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Introduction Since 2001, the Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016-February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child’s health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible. [ABSTRACT FROM AUTHOR]

Objectives: Population-based recruitment of a cohort of women who are currently pregnant or who may become pregnant in a given timeframe presents challenges unique to identifying pregnancy status or the likelihood of future pregnancy. Little is known about the performance of individual eligibility items on pregnancy screeners although they are critical to participant recruitment. This paper examined the patterns and respondent characteristics of key pregnancy screener items used in a large national study.Methods: Cross-sectional analyses were conducted. Descriptive statistics and multivariable logistic regression models were used to examine nonresponse patterns to three questions (currently pregnant, trying to get pregnant and able to get pregnant). The questions were asked of 50,529 women in 17 locations across the US, as part of eligibility screening for the National Children's Study Vanguard Study household-based recruitment.Results: Most respondents were willing to provide information about current pregnancy, trying, and able to get pregnant: 99.3% of respondents answered all three questions and 97.4% provided meaningful answers. Nonresponse ranged from 0.3 to 2.5% for individual items. Multivariable logistic regression results identified small but statistically significant differences in nonresponse by respondent age, marital status, race/ethnicity-language, and household-based recruitment group.Conclusions for Practice: The high levels of response to pregnancy-related items are impressive considering that the eligibility questions were fairly sensitive, were administered at households, and were not part of a respondent-initiated encounter. [ABSTRACT FROM AUTHOR]

This paper examines body mass index (BMI) trajectories among children from different race/ethnic and maternal nativity backgrounds in the United States and England from early- to middle-childhood. This study is the first to examine race/ethnic and maternal nativity differences in BMI trajectories in both countries. We use two longitudinal birth cohort studies-The Fragile Families and Child Wellbeing Study (n = 3,285) for the United States and the Millennium Cohort Study (n = 6,700) for England to estimate trajectories in child BMI by race/ethnicity and maternal nativity status using multilevel growth models. In the United States our sample includes white, black, and Hispanic children; in England the sample includes white, black, and Asian children. We find significant race/ethnic differences in the initial BMI and BMI trajectories of children in both countries, with all non-white groups having significantly steeper BMI growth trajectories than whites. Nativity differences in BMI trajectories vary by race/ethnic group and are only statistically significantly higher for children of foreign-born blacks in England. Disparities in BMI trajectories are pervasive in the United States and England, despite lower overall BMI among English children. Future studies should consider both race/ethnicity and maternal nativity status subgroups when examining disparities in BMI in the United States and England. Differences in BMI are apparent in early childhood, which suggests that interventions targeting pre-school age children may be most effective at stemming childhood disparities in BMI. [ABSTRACT FROM AUTHOR]

This paper discusses characteristics that are associated with enhanced maternal and child health (MCH) epidemiology functioning in state health agencies. The concept of the 'MCH Epidemiology Effort' is introduced as 'the epidemiologic work carried out by multiple units and agencies aimed at informing program planning and policy development on behalf of women, children and families.' This concept focuses attention on MCH epidemiology functioning at the organizational level rather than on individual MCH epidemiologists. The analysis used data from all 50 states and the District of Columbia. Each state participated in a telephone interview and submitted material that demonstrated the breadth, depth, and capacity of its MCH Epidemiology Effort. Several organizations, including the Council for State and Territorial Epidemiologists, the Health Resources and Services Administration/Maternal and Child Health Bureau, and the Centers for Disease Control and Prevention provided additional secondary data. The outcome for analysis was a three-category measure of MCH epidemiology functioning. The findings are consistent with, and add specificity to, those from prior assessments. In a multivariable model, agenda-setting by consensus, involvement of external stakeholders, the total of doctorally trained staff, and accessing CDC assignees or other staff were all significantly related to higher level MCH epidemiology functioning (ORs of 6.1, 6.6, 2.5, and 6.4, respectively; P < 0.05). Organizational visibility of the MCH Epidemiology Effort and a data environment marked by routine data-sharing and data integration were marginally related. We provide recommendations for action at the state and federal level for advancing evidence-based decision-making in maternal and child health. [ABSTRACT FROM AUTHOR]

Purpose: Opioid use disorder among women of childbearing age has reached epidemic proportions. In rural regions of the United States, recruiting perinatal women who use nonmedical opioids to participate in research is wrought with challenges, including barriers such as community stigma, lack of transportation, and time constraints. The current study describes our process and challenges of recruiting pregnant and postpartum women in rural Indiana consisting of women who misuse opioids and those who do not. Description: We employed multiple strategies to recruit participants. Methods included (1) sampling from healthcare facilities based on referrals from front-desk staff and frontline healthcare workers; (2) dissemination of flyers and brochures within healthcare facilities and the community, supported with onsite research assistant presence; (3) digital methods coupled with snowball sampling; and (4) local community talks that provided information about the study. Assessment: Our multiple recruitment efforts revealed that building relationships with community stakeholders was key in recruiting women who use nonmedical opioids, but that digital methods were more effective in recruiting a larger sample of pregnant and postpartum women in a short amount of time. Conclusion: We conclude by making several recommendations to enhance academic-community partnerships in order to bolster sample sizes for prolonged research studies. Furthermore, we highlight the need to destigmatize addiction in order to better serve hard-to-reach populations through research and practice. [ABSTRACT FROM AUTHOR]

Objectives The Family-Centered Medical Home (FCMH) has become a model of effective and efficient primary care. However, efforts to measure the FCMH may ignore its complexity. We sought to determine whether U.S. primary care pediatricians view structure-focused and relationship-focused practice activities of the FCMH as distinct constructs and how these constructs are associated with practice functions. Methods We analyzed data from the 2012 American Academy of Pediatrics Periodic Survey of Fellows #79 (n = 572) addressing opinions and practice activities related to the FCMH. Through a modified Delphi expert process, we selected items believed to be primarily structure-focused and items that were relationship-focused. Confirmatory factor analysis was used to test whether these constructs were distinct. Separate structural equation models assessed whether structure-focused and relationship-focused activities predicted three broader survey items: (1) interest in FCMH; (2) application for FCMH recognition; and (3) whether a team meets to discuss FCMH improvements. Results The initial two-factor model did not fit well, but improved with movement of two items from the structure to the relationship-focused group. The two factors correlated at r = 0.70. Respondents with increased relationship-focused activities had statistically higher odds of having medium/high interest in FCMH, and having a team meet to discuss FCMH improvements. Respondents with increased structure-focused activities also had higher odds of having team meetings to discuss FCMH improvements, but lower odds of applying for FCMH recognition. Conclusions for Practice The FCMH is multi-dimensional, with relationship- and structure-focused activities differentially linked to pediatrician reports of broader FCMH functions. [ABSTRACT FROM AUTHOR]

Objectives Excessive gestational weight gain (GWG) is a key modifiable risk factor for negative maternal and child health. We examined the efficacy of a behavioral intervention in preventing excessive GWG. Methods 230 pregnant women (87.4 % Caucasian, mean age = 29.2 years; second parity) participated in the longitudinal Glowing study (clinicaltrial.gov #NCT01131117), which included six intervention sessions focused on GWG. To determine the efficacy of the intervention in comparison to usual care, participants were compared to a matched contemporary cohort group from the Arkansas Pregnancy Risk Assessment Monitoring Survey (PRAMS). Results Participants attended 98 % of intervention sessions. Mean GWG for the Glowing participants was 12.7 ± 2.7 kg for normal weight women, 12.4 ± 4.9 kg for overweight women, and 9.0 ± 4.2 kg for class 1 obese women. Mean GWG was significantly lower for normal weight and class 1 obese Glowing participants compared to the PRAMS respondents. Similarly, among those who gained excessively, normal weight and class 1 obese Glowing participants had a significantly smaller mean weight gain above the guidelines in comparison to PRAMS participants. There was no significant difference in the overall proportion of the Glowing participants and the proportion of matched PRAMS respondents who gained in excess of the Institute of Medicine GWG guidelines. Conclusions for Practice This behavioral intervention was well-accepted and attenuated GWG among normal weight and class 1 obese women, compared to matched participants. Nevertheless, a more intensive intervention may be necessary to help women achieve GWG within the Institute of Medicine's guidelines. [ABSTRACT FROM AUTHOR]

Objective Evidence suggests that women with postpartum depression (PPD) are at risk for early breastfeeding cessation, but previous studies have been limited by small samples. The objective of this analysis is to estimate the association between PPD symptoms and breastfeeding using a national, stratified, random sample of U.S. mothers. Methods Data from the 2010-2011 Pregnancy Risk Assessment Monitoring System were analyzed for New York City and the 29 states for which data were available. Multivariable logistic regression was used to explore the association between a pre-pregnancy mental health visit and subsequent breastfeeding initiation as well as PPD and 3-month any and exclusive breastfeeding. To identify state-level variation, we created maps of prevalence and adjusted odds of breastfeeding by PPD and pre-pregnancy mental health status. Results Women reporting a pre-pregnancy mental health visit had 0.61 (95 % CI 0.56, 0.67) times the odds of initiating breastfeeding compared with women who reported no pre-pregnancy visit. At 3 months postpartum, women with PPD symptoms since birth had 0.79 (95 % CI 0.70, 0.88) times the odds of any breastfeeding and reduced odds of exclusive breastfeeding modified by race/ethnicity. We found variation in state-level PPD symptoms and pre-pregnancy mental health prevalence and adjusted odds of breastfeeding. Conclusions for Practice Our results highlight the importance of providing targeted breastfeeding support to women with PPD symptoms, because they are at risk of early breastfeeding cessation. Given the cross-sectional nature of these data, women with early breastfeeding cessation may also be at risk for PPD, requiring screening and treatment. [ABSTRACT FROM AUTHOR]

Objectives To determine use of recommended maternal healthcare services among refugee and immigrant women in a setting of near-universal insurance coverage. Methods Refugee women age ≥18 years, who arrived in the US from 2001 to 2013 and received care at the same Massachusetts community health center, were matched by age, gender, and date of care initiation to Spanish-speaking immigrants and US-born controls. The primary outcome was initiation of obstetrical care within the first trimester (12 weeks gestation). Secondary outcomes were number of obstetrical visits and attending a postpartum visit. Results We included 375 women with 763 pregnancies (women/pregnancies: 53/116 refugee, 186/368 immigrant, 136/279 control). More refugees (20.6 %) and immigrants (15.0 %) had their first obstetric visit after 12 weeks gestation than controls (6.0 %, p < 0.001). In logistic regression models adjusted for age, education, insurance, BMI, and median census tract household income, both refugee (odds ratio [OR] 4.58, 95 % confidence interval [CI] 1.73-12.13) and immigrant (OR 2.21, 95 % CI 1.00-4.84) women had delayed prenatal care initiation. Refugees had fewer prenatal visits than controls (median 12 vs. 14, p < 0.001). Refugees (73.3 %) and immigrant (78.3 %) women were more likely to have postpartum care (controls 54.8 %, p < 0.001) with differences persisting after adjustment (refugee [OR 2.00, 95 % CI 1.04-3.83] and immigrant [OR 2.79, 95 % CI 1.72-4.53]). Conclusions for Practice Refugee and immigrant women had increased risk for delayed initiation of prenatal care, but greater use of postpartum visits. Targeted outreach may be needed to improve use of beneficial care. [ABSTRACT FROM AUTHOR]

Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices. [ABSTRACT FROM AUTHOR]

Objective To assess the potential impact of missing data on body mass index (BMI) on the association between prepregnancy obesity and specific birth defects. Methods Data from the National Birth Defects Prevention Study (NBDPS) were analyzed. We assessed the factors associated with missing BMI data among mothers of infants without birth defects. Four analytic methods were then used to assess the impact of missing BMI data on the association between maternal prepregnancy obesity and three birth defects; spina bifida, gastroschisis, and cleft lip with/without cleft palate. The analytic methods were: (1) complete case analysis; (2) assignment of missing values to either obese or normal BMI; (3) multiple imputation; and (4) probabilistic sensitivity analysis. Logistic regression was used to estimate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (CI). Results Of NBDPS control mothers 4.6 % were missing BMI data, and most of the missing values were attributable to missing height (~90 %). Missing BMI data was associated with birth outside of the US (aOR 8.6; 95 % CI 5.5, 13.4), interview in Spanish (aOR 2.4; 95 % CI 1.8, 3.2), Hispanic ethnicity (aOR 2.0; 95 % CI 1.2, 3.4), and <12 years education (aOR 2.3; 95 % CI 1.7, 3.1). Overall the results of the multiple imputation and probabilistic sensitivity analysis were similar to the complete case analysis. Conclusions Although in some scenarios missing BMI data can bias the magnitude of association, it does not appear likely to have impacted conclusions from a traditional complete case analysis of these data. [ABSTRACT FROM AUTHOR]

Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = −0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = −0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population. [ABSTRACT FROM AUTHOR]

Objective The future of the Children's Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children's healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance. Methods Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2-18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups. Results After Oregon's 2009-2010 CHIP expansions, newly insured patients' utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94-2.26) for primary care visits to 2.77 (2.56-2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. Conclusions This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine disparities in quality of pediatric primary care among children from immigrant families in the US. Drawing from a nationally representative sample of 83,528 children ages 0-17 years from the 2007 National Survey of Children's Health, weighted logistic regression was used to assess the effect of immigrant family type on five indicators of quality of healthcare across children's racial/ethnic groups. Analyses controlled for indicators of child's access to care, family socio-economic characteristics, and primary language spoken in the household. Unadjusted estimates revealed a pattern of decreasing disparities from immigrant children to second-generation children, native-born children of immigrant parents, and to third-generation children, native-born children of native-born parents. Controlling for confounders showed that the positive effect of generational status on the quality of healthcare of children from immigrant families varied across indicators and among racial/ethnic groups. Not even third-generation Hispanic and Black children reached parity with third-generation White children on reported amount of time that providers devoted to their care and on providers' sensitivity to their family's values and customs. In contrast, disparities in reports of providers listening carefully to caregivers disappeared after adjusting for confounders, and only families headed by immigrant parents reported receiving less specific health-related information than the families of native-born White children. Our study suggests that it is important to develop interventions that help healthcare professionals to learn how different types of immigrant families perceive the interactions with the healthcare system and how to deliver care that increases the satisfaction of children from different racial/ethnic groups. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB) is a leading cause of newborn deaths and morbidities. The pregnancy risk assessment monitoring system (PRAMS) from the U.S., and the maternity experiences survey (MES) from Canada, which was modeled from PRAMS, were used to examine between-country differences in risk factors of preterm birth. The adjusted risk ratio and population attributable fraction (PAF) were calculated for modifiable and semi-modifiable risk factors of PTB, and all measures were compared between the U.S. and Canada. PTB was defined here as a live singleton birth between 28 and 37 completed weeks gestation (using the clinical gestational age estimate) where the baby was living with the mother at the time of the survey. The PTB risk was 7.6 % (SE = 0.2) in the U.S. and 4.9 % (SE = 0.3) in Canada. The a priori high risk category of factors was almost always more prevalent in the U.S. than Canada, suggesting broad social differences, but individually most of these differences were not associated with PTB. The underlying risk of PTB was generally higher in the U.S. in both the higher risk and referent categories, and the risk ratios for most risk factors were similar between the countries. The primary exception was for recurrence of PTB, where the risk ratio (RR) and PAF were much higher in Canada. We observed between-country differences in both the prevalence of risk factors and the adjusted RR. Further between-country comparisons may lead to important inferences as to the influence of modifiable risk factors contributing to PTB. [ABSTRACT FROM AUTHOR]

Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR) = 2.43, 95 % CI 1.56, 3.77 and AOR = 2.6, 95 % CI 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AOR = 0.47, 95 % CI 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39 % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95 % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties. [ABSTRACT FROM AUTHOR]

To investigate the health care experiences of children with autism spectrum disorder, whether they have unmet needs, and if so, what types, and problems they encounter accessing needed care. We address these issues by identifying four core health care services and access problems related to provider and system characteristics. Using data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) we compared children with autism spectrum disorder with children with special health care needs with other emotional, developmental or behavioral problems (excluding autism spectrum disorder) and with other children with special health care needs. We used weighted logistic regression to examine differences in parent reports of unmet needs for the three different health condition groups. Overall unmet need for each service type among CSHCN ranged from 2.5% for routine preventive care to 15% for mental health services. After controlling for predisposing, enabling and need factors, some differences across health condition groups remained. Families of children with autism spectrum disorder were in fact significantly more at risk for having unmet specialty and therapy care needs. Additionally, families of children with autism spectrum disorder were more likely to report provider lack of skills to treat the child as a barrier in obtaining therapy and mental health services. Disparities in unmet needs for children with autism suggest that organizational features of managed care programs and provider characteristics pose barriers to accessing care. [ABSTRACT FROM AUTHOR]

The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20-3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45-3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03-0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population. [ABSTRACT FROM AUTHOR]

Context is important for understanding and making change to improve health outcomes. The purpose of this study was to examine the relationship between parent perceptions of neighborhood and youth aerobic physical activity and weight. This study is a secondary data analysis of 64,076 parents and guardians of children and adolescents (6-17 years) participating in the 2007 National Survey of Children's Health. Logistic regression models were used to evaluate the relationship between neighborhood characteristics, including constructs for social capital, physical condition, resource availability, and safety, and youth likelihood of meeting healthy standards for physical activity and weight. Neighborhood characteristics, including social capital, resource availability, and safety were significantly associated with increased likelihood of youth achieving healthy physical activity and normal weight parameters even with adjustment for individual and family-level demographic and behavioral characteristics. Findings support neighborhood assessment during behavioral counseling and continued exploration of neighborhood context as a means to positively impact youth physical activity and weight outcomes. [ABSTRACT FROM AUTHOR]

To identify gender differences in correlates of anticipation and initiation of sexual activity in the baseline survey of 562 African-American 5th grade students prior to initiation of a school-based pregnancy prevention intervention curriculum. Students from 16 elementary schools were administered the baseline questionnaire during classroom periods. Using these data, binary and ordered logistic regression models were used to analyze the factors affecting virginity and anticipation of sexual activity separately by gender, and tests of interaction between each factor and gender were conducted on the combined sample. More boys than girls had already had sex (18% vs. 5%) and anticipated having sexual intercourse in the next 12 months (56% vs. 22%). Boys and girls also differed in the factors that affected these outcomes. The perception that their neighborhood was safe reduced the odds that boys anticipated sexual activity but was not associated with this outcome among girls. Pubertal knowledge increased the odds of anticipation, but only among boys. Attitudes favoring abstinence decreased anticipation of sex among both genders, but slightly more among girls than boys. Having more frequent parent-child communication about sex was associated with increased anticipation among girls but decreased anticipation among boys. Curriculum based approaches to adolescent pregnancy prevention are appropriate for 5th grade elementary students who may already be anticipating sexual activity in communities with disproportionate rates of teen pregnancy. The design of the interventions should consider the differences in motivating factors by gender. [ABSTRACT FROM AUTHOR]

To examine the relationship between measures of state economic, political, health services, and Title V capacity and individual level measures of the well-being of CSHCN. We selected five measures of Title V capacity from the Title V Information System and 13 state capacity measures from a variety of data sources, and eight indicators of intermediate health outcomes from the National Survey of Children with Special Health Care Needs. To assess the associations between Title V capacity and health services outcomes, we used stepwise regression to identify significant capacity measures while accounting for the survey design and clustering of observations by state. To assess the associations between economic, political and health systems capacity and health outcomes we fit weighted logistic regression models for each outcome, using a stepwise procedure to reduce the models. Using statistically significant capacity measures from the stepwise models, we fit reduced random effects logistic regression models to account for clustering of observations by state. Few measures of Title V and state capacity were associated with health services outcomes. For health systems measures, a higher percentage of uninsured children was associated with decreased odds of receipt of early intervention services, decreased odds of receipt of professional care coordination, and increased odds of delayed or missed care. Parents in states with higher per capita Medicaid expenditures on children were more likely to report receipt of special education services. Only two state capacity measures were associated explicitly with Title V: states with higher generalist physician to population ratios were associated with a greater likelihood of parent report of having heard of Title V and states with higher per capita gross state product were less likely to be associated with a report of using Title V services, conditional on having heard of Title V. The state level measure of family participation in Title V governance was negatively associated with receipt of care coordination and having used Title V services. The measures of state economic, political, health systems, and Title V capacity that we have analyzed are only weakly associated with the well-being of children with special health care needs. If Congress and other policymakers increase the expectations of the states in assuring that the needs of CSHCN and their families are addressed, it is essential to be cognizant of the capacities of the states to undertake that role. [ABSTRACT FROM AUTHOR]

Millions of US children have unstable health insurance coverage. Some of these uninsured children have parents with stable coverage. We examined whether household income was associated with longer coverage gaps among US children with at least one insured parent. A secondary data analysis of the nationally-representative 2004 Medical Expenditure Panel Survey, this study uses logistic regression models to examine the association between income and children's insurance gaps. We focused on children with at least one parent insured all year ( n = 6,151; estimated weighted N = 53.5 million). In multivariate models, children from families earning between 125 and 400% of the federal poverty level (FPL) had twice the odds of experiencing coverage gaps >6 months, as compared to those from high income families. Children in the poorest income groups (<125% FPL) did not have significantly greater odds of a gap >6 months. However, the odds of a gap ≤6 months were significantly greater for all income groups below 400% FPL, when compared to the highest income group. Among children with continuously insured parents, those from lower middle income families were most vulnerable to experiencing coverage gaps >6 months, as compared to those from the lowest and highest income families. These findings are likely due to middle class earnings being too high to qualify for public insurance but not high enough to afford private coverage. This study highlights the need for new US health care financing models that give everyone in the family the best chance to obtain stable coverage. It also provides valuable information to other countries with employer-sponsored insurance models or those considering privatization of insurance payment systems and how this might disproportionately impact the middle class. [ABSTRACT FROM AUTHOR]

Objective of the study was to explore factors associated with early childhood obesity and assess whether having a foreign born mother is protective against childhood obesity. Data sources include 9 months and 4 years parent interviews and direct assessments of possessive children's weight and height (4 years) or length (9 months) from the Early Childhood Longitudinal Study-Birth Cohort. Subjects were children with anthropometric measures who lived with their mothers ( n = 9,700 at 9 months and 8,200 at 4 years). Overweight is defined as a weight-for-length ratio at or above the 95th percentile at 9 months; obesity is defined as a body mass index at or above the 95th percentile at 4 years. The prevalence of overweight/obesity was 15.4% at 9 months and 18.0% at 4 years. After adjustment for potential confounders, having a foreign-born mother was not associated with the odds of overweight at 9 months or 4 years. At 9 months and 4 years, low birth weight, pre-pregnancy weight and weight gain during pregnancy were protective of overweight. In addition to these factors, at 4 years, excessive weight gain in the first 9 months was the strongest predictors for obesity. Living in a safe neighborhood and ever having breastfed were protective against obesity. Having a foreign born mother is not protective of early childhood obesity. A focus on health of women prior to conception and on women's and infants' health in the perinatal period are key to addressing childhood obesity. [ABSTRACT FROM AUTHOR]