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The emergence of the International Social Marketing Association (iSMA) and its affiliated regional associations is a key indicator that social marketing is maturing, both as a community of practice and as a profession. Through these associations, the international social marketing community has developed a consensus definition of the discipline and a consensus list of basic competencies for social marketing certificate programs. The associations are currently working on certification programs and a code of ethics. Continued movement toward professionalization can help social marketers be recognized and valued more highly for their relevant skills, knowledge, expertise, trustworthiness and altruism. At the same time, the discipline must address a number of key challenges and opportunities, to stay relevant and thrive.

Purpose Community coalitions are an important part of the public milieu and subject to similar external pressures as other publicly funded organizations – including changes in required strategic orientation. Many US government agencies that fund efforts such as community-based social marketing initiatives have shifted their funding agenda from program development to policy development. The Florida Prevention Research Center at the University of South Florida (Tampa, Florida, USA) created community-based prevention marketing (CBPM) for policy development framework to teach community coalitions how to apply social marketing to policy development. This paper aims to explicate the framework’s theory of change. Design/methodology/approach The research question was: “How does implementing the CBPM for Policy Development framework improve coalition performance over time?” The authors implemented a case study design, with the “case” being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling. Findings Results from computer model simulations show that gains in community coalition performance depend on a coalition’s initial culture and initial efficiency, and that only the most efficient coalitions’ performance might improve from implementing the CBPM framework. Originality/value Practical implications for CBPM’s developers and users are discussed, namely, the importance of managing the early expectations of academic-community partnerships seeking to shift their orientation from downstream (e.g. program development) to upstream social marketing strategies (e.g. policy change).

In this “Tools From the Field” paper, we report our experiences using human-centered design (HCD), a process for using innovation as a means of developing more effective marketing offerings. The context for our use of HCD tools was a partnership with a new community committee. We combined elements of our previous social marketing frameworks -Community-Based Prevention Marketing (CBPM) for Program Development; CBPM for Policy Development–into a version better suited to address complex, dynamic problems that require a whole-systems perspective. Our product development work for this next iteration of the CBPM framework incorporated several HCD tools adapted from the prolific design firm, IDEO. The HCD process consists of three phases: inspiration (e.g., learning from those that one is designing for), ideation (e.g., brainstorming and prototyping), and implementation (e.g., building partnerships and launching a business model). In this paper, we describe “tools” for the application of HCD within the context of rapidly prototyping and testing CBPM framework activities for use with our community committee partners; we provide practical advice for the use of these tools (“process points”); and we present a real-world application from development of our new CBPM framework (“tools in action”). Overall, the HCD tools from IDEO helped us see new opportunities for our framework, transform insights into actionable ideas, and increase the speed of producing a minimum viable product and gathering feedback on it from our customers. We believe that HCD tools are worth exploring when it comes to the social marketing planning process.

PurposeThe purpose of this paper is to show how non-linear causal modelling knowledge, already accumulated by other disciplines, is central to unravelling wicked problem scoping and definition in social marketing. Design/methodology/approachThe paper is an illustrative case study approach, highlighting three real-world exemplars of causal modelling for wicked problem definition. FindingsThe findings show how the traditional linear research methods of social marketing are not sensitive enough to the dynamics and complexities of wicked problems. A shift to non-linear causal modelling techniques and methods, using interaction as the unit of analysis, provides insight and understanding into the chains of causal dependencies underlying social marketing problems. Research limitations/implicationsThis research extends the application of systems thinking in social marketing through the illustration of three non-linear causal modelling techniques, namely, collective intelligence, fuzzy cognitive mapping and system dynamics modelling. Each technique has the capacity to visualise structural and behavioural properties of complex systems and identify the central interactions driving behaviour. Practical implicationsNon-linear causal modelling methods provide a robust platform for practical manifestations of collaborative-based strategic projects in social marketing, when used with participatory research, suitable for micro, meso, macro or systems wide interventions. Originality/valueThe paper identifies non-linear causality as central to wicked problem scoping identification, documentation and analysis in social marketing. This paper advances multi-causal knowledge in the social marketing paradigm by using fuzzy, collective and interpretative methods as a bridge between linear and non-linear causality in wicked problem research.

The amount of human effort required to do content analysis research “by hand” is often time-consuming, and unreliability is a common concern. Our aim was to conduct a content analysis that traces the history of Social Marketing Quarterly ( SMQ) articles by using Leximancer (version 4.5)—a software tool designed for analyzing natural-language text data. We adhered to Krippendorff’s network of steps to address two research questions: (1) “What are the prevailing conceptualizations of the application of social marketing?” and (2) “How have those conceptualizations changed over time?” We identified all SMQ volumes/issues published between May 1994 (inaugural issue) and September 2015. Our sampling units consisted of all SMQ “Application” articles published during that time ( n = 162). Leximancer output includes a conceptual map representing the main concepts within the text and how they are related (themes). Based on conceptual and relational analyses, one would surmise that social marketing applications (e.g., campaigns) predominantly address health-related problems through behavioral influence strategies, informed by audience research and designed to include the elements of the marketing mix (e.g., messaging). The predominant health topic addressed by social marketing applications has been tobacco use and smoking. Leximancer has a number of desirable features including an ability to quickly handle large amounts of text in various formats and languages. However, those features are no substitute for a content analysis design that makes the research reproducible and available for critical examination—a shortcoming of previous content analyses of the social marketing field.

Background: The purpose of this review was to examine and chart the “scope” of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non–face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14 years (2003–2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: “screening” (e.g., computer tablet screening), “brief intervention” (e.g., text message–based brief interventions), and “referral to treatment” (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies—including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.

Objective: The Emergency Department (ED) Geriatric Readmission Assessment (ED-GRAY) is a 16-item questionnaire we developed that can be used to evaluate the prognostic ability to determine if geriatric patients will recidivate to the ED, be admitted or die within 30 days. Methods: We conducted an observational prospective cohort study at a single academic urban university-affiliated hospital. Subjects (n=250) were consenting, non-critically ill, English-speaking Original Research Article Post et al.; BJMMR, 14(1): 1-8, 2016; Article no.BJMMR.23877 2 adults older than 65 years and receiving care in the ED. Multivariable logistic regression and receiver operating characteristic (ROC) curves were used to evaluate the ability to accurately predict the likelihood of a 30-day event: subsequent ED visit, hospitalization, or death. Results: 56 participants (22%) experienced at least one 30-day return visit or death. Greater disability as measured by the ED GRAY global disability was associated with an increased likelihood of an event (OR=1.7 for each 1-point worsening in severity; 95% CI 1.2, 2.5). In the multivariable model, prior ED visits (OR=2.7, 95% CI=1.4, 5.2), ED GRAY global score (OR=1.4, 95% CI=1.0, 2.1), and age (OR=1.03, 95% CI=0.99, 1.07) were associated with a greater likelihood of a 30-day event. The fit of the multivariable model was good (Hosmer-Lemeshow Goodness of Fit test, p=0.85) and it provided good discrimination between those having and not having a 30-day event (AUROC=0.70). The predicted probability of a return visit ranged from 3–56%. Conclusions: ED GRAY demonstrated good predictive validity when combined with prior ED visits, poly-pharmacy and age.

Objective: Our primary objective was to develop a reliable, valid, and efficient screening tool that measures recovery disability among geriatric patients for the Department of Emergency Medicine (ED) Geriatric Readmission Assessments (GRAY). Methods: We conducted a retrospective medical chart review and prospective data analysis of geriatric patients admitted to hospital from the emergency department that were discharged, admitted, or died at a single academic urban university-affiliated hospital to identify items for ED GRAY. Rasch analysis was then used to reduce items and construct an interval/ratio scale of physical and cognitive disabilities. Patients consisted of a cohort of consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED to reduce the number of items. Original Research Article Post et al.; BJMMR, 14(1): 1-14, 2016; Article no.BJMMR.23875 2 Results: Rasch analyses resulted in infit and outfit statistics that eliminated redundant items or items that did not fit a unidimensional disability construct. From the 158 original items, sixteen items comprise the ED GRAY global health questionnaire, representing five sub-constructs: physical disability, cognitive disability, stress, depression, and isolation. All infit and outfit statistics for the global recovery disability score ranging from 1 (least healthy) to 5 (most healthy) were consistent with forming a unidimensional scale. Conclusions: Our study resulted in an objective measurement tool of physical and cognitive disability using Rasch analyses. This screening tool allows healthcare providers the ability to screen older ED patients on a continuum of risk, with high-risk patients being most likely to benefit from indepth evaluation—e.g., comprehensive geriatric assessment—followed by intervention (when necessary).

Introduction Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. Objective To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. Design and Setting A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year. Main Outcomes and Measures Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. Results Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95%UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95%UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), andWest Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5%(95%UI, 42.8%to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5%of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). Conclusions and Relevance There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

In the United States, community coalitions are an important part of the public health milieu, and thus, subject to many of the same external pressures as other organizations—including changes in required strategic orientation. Many funding agencies have shifted their funding agenda from program development to policy change. Thus, the Florida Prevention Research Center created the Community-Based Prevention Marketing (CBPM) for Policy Development framework to teach community coalitions how to apply social marketing to policy change. The research reported here was designed to explicate the framework’s theory of change. We describe and demonstrate a hybrid evaluation approach: utilization-focused developmental evaluation. The research question was “What are the linkages and connections among CBPM inputs, activities, immediate outcomes, intermediate outcomes, and ultimate impacts?” We implemented a case study design, with the case being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling. Community coalition leaders may expect CBPM to provide immediate gains in coalition performance. Results from causal diagramming show how gains in performance are delayed and follow an initial decline in performance. We discuss the practical implications for CBPM’s developers—for example, importance of managing coalition expectations—and other social marketers—for example, expansion of the evaluation toolkit.

Community-based prevention marketing (CBPM) is a community-driven framework for program planning, which applies social marketing concepts and techniques to the development of health behavior interventions. Whereas community members who comprise an action committee or coalition set the goals and make programmatic decisions, social marketing provides the planning framework to guide program design, implementation, and evaluation. CBPM has guided successful initiatives to promote physical activity in both youth and adults, to increase safety eyewear use in agricultural settings, and to delay alcohol and tobacco initiation among youth. However, the emergence of evidence-based policy has fostered renewed interest in “upstream” approaches to health behavior change that, in the United States, have included community partnerships as an important tool for policy development. Unfortunately, these community partnerships have had variable success because of the lack of a systematic framework for identifying, selecting, tailoring, and promoting evidence-based policies. We describe the adaptation and application of CBPM to improve community capacity for identifying and promoting evidence-based policies. The resulting framework, CBPM for Policy Development, is comprised of the following eight steps: (1) build a strong foundation for success; (2) review evidence-based policy options; (3) select a policy to promote; (4) identify priority audiences among beneficiaries, stakeholders, and policy makers; (5) conduct formative research with priority audiences; (6) develop a marketing plan for promoting the policy; (7) develop a plan for monitoring implementation and evaluating impact; and (8) advocate for policy change. We provide a description of each step and an examination of the experiences and lessons learned in applying it to youth obesity prevention.

Healthy People sets the decennial public health agenda for the United States (US). Healthy People 2020 includes objectives for social marketing education and training in schools of public health and for applying it in state health departments. In the present study, two online surveys were conducted to estimate the application of, as well as education and training opportunities available in, social marketing in the US. First, state health department professionals were surveyed online regarding application of eight social marketing benchmarks in their disease prevention and health promotion programs. Eight of 29 participating state health departments used social marketing. Second, an online survey was administered to associate deans of US schools of public health concerning education and professional development opportunities available for students and public health professionals, respectively. Forty percent (20/50) of associate deans participated. In the past academic year, four schools reported offering a social marketing course and six additional schools reported offering a combined health communication/social marketing course. Professional development opportunities in social marketing were even more limited. The present findings may serve as baseline measures for the national objectives to increase the use of social marketing in US disease prevention and health promotion. The paper concludes with discussion of the challenges for schools of public health and other enterprises in meeting the social marketing education and training needs of the public health workforce.

Objectives The purpose of this study was to determine whether junior residents had higher rates of first cannulation and overall success at central venous catheter insertions with the use of ultrasound (US) guidance compared to the landmark technique. Methods We conducted a secondary analysis of data from a prospective randomized controlled study of junior residents from January 2007 through September 2008, which assessed the impact of simulation training on central venous catheter insertion success rates. Blinded independent raters observed in-hospital central venous catheter insertions using a procedural checklist. Success at first cannulation and successful insertion were the primary outcomes. Secondary outcomes included rates of technical errors and mechanical complications. Results Independent raters observed 480 central venous catheter insertions by 115 residents. Successful first cannulation occurred in 27% of landmark compared to 49% of dynamic US-guided (P < .01), and 50% of static US-guided (P = .01) cannulations. Insertion success occurred for 55% of landmark compared to 80% of dynamic US-guided (P < .01) and 80% of static US-guided (P < .01) cannulations. Dynamic US guidance was associated with increased odds of first cannulation success compared to the landmark technique (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.37–3.67) and successful insertion (OR, 3.80; 95% CI, 2.34–6.19). Static US guidance was associated with increased odds of first cannulation success compared to the landmark technique (OR, 2.59; 95% CI, 1.25–5.39) and successful insertion (OR, 3.48; 95% CI, 1.54–7.87). The results were independent of central venous catheter insertion training, patient comorbidities, and resident specialties. There was no difference related to mechanical complications between the procedures. Conclusions Dynamic and static US guidance during central venous catheter insertion was associated with improved in-hospital first cannulation rates and overall success rates of insertions by junior residents.

The debate over immigration continues to be one of the most politically charged policy issues in the United States (US). Given the charged nature of this topic, it is vitally important to have reliable data on not only the number of US foreign nationals but also the characteristics of this extremely heterogeneous group – a population comprised not only of immigrants but also of refugees. There exist a small number of data sources for informing policy and practice at the national level. However, such data are often lacking for smaller geographical areas. This paper describes a recent effort to generate serviceable data on the immigrant and refugee population for a medium-sized metropolitan area in the US. The objectives of this research were twofold. Our first goal was to provide local stakeholders with information to assist them with resettling and obtaining funding for immigrants and refugees. The second aim was to develop better techniques for tabulating diverse refugees and immigrants in a medium-sized community. By comparing and contrasting three data sources – that is, refugee services, public schools and a local health plan – we are able to generate estimates of the local refugee and immigrant population. During the period from 2005 to 2007, we estimate the total number of immigrants and refugees in the community to be somewhere between 10,938 and 13,282. Although perhaps a bit on the high end due to methodological assumptions, these estimates seem plausible, based on previously cited figures for the region. While such estimates are valuable, a number of shortcomings related to the data prevent us from painting a more complete picture of these populations. We conclude this paper with a number of recommendations that will assist others in planning research designed to inform migration policy and practice in medium-sized metropolitan areas.

Please cite this paper as: August E, Salihu H, Weldeselasse H, Biroscak B, Mbah A, Alio A. Infant mortality and subsequent risk of stillbirth: a retrospective cohort study. BJOG 2011;118:1636–1645. Objective To examine the association between infant mortality in a first pregnancy and risk for stillbirth in a second pregnancy. Design Population-based, retrospective cohort study. Setting Maternally linked cohort data files for the state of Missouri. Population Women who had two singleton pregnancies in Missouri during the period 1989–2005 (n = 320 350). Methods Women whose first pregnancy resulted in infant death were compared with those whose infant from the first pregnancy survived the first year of life. The Kaplan–Meier product limit estimator was employed to compare probabilities for stillbirth in the second pregnancy between both groups of women. Adjusted hazard ratios (AHRs) and 95% confidence intervals (95% CIs) were generated to assess the association between infant mortality in the first pregnancy and stillbirth in the second pregnancy. Main outcome measures Exposure was defined as infant mortality in the first pregnancy, and the outcome was defined as stillbirth in the second pregnancy. Results Women with prior infant deaths were about three times as likely to experience stillbirth in their subsequent pregnancy (AHR 2.91; 95% CI 2.02–4.18). White women with a previous infant death were nearly twice as likely to experience a subsequent stillbirth, compared with white women with a surviving infant (AHR 1.96; 95% CI 1.13–3.39). Black women with a previous infant death were more than four times as likely to experience subsequent stillbirth, compared with black women with a surviving infant (AHR 4.28; 95% CI 2.61–6.99). Conclusions Previous infant mortality results in an elevated risk for subsequent stillbirth, with the most profound increase observed among black women. Interconception care should consider prior childbearing experiences to avert subsequent fetal loss.

The authors investigated types and patterns of elder abuse by paid caregivers in long-term care and assessed the role of several risk factors for different abuses and for multiple abuse types. The results are based on a 2005 random-digit-dial survey of relatives of persons in long-term care. We computed occurrence rates and conditional occurrence rates for each of six abuse types: physical, caretaking, verbal, emotional, neglect, and material. Among older adults who have experienced at least one type of abuse, more than half (51.4%) have experienced another type of abuse. Physical functioning problems, activities of daily living limitations, and behavioral problems are significant risk factors for at least three types of abuse and are significant for multiple abuse types. The findings have implications for those monitoring the well-being of older adults in long-term care as well as those responsible for developing public health interventions.

BackgroundLittle is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. ObjectiveThe objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health. MethodsFace-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. ResultsA total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P.05) and personal health records (P

Objectives. Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis. Methods. Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records. Results. The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports—the most frequently cited data source for IPH case ascertainment—and 22% more cases than newspaper data alone would have allowed for. Conclusions. While it was discovered that at least 181 IPHs—and at least 128 other deaths related to intimate partnerships—occurred in Michigan from 1999–2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.

Objective To assess the current state of knowledge regarding sleep disorders and their relationship to obstetric outcomes. Study Design A systematic literature review of the previous two decades (1991 to 2010) was conducted. The exposure was sleep disorders during pregnancy, and the outcomes of interest were feto-infant morbidity and maternal complications. Results Sleep apnea, snoring, and sleep quantity/duration were identified as the most frequently examined sleep disorders among pregnant women. Although our review found that studies examining the impact of sleep disorders on feto-infant outcomes were lacking, previous research indicates that such disorders may enhance the risk of preterm birth. Additionally, the current body of evidence suggests that sleep disorders adversely impact maternal health, increasing the likelihood of preeclampsia, and gestational diabetes. Conclusion Existing research points to the potentially harmful effects of sleep disorders on obstetric outcomes. The limited research in this arena highlights the need for further studies regarding the nature and strength of this relationship. Given the multiple dimensions of sleep and pregnancy, multivariate research approaches that incorporate biological and psychosocial factors are warranted.

To assess the association between bariatric surgery and pregnancy-related outcomes among obese and non-obese women in the state of Florida. We conducted a population-based, retrospective cohort analysis using vital records and hospital discharge data in Florida during 2004–2007. Women were categorized based on prior bariatric surgery and pre-pregnancy obesity status. Maternal complications (i.e., anemia, pre-eclampsia, gestational diabetes, chronic hypertension, endocrine disorders, cesarean section, prolonged hospital stay) and fetal morbidities [macrosomia, preterm birth, small for gestational age (SGA)] were the outcomes of interest. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were computed. Mothers with a prior history of bariatric surgery, regardless of obesity status, were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants. Classification based on prior history of bariatric surgery and obesity status showed that non-obese mothers with prior bariatric surgery were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants, whereas obese mothers without prior bariatric surgery were at greater risk of having gestational diabetes, chronic hypertension, macrosomic infants (AOR = 1.69, 95% CI = 1.65–1.73), and prolonged hospital stay as compared to non-obese mother without prior bariatric surgery. Although prior bariatric surgery is associated with multiple negative maternal and fetal outcomes, it is protective against infant macrosomia in obese mothers. Our findings support the need for preconception/interconception services tailored for former bariatric surgery patients to improve maternal and feto-infant health outcomes.

Infant mortality is an important indicator of the health and wellness of a society. Multiple risk factors for infant mortality have been identified and investigated; however, the influence of prior pregnancy experience on subsequent infant mortality is under-researched.To examine the association between stillbirth in the first pregnancy and risk for infant mortality in the second pregnancy in a large population-based dataset.Population-based, retrospective cohort studyMissouri maternally linked cohort data files were utilized from 1989 through 2005. Analyses were restricted to women who had two singleton pregnancies during the study period.The exposure was stillbirth in the first pregnancy, while the primary outcome was infant mortality in the second pregnancy.Women who experienced stillbirth in their first pregnancy were more likely to be of advanced age, black, and obese and had higher rates of pregnancy-related complications (p0.01). Previous stillbirth was associated with an elevated risk for subsequent infant mortality (AHR=2.51, 95% CI: 1.73-3.65) and neonatal mortality (AHR=3.04, 95% CI: 1.99-4.65), after adjustment for socio-demographic variables and pregnancy complications. Risk estimates for mortality in the second pregnancy were most profound among black mothers with a history of stillbirth in the first pregnancy [risk for infant mortality: (AHR=2.68, 95% CI: 1.41-5.09) and neonatal death: (AHR=4.25, 95% CI: 2.34-7.60)].Women with prior stillbirth bear elevated risks for subsequent infant mortality. Women's previous childbearing experiences could serve as important criteria in determining appropriate interconception strategies to improve subsequent feto-infant health and survival.

Introduction Victims of intimate partner violence against women (IPVAW) often come into contact with various health care professionals, including emergency nurses. Michigan has implemented an ED surveillance system to monitor IPVAW in the state. Methods Twenty-three emergency departments participate in the Michigan Intimate Partner Violence Surveillance System. Female assault and maltreatment victims are identified using International Classification of Diseases Clinical Modification (ICD-9-CM) diagnostic and E codes (External Cause of Injury/Adverse Effects codes). For a 2-year period (1999-2000), patients' charts were reviewed, usually by an emergency nurse, to identify IPVAW victims. Results A total of 3111 female assault and maltreatment victims were identified. Of the 2926 incidents for which physical and/or sexual violence was confirmed by chart review, 1136 (38.8% [95% confidence interval: 37.1% to 40.6%]) involved IPVAW. Discussion A hospital ED surveillance system revealed that more than a third of female assault and maltreatment incidents were attributable to intimate partner violence, with a considerable proportion being young women abused by an ex-boyfriend. Surveillance also identified a need for improved documentation of female assault and maltreatment in ED records. We realized the benefits of using a public health surveillance process to monitor IPVAW incidence, identify high-risk groups, and reduce research costs.

Objective. Hepatitis B vaccine is recommended for all infants, and the series may be started during the delivery admission. For infants who are born either to women who are positive for hepatitis B surface antigen (HBsAg) or to women whose HBsAg status is unknown, vaccination should be started within 12 hours of birth to prevent perinatal and early childhood hepatitis B virus infection. Because of concerns about mercury exposures from vaccines that contain thimerosal, the United States Public Health Service (USPHS) and the American Academy of Pediatrics (AAP) recommended in July 1999 that the first dose of hepatitis B vaccine be deferred until 2–6 months of age but only for infants who are born to HBsAg-negative women. To assess the impact on birth-dose vaccine coverage for infants who are born to women with unknown HBsAg status, we measured coverage before and after July 1999. Methods. A sample of Michigan infants who were born to women whose HBsAg status was either unknown or missing were identified by reviewing newborn screening cards for infants who were born during 1) March–April 1999 (before recommendation changes [T1]); 2) July 15–September 15, 1999 (immediately after recommendation changes [T2]); and 3) March–April 2000 (6 months after resumption of pre-1999 practices were recommended [T3]). We verified maternal HBsAg screening and newborn hepatitis B vaccination by reviewing infant and maternal hospital records. Results. Of 1201 infants who were born to women whose HBsAg status was indicated as unknown or missing on the newborn screening card during the 3 time periods, 216 (18%) were born to women whose status was truly unknown at the time of delivery, as determined by medical record review. During T1, 53% of these 216 infants received hepatitis B vaccine before hospital discharge, compared with 7% of infants who were born during T2 and 57% of infants who were born during T3. During T1, 19% of these infants received hepatitis B vaccine within 12 hours of birth compared with 1% of infants who were born during T2 and 14% of infants who were born during T3. Conclusions. Hepatitis B vaccine birth-dose coverage for infants who were born to women whose HBsAg status was unknown at the time of delivery was already low in Michigan before the July 1999 USPHS/AAP Joint Statement but decreased significantly during the 2 months after the USPHS/AAP Joint Statement. Abrupt changes in established vaccination recommendations for lower risk children may lead to decreased coverage among higher risk children. Increases in hepatitis B vaccine coverage at birth are necessary to reduce the risk of perinatal infection for infants who are born to women with unknown HBsAg status.