 2019; 89:847-859. [PMID: 31397903 PMCID: PMC8644387 DOI: 10.1111/josh.12821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/12/2018] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Blended learning is a combination of online learning and face-to-face instruction, and is increasingly being used in K-12 settings. A meta-analysis conducted for the Department of Education suggests blended learning is more effective than either group-based or online learning alone, particularly in K-12 settings. METHODS This paper provides a narrative review of the literature from 2000 to 2017 on blended learning as it applies to sexual health education programs, and discusses outcomes, best practices and potential challenges of blended learning that may be important for practitioners and researchers considering this approach. RESULTS Blended learning approaches are being used successfully in sexual health education programs, including school-based programs, and have yielded positive behavioral and psychosocial changes. Similar to traditional group-based programs, not all outcomes tested in these programs showed positive impact. Designing blended learning programs can be challenging, but there is a large best-practice literature that can inform practitioners interested in using it. CONCLUSIONS Blended learning approaches are viable for sexual health education and offer numerous advantages to group-based only programs, such as confidential personalization and an instructional approach that is familiar and engaging for participants.
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Affiliation(s)
- Karin K Coyle
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA 95066
| | - Brittany D Chambers
- Preterm Birth Initiative-California, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158
| | | | | | - Emily A Waterman
- Prevention Research Centerm The Pennsylvania State University, 119 Health & Human Development, University Park, PA 16802
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25
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Ross KM, Dunkel Schetter C, McLemore MR, Chambers BD, Paynter RA, Baer R, Feuer SK, Flowers E, Karasek D, Pantell M, Prather AA, Ryckman K, Jelliffe-Pawlowski L. Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women. J Racial Ethn Health Disparities 2019; 6:1182-1191. [PMID: 31368002 DOI: 10.1007/s40615-019-00619-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Higher socioeconomic status (SES) has less impact on cardio-metabolic disease and preterm birth risk among Black women compared to White women, an effect called "diminishing returns." No studies have tested whether this also occurs for pregnancy cardio-metabolic disease, specifically preeclampsia, or whether preeclampsia risk could account for race-by-SES disparities in birth timing. METHODS A sample of 718,604 Black and White women was drawn from a population-based California cohort of singleton births. Education, public health insurance status, gestational length, and preeclampsia diagnosis were extracted from a State-maintained birth cohort database. Age, prenatal care, diabetes diagnosis, smoking during pregnancy, and pre-pregnancy body mass index were covariates. RESULTS In logistic regression models predicting preeclampsia risk, the race-by-SES interaction (for both education and insurance status) was significant. White women were at lower risk for preeclampsia, and higher SES further reduced risk. Black women were at higher risk for preeclampsia, and SES did not attenuate risk. In pathway analyses predicting gestational length, an indirect effect of the race-by-SES interaction was observed. Among White women, higher SES predicted lower preeclampsia risk, which in turn predicted longer gestation. The same was not observed for Black women. CONCLUSIONS Compared to White women, Black women had increased preeclampsia risk. Higher SES attenuated risk for preeclampsia among White women, but not for Black women. Similarly, higher SES indirectly predicted longer gestational length via reduced preeclampsia risk among White women, but not for Black women. These findings are consistent with diminishing returns of higher SES for Black women with respect to preeclampsia.
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Affiliation(s)
- Kharah M Ross
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, #355, 3820 24th Ave, Calgary, AB, T3B 2X9, Canada.
| | | | - Monica R McLemore
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Randi A Paynter
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Baer
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Sky K Feuer
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Elena Flowers
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Deborah Karasek
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Matthew Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Aric A Prather
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Kelli Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Laura Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Chambers BD, Baer RJ, McLemore MR, Jelliffe-Pawlowski LL. Using Index of Concentration at the Extremes as Indicators of Structural Racism to Evaluate the Association with Preterm Birth and Infant Mortality-California, 2011-2012. J Urban Health 2019; 96:159-170. [PMID: 29869317 PMCID: PMC6458187 DOI: 10.1007/s11524-018-0272-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Disparities in adverse birth outcomes for Black women continue. Research suggests that societal factors such as structural racism explain more variation in adverse birth outcomes than individual-level factors and societal poverty alone. The Index of Concentration at the Extremes (ICE) measures spatial social polarization by quantifying extremes of deprived and privileged social groups using a single metric and has been shown to partially explain racial disparities in black carbon exposures, mortality, fatal and non-fatal assaults, and adverse birth outcomes such as preterm birth and infant mortality. The objective of this analysis was to assess if local measures of racial and economic segregation as proxies for structural racism are associated and preterm birth and infant mortality experienced by Black women residing in California. California birth cohort files were merged with the American Community Survey by zip code (2011-2012). The ICE was used to quantify privileged and deprived groups (i.e., Black vs. White; high income vs. low income; Black low income vs. White high income) by zip code. ICE scores range from - 1 (deprived) to 1 (privileged). ICE scores were categorized into five quintiles based on sample distributions of these measures: quintile 1 (least privileged)-quintile 5 (most privileged). Generalized linear mixed models were used to test the likelihood that ICE measures were associated with preterm birth or with infant mortality experienced by Black women residing in California. Black women were most likely to reside in zip codes with greater extreme income concentrations, and moderate extreme race and race + income concentrations. Bivariate analysis revealed that greater extreme income, race, and race + income concentrations increased the odds of preterm birth and infant mortality. For example, women residing in least privileged zip codes (quintile 1) were significantly more likely to experience preterm birth (race + income ICE OR = 1.31, 95% CI = 1.72-1.46) and infant mortality (race + income ICE OR = 1.70, 95% CI = 1.17-2.47) compared to women living in the most privileged zip codes (quintile 5). Adjusting for maternal characteristics, income, race, and race + income concentrations remained negatively associated with preterm birth. However, only race and race + income concentrations remained associated with infant mortality. Findings support that ICE is a promising measure of structural racism that can be used to address racial disparities in preterm birth and infant mortality experienced by Black women in California.
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Affiliation(s)
- Brittany D Chambers
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
| | - Rebecca J Baer
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Monica R McLemore
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Family Health Care Nursing Department, University of California San Francisco, San Francisco, CA, USA
| | - Laura L Jelliffe-Pawlowski
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Epidemiology and Biostatistics Department, University of California San Francisco, San Francisco, CA, USA
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Karasek D, Baer RJ, Anderson JG, Arcara J, Berkowitz R, Chambers BD, Feuer S, Flowers E, Fuchs J, Gomez AM, Hamad R, Kuppermann M, Pacheco-Werner T, Pantell M, Oltman SP, Rand L, Ryckman KK, Jelliffe-Pawlwski L. 695: Recurrence of early preterm, late preterm, and early term birth by race/ethnicity and insurance status. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Pantell MS, Baer RJ, Torres JM, Felder JN, Gomez AM, Chambers BD, Dunn J, Parikh N, Pacheco-Werner T, Rogers EE, Feuer S, Ryckman KK, Novak N, Tabb KM, Rand L, Jelliffe-Pawlowski LL. 459: Unstable housing is linked to adverse obstetric outcomes. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Oltman SP, Chambers BD, Baer RJ, McLemore MR, Scott K, Karasek D, Kuppermann M, Steurer MA, Anderson JG, Pantell M, Rogers EE, Ryckman KK, Rand L, Jelliffe-Pawlowski LL. 479: One-year mortality risk by complication for Black compared to White preterm infants. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Baer RJ, Bandoli G, Chambers BD, Chambers CD, Oltman SP, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. 653: Risk of preterm birth among women with a urinary tract infection by trimester of pregnancy. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ma A, Merçon-Vargas EA, Chambers BD, Nyambe M, Williams TA. Context of Breastfeeding among Latina Mothers using a Social-ecological Approach: An Exploratory Study. J Public Health Issues Pract 2018; 2:124. [PMID: 31414077 PMCID: PMC6693519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emerging research has begun to examine the breastfeeding experiences among racial/ethnic minority women. However, limited research to date has explored the potential factors that impact Latina mothers' breastfeeding through a multi-level lens. We examined the context of breastfeeding among Latina mothers in an exploratory study. METHODS We conducted semi-structured interviews with a convenience sample of 9 Latina mothers. Guided by the social-ecological model, thematic content analysis was used. RESULTS Latina mothers described individual- (e.g., knowledge of breastfeeding), interpersonal- (e.g., social support and norms), institutional- (e.g., healthcare system), and community-level (e.g., cultural norms) influences on their breastfeeding. Mothers recommended provision of bilingual and bicultural health professionals, information on US breastfeeding norms, and Latino-friendly informational materials in other languages. CONCLUSIONS Considering the multi-level factors that shape Latina mothers' breastfeeding is essential to develop and implement culturally tailored initiatives and facilitate access to breastfeeding support to improve maternal and infant health.
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Affiliation(s)
- Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, IL, 62025-1126, USA
| | - Elisa A. Merçon-Vargas
- Department of Social and Developmental Psychology, Federal University of Espírito Santo, Vitória, Espírito Santo, 29075-073, Brazil
| | - Brittany D. Chambers
- Department of Epidemiology and Biostatistics, UCSF Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Monde Nyambe
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, IL, 62025-1126, USA
| | - Tiffany A. Williams
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, IL, 62025-1126, USA
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Baer RJ, McLemore MR, Adler N, Oltman SP, Chambers BD, Kuppermann M, Pantell MS, Rogers EE, Ryckman KK, Sirota M, Rand L, Jelliffe-Pawlowski LL. Pre-pregnancy or first-trimester risk scoring to identify women at high risk of preterm birth. Eur J Obstet Gynecol Reprod Biol 2018; 231:235-240. [PMID: 30439652 DOI: 10.1016/j.ejogrb.2018.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/04/2018] [Indexed: 11/16/2022]
Abstract
Objective To develop a pre-pregnancy or first-trimester risk score to identify women at high risk of preterm birth. Study design In this retrospective cohort analysis, the sample was drawn from California singleton livebirths from 2007 to 2012 with linked birth certificate and hospital discharge records. The dataset was divided into a training (2/3 of sample) and a testing (1/3 of sample) set for discovery and validation. Predictive models for preterm birth using pre-pregnancy or first-trimester maternal factors were developed using backward stepwise logistic regression on a training dataset. A risk score for preterm birth was created for each pregnancy using beta-coefficients for each maternal factor remaining in the final multivariable model. Risk score utility was replicated in a testing dataset and by race/ethnicity and payer for prenatal care. Results The sample included 2,339,696 pregnancies divided into training and testing datasets. Twenty-three maternal risk factors were identified including several that were associated with a two or more increased odds of preterm birth (preexisting diabetes, preexisting hypertension, sickle cell anemia, and previous preterm birth). Approximately 40% of women with a risk score ≥ 3.0 in the training and testing samples delivered preterm (40.6% and 40.8%, respectively) compared to 3.1-3.3% of women with a risk score of 0.0 [odds ratio (OR) 13.0, 95% confidence interval (CI) 10.7-15.8, training; OR 12.2, 95% CI 9.4-15.9, testing). Additionally, over 18% of women with a risk score ≥ 3.0 had an adverse outcome other than preterm birth. Conclusion Maternal factors that are identifiable prior to pregnancy or during the first-trimester can be used create a cumulative risk score to identify women at the lowest and highest risk for preterm birth regardless of race/ethnicity or socioeconomic status. Further, we found that this cumulative risk score could also identify women at risk for other adverse outcomes who did not have a preterm birth. The risk score is not an effective screening test, but does identify women at very high risk of a preterm birth.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Monica R McLemore
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, CA, United States
| | - Nancy Adler
- Departments of Psychiatry and Pediatrics, Center for Health and Community, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Scott P Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Miriam Kuppermann
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, San Francisco, CA, United States
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Elizabeth E Rogers
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa College of Public Health and Carver College of Medicine, Iowa City, IA, United States
| | - Marina Sirota
- Institute for Computational Health Sciences University of California San Francisco, San Francisco, CA, United States
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, San Francisco, CA, United States
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, United States
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Tanner AE, Philbin MM, Chambers BD, Ma A, Hussen S, Ware S, Lee S, Fortenberry JD. Healthcare Transition for Youth Living With HIV: Outcomes from a Prospective Multi-site Study. J Adolesc Health 2018; 63:157-165. [PMID: 29887488 PMCID: PMC6113059 DOI: 10.1016/j.jadohealth.2018.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Youth living with HIV (YLHIV) in the United States (U.S.) account for nearly one-third of new HIV infections and face significant barriers to care engagement; only 25% are virally suppressed. Healthcare transition (HCT) from pediatric/adolescent to adult-oriented care can be particularly disruptive. Accordingly, we prospectively examined HCT processes at 14 distinct geographical sites across the U.S. METHODS We collected Audio Computer-Assisted Self-Interviews data and abstracted electronic medical records from 135 HCT-eligible YLHIV at baseline and 9-month follow-up. Descriptive analyses and multilevel modeling were conducted. Data also included qualitative interviews with 28 adolescent and 30 adult providers across 14 adolescent and 20 adult clinics, respectively. Interviews were analyzed using the constant comparative method; this analysis focused on specific HCT recommendations. RESULTS At baseline, youth were primarily age 24 (78.8%), male (76.8%), black (78.0%), identified as a sexual minority (62.9%), had attended an HIV appointment in the past 3 months (90.2%), had Medicaid for insurance (65.2%), and were always or mostly always adherent to their antiretroviral therapy (65.9%). At the 9-month follow-up only 37% of YLHIV successfully transitioned to adult care. Both individual-level (insurance status and disclosure-related stigma) and clinic-level (adolescent clinic best practices) factors were significant. Adolescent and adult clinic staff offered recommendations to support HCT; these focused primarily on clinical changes. CONCLUSIONS This study highlights the complex set of individual- and clinic-level factors associated with HCT. Addressing these key factors is essential for developing streamlined, comprehensive, and context-specific HCT protocols to support continuous care engagement for YLHIV.
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina.
| | - Morgan M Philbin
- Mailman School of Public Health, Columbia University, New York City, New York
| | | | - Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Sophia Hussen
- Department of Global Health, Emory University School of Public Health, Atlanta, Georgia; Division of Infectious Diseases, Emory University of School of Medicine, Atlanta Georgia
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Sonia Lee
- Maternal and Pediatric Disease Branch, National Institute of Child Health and Human Development, Rockville, Maryland
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Chambers BD, Erausquin JT. Race, Sex, and Discrimination in School Settings: A Multilevel Analysis of Associations With Delinquency. J Sch Health 2018; 88:159-166. [PMID: 29333643 DOI: 10.1111/josh.12589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/26/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adolescence is a critical phase of development and experimentation with delinquent behaviors. There is a growing body of literature exploring individual and structural impacts of discrimination on health outcomes and delinquent behaviors. However, there is limited research assessing how school diversity and discrimination impact students' delinquent behaviors. In response, the purpose of this study was to assess if individual- and school-level indicators of discrimination and diversity were associated with student delinquent behaviors among African American and White students. METHODS We analyzed Wave I (1994-1995) data from the National Longitudinal Study of Adolescent Health. Our analysis was limited to 8947 African American and White students (73% White, 48% male, and 88% parent ≥ high school education). We used multilevel zero-inflated negative binomial regression to test the association of individual- and school characteristics and discrimination with the number of self-reported delinquent behaviors. RESULTS Race, sex, perceived peer inclusion, and teacher discrimination were predictors of students' delinquent behaviors. The average school perceived peer inclusion and percentage of African Americans in teaching roles were associated with delinquent behaviors. CONCLUSIONS Findings from this study highlight the potential for intervention at the interpersonal and school levels to reduce delinquency among African American and White students.
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Affiliation(s)
- Brittany D Chambers
- Department of Public Health Education, University of North Carolina, Greensboro, 1408 Walker Avenue, 437 Coleman Building, Greensboro, NC 27412
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina, Greensboro, 1408 Walker Avenue, 437 Coleman Building, Greensboro, NC 27412
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Chambers BD, Capitman JA. The Association Between the Intersection of Immigrant Status and Insurance with Adverse Birth Outcomes Among Mexican Women Residing in the San Joaquin Valley: A Mediation Analysis of Late Initiation or No Prenatal Care. J Immigr Minor Health 2018. [PMID: 29352396 DOI: 10.1007/s10903-018-0689–6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Latinos are the largest growing population and have the highest fertility rates in the US. In response, this study assessed if late initiation of or no prenatal care (PNC) mediated the relationship among adverse birth outcomes and interactions between immigrant and insurance status. This study used cross-sectional data (2002-2004) limited to 109,399 women of Mexican ethnicity who had singleton births in the San Joaquin Valley, California. We conducted hierarchical mediation analyses. US-born Mexican women who used private or public insurance for PNC were more likely to have infants born at low-birth weight and premature compared to Mexican first generation immigrant women. Nonetheless, initiation of late or no PNC positively mediated the relationship between infants born premature to Mexican first generation immigrant women who used public insurance (ab/se(ab) = 2.123, p = .034). Findings from this study support acculturation theory and the need for multilevel approaches to address PNC among women of Mexican ethnicity.
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Affiliation(s)
- Brittany D Chambers
- Preterm Birth Initiative-California, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - John A Capitman
- The Central Valley Health Policy Institute, California State University Fresno, 1625 East Shaw Ave., Suite 146, Fresno, CA, 93710-8106, USA
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Chambers BD, Arega H, Spellen S, Arabia SE, Stanley D, Gomez AM, Franck L, Berkowitz R, Feuer S, Jelliffe-Pawlowski L, McLemore MR. 961: Pregnant Black women's experiences of racial discrimination. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chambers BD, Erausquin JT, Tanner AE, Nichols TR, Brown-Jeffy S. Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women. J Racial Ethn Health Disparities 2017; 5:966-977. [PMID: 29218496 DOI: 10.1007/s40615-017-0444-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009-2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.
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Affiliation(s)
- Brittany D Chambers
- UCSF Preterm Birth Initiative- California, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Tracy R Nichols
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Shelly Brown-Jeffy
- Department of Sociology, University of North Carolina, Greensboro, Greensboro, NC, USA
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Philbin MM, Tanner AE, Ma A, Chambers BD, Ware S, Kinnard EN, Hussen SA, Lee S, Fortenberry JD. Adolescent and Adult HIV Providers' Definitions of HIV-Infected Youths' Successful Transition to Adult Care in the United States. AIDS Patient Care STDS 2017; 31:421-427. [PMID: 28981334 PMCID: PMC5650713 DOI: 10.1089/apc.2017.0131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Brittany D. Chambers
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Elizabeth N. Kinnard
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Sophia A. Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Sonia Lee
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Tanner AE, Philbin MM, Ma A, Chambers BD, Nichols S, Lee S, Fortenberry JD. Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States. J Adolesc Health 2017; 61:434-439. [PMID: 28754584 PMCID: PMC5898429 DOI: 10.1016/j.jadohealth.2017.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives. METHODS We examined health care transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies. RESULTS Overall, participants described health care transition as a "warm handoff" and a collaborative effort across adolescent and adult clinics. Emergent transition themes included adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth's first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols). CONCLUSIONS Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and to improve continuum of care outcomes.
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina.
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York
| | - Alice Ma
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Brittany D Chambers
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California
| | - Sonia Lee
- Maternal and Pediatric Infectious Disease Branch, National Institute of Child Health and Human Development, Bethesda, Maryland
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Philbin MM, Tanner AE, Chambers BD, Ma A, Ware S, Lee S, Fortenberry JD, The Adolescent Trials Network. Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers. AIDS Care 2017; 29:1227-1234. [PMID: 28599596 DOI: 10.1080/09540121.2017.1338655] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015-June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents' transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers' ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.
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Affiliation(s)
- Morgan M Philbin
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Amanda E Tanner
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Brittany D Chambers
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Alice Ma
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Samuella Ware
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Sonia Lee
- c Maternal and Pediatric Infectious Disease Branch , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA
| | - J Dennis Fortenberry
- d Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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Chambers BD, Ma A. Applying an intervention framework to assess North Carolina's adolescent pregnancy prevention efforts. Sex Reprod Healthc 2016; 8:102-4. [PMID: 27179386 DOI: 10.1016/j.srhc.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/09/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE We assessed the extent to which implementing adolescent pregnancy prevention programs in conjunction with three level implementation strategies reduces adolescent pregnancy rates at the county-level in North Carolina (NC). METHODS Fixsen and colleagues' (2005) three levels of implementation were used to organize the prevention strategies: core (e.g., training, fidelity monitoring), organizational (e.g., administrative support), and external (e.g., community resources). RESULTS Counties that had adolescent friendly clinic/services (external) were more likely to report lower adolescent pregnancy rates in comparison to counties that did not have access to such services. CONCLUSIONS Findings suggest external implementation strategies are key to reducing adolescent pregnancy rates.
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Affiliation(s)
- Brittany D Chambers
- Department of Public Health Education, University of North Carolina, Greensboro, NC, USA.
| | - Alice Ma
- Department of Public Health Education, University of North Carolina, Greensboro, NC, USA
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Abstract
Purpose and Background: This study aimed to (1) identify predictors of initiation of sexual intercourse before program implementation, and (2) assess the one-year impact of Reducing the Risk (RTR) on the delay of sexual intercourse initiation and safe sex practices among a predominantly Latino sample of 9th graders in Tulare County. RTR is an evidence-based program designed to delay initiation of adolescent sexual intercourse, and increase safe practices among those who are already sexually active. The program was implemented in Tulare County; whose average teen birth rate for 2009-2011 was 60.2 per 1,000 teens aged 15-19. Methods: Baseline and one-year follow-up data were collected on 390 students, beginning in their 9th grade year (53% female, 72.2% Latino/Hispanic). Students participated in a school-based pregnancy prevention program (RTR) and answered questions on HIV/STIs knowledge, attitudes about abstinence and teen pregnancy, parent communication, sexual intercourse, and safe sex practices. Results: Over one in eight students were sexually active at baseline. Overall, students reported long-term increases in HIV/STI knowledge and parent communication, decreases in intentions to have sexual intercourse and positive attitudes about teen pregnancy. Controlling for baseline differences, sexually active students reported fewer positive attitudes about abstinence. Conclusion: RTR may be more effective in preventing pregnancy and HIV/STIs among students who are not yet sexually active. Further, RTR does appear to successfully impact students who have already initiated sexual intercourse decisions to practice safe sex; however, not to become abstinent.
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