76 results on '"Denise V. D’Angelo"'
Search Results
2. Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017
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Letitia Williams, Denise V. D’Angelo, Brenda Bauman, Ada C. Dieke, Sascha R. Ellington, Carrie K. Shapiro-Mendoza, Shanna Cox, Philip Hastings, Holly Shulman, Leslie Harrison, Martha Kapaya, Wanda D. Barfield, and Lee Warner
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Zika virus ,PRAMS ,travel advisory ,health care provider ,pregnancy ,prenatal care ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We surveyed women with a recent live birth who resided in 16 US states and 1 city during the 2016 Zika outbreak. We found high awareness about the risk of Zika virus infection during pregnancy and about advisories to avoid travel to affected areas but moderate levels of discussions with healthcare providers.
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- 2020
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3. Preventing Sexual Transmission of Zika Virus Infection during Pregnancy, Puerto Rico, USA, 2016
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Beatriz Salvesen von Essen, Katie Kortsmit, Lee Warner, Denise V. D’Angelo, Holly B. Shulman, Wanda Hernández Virella, Aspy Taraporewalla, Leslie Harrison, Sascha Ellington, Carrie Shapiro-Mendoza, Wanda Barfield, Ruben A. Smith, Denise J. Jamieson, Shanna Cox, Karen Pazol, Patricia García Díaz, Beatriz Ríos Herrera, and Manuel Vargas Bernal
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pregnancy risk assessment monitoring system ,Zika postpartum emergency response ,Zika ,Zika virus ,viruses ,infections ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We examined condom use throughout pregnancy during the Zika outbreak in Puerto Rico during 2016. Overall,
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- 2019
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4. Attempted Breastfeeding Before Hospital Discharge on Both Sides of the US-Mexico Border, 2005: The Brownsville-Matamoros Sister City Project for Women’s Health
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Brian C. Castrucci, MA, Leticia E. Piña Carrizales, MD, Denise V. D’Angelo, MPH, Jill A. McDonald, PhD, Hillary Foulkes, MPH, Indu B. Ahluwalia, PhD, Ginger L. Gossman, PhD, Juan Acuña, MD, MSc, Tracy Erickson, RD, LD, Kathy Clatanoff, RN, MSN, Kayan Lewis, PhD, Gita Mirchandani, PhD, MPH, and Brian Smith, MD
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The Brownsville-Matamoros Sister City Project for Women’s Health ,women's health ,breast feeding ,Mexican women's health ,Public aspects of medicine ,RA1-1270 - Abstract
IntroductionThe US-Mexico border region has a growing population and limited health care infrastructure. Preventive health behaviors such as breastfeeding ease the burden on this region’s health care system by reducing morbidity and health care costs. We examined correlates of attempted breastfeeding before hospital discharge on each side of the US-Mexico border and within the border region.MethodsThe cross-sectional study included women who delivered a live infant in Matamoros, Tamaulipas, Mexico (n = 489), and Cameron County, Texas (n = 457), which includes Brownsville, Texas. We interviewed women before hospital discharge from August 21 through November 9, 2005. We used multivariate logistic regression to estimate the odds of attempted breastfeeding before hospital discharge in Cameron County, Texas, the municipality of Matamoros, Mexico, and the 2 communities combined.ResultsPrevalence of attempted breastfeeding before hospital discharge was 81.9% in Matamoros compared with 63.7% in Cameron County. After adjusting for potential confounders, the odds of attempted breastfeeding before hospital discharge were 90% higher in Matamoros than in Cameron County (adjusted odds ratio [AOR], 1.93; 95% confidence interval [CI], 1.31-2.84 for the combined model). In the 2 communities combined, odds of attempted breastfeeding before hospital discharge were higher among women who had a vaginal delivery than among women who had a cesarean delivery (AOR, 1.98; 95% CI, 1.43-2.75) and were lower among women who delivered infants with a low birth weight than among women who delivered infants with a normal birth weight (AOR, 0.26; 95% CI, 0.15-0.44).ConclusionThe rate of attempted breastfeeding in Matamoros was significantly higher than in Cameron County. Additional breastfeeding support and messages on the US side of the US-Mexico border are needed.
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- 2008
5. Rapid Population-Based Surveillance of Prenatal and Postpartum Experiences During Public Health Emergencies, Puerto Rico, 2016‒2018
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Beatriz Salvesen von Essen, Denise V. D’Angelo, Holly B. Shulman, Wanda Hernández Virella, Katherine Kortsmit, Beatriz Ríos Herrera, Patricia García Díaz, Aspy Taraporewalla, Leslie Harrison, Lee Warner, and Manuel Vargas Bernal
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Pregnancy ,Zika Virus Infection ,Surveys and Questionnaires ,Postpartum Period ,Puerto Rico ,Public Health, Environmental and Occupational Health ,Humans ,Female ,Public Health ,Vitamins ,Zika Virus ,Emergencies - Abstract
The Pregnancy Risk Assessment Monitoring System–Zika Postpartum Emergency Response study, implemented in Puerto Rico during the Zika virus outbreak (2016–2017) and after Hurricanes Irma and María (2017–2018), collected pregnancy-related data using postpartum hospital-based surveys and telephone follow-up surveys. Response rates of 75% or more were observed across five study surveys. The study informed programs, increased the Puerto Rico Department of Health’s capacity to conduct maternal‒infant health surveillance, and demonstrated the effectiveness of this methodology for collecting data during public health emergencies. (Am J Public Health. 2022;112(4):574–578. https://doi.org/10.2105/AJPH.2021.306687 )
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- 2024
6. Association of Mental Health Conditions, Recent Stressful Life Events, and Adverse Childhood Experiences with Postpartum Substance Use ― Seven States, 2019–2020
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Andrea Stewart, Jean Ko, Beatriz Salvesen von Essen, Madison Levecke, Denise V. D’Angelo, Lisa Romero, Shanna Cox, Lee Warner, and Wanda Barfield
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Health (social science) ,Health Information Management ,Epidemiology ,Health, Toxicology and Mutagenesis ,General Medicine - Published
- 2023
7. Associations of Adverse Childhood Experiences With Pregnancy and Infant Health
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Elizabeth A. Swedo, Denise V. D'Angelo, Amy M. Fasula, Heather B. Clayton, and Katie A. Ports
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Epidemiology ,Public Health, Environmental and Occupational Health - Published
- 2023
8. The Postpartum Period: An Opportunity for Alcohol Screening and Counseling to Reduce Adverse Health Impacts
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Amy Board, Denise V. D’Angelo, Beatriz Salvesen von Essen, Clark H. Denny, Kathryn Miele, Janae Dunkley, Youngjoo Park, and Shin Y. Kim
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Psychiatry and Mental health ,Pharmacology (medical) - Published
- 2023
9. Design and Methodology of the Study of Associated Risks of Stillbirth (SOARS) in Utah
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Carla L. DeSisto, Lee Warner, Ada C. Dieke, Laurie Baksh, Barbara Algarin, Nicole Stone, Denise V. D’Angelo, Leslie Harrison, and Holly B. Shulman
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Adult ,Sociodemographic Factors ,Gestational Age ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Surveys and Questionnaires ,Utah ,medicine ,Humans ,030212 general & internal medicine ,Postal Service ,Pregnancy ,030219 obstetrics & reproductive medicine ,Fetal death ,business.industry ,Medical record ,Research ,Public Health, Environmental and Occupational Health ,Stillbirth ,medicine.disease ,Telephone ,Female ,Medical emergency ,business - Abstract
Objectives The Utah Study of Associated Risks of Stillbirth (SOARS) collects data about stillbirths that are not included in medical records or on fetal death certificates. We describe the design, methods, and survey response rate from the first year of SOARS. Methods The Utah Department of Health identified all Utah women who experienced a stillbirth from June 1, 2018, through May 31, 2019, via fetal death certificates and invited them to participate in SOARS. The research team based the study protocol on the Pregnancy Risk Assessment Monitoring System surveillance of women with live births and modified it to be sensitive to women’s recent experience of a stillbirth. We used fetal death certificates to examine survey response rates overall and by maternal characteristics, gestational age of the fetus, and month in which the loss occurred. Results: Of 288 women invited to participate in the study, 167 (58.0%) completed the survey; 149 (89.2%) responded by mail and 18 (10.8%) by telephone. A higher proportion of women who were non-Hispanic White (vs other races/ethnicities), were married (vs unmarried), and had ≥high school education (vs Conclusions: The response rate suggests that a mail- and telephone-based survey can be successful in collecting self-reported information about risk factors for stillbirths not currently included in medical records or fetal death certificates.
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- 2023
10. Recent Incarceration Exposure Among Parents of Live-Born Infants and Maternal and Child Health
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Rosalyn D. Lee, Denise V. D’Angelo, Ada Dieke, and Kim Burley
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Public Health, Environmental and Occupational Health - Abstract
Objective: Women who have direct exposure to incarceration or indirect exposure through their partner are at high risk for poor health behaviors and outcomes, which may have lasting impacts on their children. The objectives of this study were to estimate the prevalence of recent incarceration exposure among women with a recent live birth and assess the relationship between incarceration exposure and maternal and child health. Methods: We used data from the Pregnancy Risk Assessment Monitoring System (36 states and New York City, 2012-2015; N = 146 329) to estimate the prevalence of women reporting that they or their husband/partner spent time in jail during the 12 months before giving birth. We used multivariable logistic regression to assess associations between incarceration exposure and maternal and infant health conditions. Results: The prevalence of incarceration exposure shortly before or during pregnancy was 3.7% (95% CI, 3.6%-3.9%). Women with incarceration exposure had increased odds of prepregnancy hypertension (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.26-1.81), prepregnancy and postpartum depressive symptoms (aOR = 1.95 [95% CI, 1.73-2.19] and 1.49 [95% CI, 1.32-1.67], respectively), and having an infant admitted to the neonatal intensive care unit (aOR = 1.18; 95% CI, 1.04-1.33). Conclusion: Because a parent’s incarceration exposure is an adverse childhood experience with the potential to disrupt important developmental periods and have negative impacts on the socioemotional and health outcomes of children, it is critical for researchers and health care providers to better understand its impact on maternal and infant health. Prenatal and postnatal care may provide opportunities to address incarceration-related health risks.
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- 2022
11. Opioid use during pregnancy: An analysis of comment data from the 2016 Pregnancy Risk Assessment Monitoring System survey
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Megan O’Connor, Brian Morrow, Michaila Czarnik, and Denise V. D’Angelo
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medicine.medical_specialty ,media_common.quotation_subject ,Medicine (miscellaneous) ,Stigma (botany) ,Coding (therapy) ,Qualitative property ,Prenatal care ,Risk Assessment ,Pregnancy ,Surveys and Questionnaires ,Gratitude ,medicine ,Humans ,media_common ,business.industry ,Infant, Newborn ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Psychiatry and Mental health ,Opioid ,Population Surveillance ,Family medicine ,Respondent ,Premature Birth ,Female ,business ,medicine.drug - Abstract
BACKGROUND Opioid misuse during pregnancy has been associated with adverse infant outcomes including preterm birth, stillbirth, and neonatal opioid withdrawal syndrome. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an on-going state-based surveillance system of maternal behaviors, attitudes, and experiences prior to, during, and after pregnancy. Methods: We analyzed qualitative comments related to opioid use during pregnancy collected in 2016 from an open-ended prompt at the end of the PRAMS survey in 35 states (N = 40,408). Key word searches were conducted on the open-ended responses (n = 9,549) to identify opioid-related content with an automated function using Microsoft Excel. All responses from the initial screening (n = 1,035) were manually reviewed, and 69 responses were confirmed to relate to the respondent's personal experience with opioid use during pregnancy. Content analysis was conducted by 3 independent coders; key themes were compiled, discussed, and finalized by the coding team. Results: Five key themes related to opioid use during pregnancy were identified: (1) gratitude for treatment, recovery, and healthy infants; (2) pregnancy as motivation to seek treatment; (3) difficulty finding prenatal care providers with training in substance use disorders; (4) concern about the effects of treatment on the infant; and (5) experiences of discrimination and stigma in the hospital around the time of delivery. Conclusions: Women may be aware of the potential impact of opioid use during pregnancy on the health of their infants and motivated to seek treatment. Findings may help inform new and ongoing initiatives designed to improve care and reduce stigma for women needing or seeking treatment.
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- 2021
12. Pregnancy Intention: Associations with Maternal Behaviors and Experiences During and After Pregnancy
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Lauren B. Zapata, Cheryl L. Robbins, Karen Pazol, Denise V. D’Angelo, and Lara I Brewer
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Pregnancy ,030219 obstetrics & reproductive medicine ,030505 public health ,business.industry ,Postpartum Period ,Intimate Partner Violence ,General Medicine ,Ambivalence ,medicine.disease ,Pregnancy, Unwanted ,United States ,03 medical and health sciences ,0302 clinical medicine ,Prevalence ,Humans ,Medicine ,Female ,Maternal Behavior ,0305 other medical science ,business ,Clinical psychology - Abstract
Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used ...
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- 2021
13. Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective
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Amy Board, Denise V. D’Angelo, Beatriz Salvesen von Essen, Clark H. Denny, Kathryn Miele, Janae Dunkley, Robert Baillieu, and Shin Y. Kim
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Pharmacology ,Psychiatry and Mental health ,Pharmacology (medical) ,Toxicology - Published
- 2023
14. Response to 'The Time has Come for All States to Measure Racial Discrimination: A Call to Action for the Pregnancy Risk Assessment Monitoring System (PRAMS)'
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Ada C. Dieke, Suzanne G. Folger, Lee Warner, Letitia Williams, Martha Kapaya, Denise V. D’Angelo, and Holly B. Shulman
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Measure (data warehouse) ,Pregnancy risk ,Epidemiology ,business.industry ,media_common.quotation_subject ,Applied psychology ,Public Health, Environmental and Occupational Health ,Large population ,Obstetrics and Gynecology ,Survey research ,Sample (statistics) ,Monitoring system ,Racism ,Call to action ,Pediatrics, Perinatology and Child Health ,Medicine ,business ,media_common - Abstract
We respond to a recent call to action for the Pregnancy Risk Assessment Monitoring System (PRAMS) to include a "core" question or validated measure on discrimination to allow for systematic assessment of the impact of racial discrimination on adverse birth outcomes among a large population-based sample in the United States. We outline activities of the CDC PRAMS project that relate to this call to action.
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- 2021
15. The Impact of Dental Insurance and Medical Insurance on Dental Care Utilization During Pregnancy
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Gina Thornton-Evans, Brenda L. Bauman, Denise V. D’Angelo, Lorena Espinoza, Mei Lin, and Valerie A. Robison
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Receipt ,Pregnancy ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Epidemiology ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Dental insurance ,medicine.disease ,Dental care ,Medical insurance ,stomatognathic diseases ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Family medicine ,Pediatrics, Perinatology and Child Health ,medicine ,030212 general & internal medicine ,business ,Live birth ,Medicaid - Abstract
To measure the association between dental and medical insurance with the receipt of dental cleaning during pregnancy. We analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2015 on 145,051 women with a recent live birth from 36 states. We used adjusted prevalence ratios [aPR] from multivariable regression to examine the association of dental and medical insurance with receipt of dental cleaning during pregnancy, controlling for selected covariates that influence dental care utilization. Seventy-seven percent (77%) of all women reported having dental insurance during pregnancy. Receipt of dental cleaning before pregnancy was strongly associated with dental cleaning during pregnancy. Among women without pre-pregnancy dental cleaning who had dental insurance, those with Medicaid medical insurance had a significantly higher prevalence of dental cleaning during pregnancy [aPR = 1.42, 95% CI (1.32 − 1.52)], compared to those private medical insurance. Among women without pre-pregnancy dental cleaning, those without dental insurance but with Medicaid medical insurance were about 70% less likely to have dental cleaning during pregnancy compared to those with dental and private medical insurance. With or without dental insurance, pre-pregnancy dental cleaning was strongly associated with dental cleaning during pregnancy. Dental insurance was an important determinant of dental utilization. Medical insurance had an independent and positive effect. This effect varied by private versus Medicaid medical insurance. Programs which provide women with dental insurance both before and during pregnancy could improve the oral health of maternal and infant populations.
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- 2021
16. Pregnant Women’s Experiences During and After Hurricanes Irma and Maria, Pregnancy Risk Assessment Monitoring System, Puerto Rico, 2018
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Regina M. Simeone, L. Duane House, Beatriz Salvesen von Essen, Katherine Kortsmit, Wanda Hernandez Virella, Manuel I. Vargas Bernal, Romeo R. Galang, Denise V. D’Angelo, Carrie K. Shapiro-Mendoza, and Sascha R. Ellington
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Public Health, Environmental and Occupational Health - Abstract
Objective: Exposure to natural disasters during and after pregnancy may increase adverse mental health outcomes. Hurricanes Irma and Maria struck Puerto Rico in September 2017. Our objectives were to understand hurricane-related experiences, maternal health concerns, and the impact of hurricane experiences on postpartum depressive symptoms (PDS). Methods: We used data from the 2018 Pregnancy Risk Assessment Monitoring System to describe differences in maternal hurricane experiences among women who were pregnant during and after the 2017 hurricanes. We assessed maternal concerns and PDS. We estimated adjusted prevalence ratios (aPRs) and 95% CIs for the associations between hurricane experiences and PDS. Results: The most frequently reported hurricane experiences were losing power for ≥1 week (97%) and feeling unsafe due to lack of order/security (70%). Almost 30% of women who were pregnant during the hurricanes reported missing prenatal care. PDS were reported by 13% of women. Most hurricane experiences were associated with an increased prevalence of PDS. Feeling unsafe (aPR = 2.4; 95% CI, 1.2-4.9) and having difficulty getting food (aPR = 2.1; 95% CI, 1.1-4.1) had the strongest associations. Conclusions: Most women who were pregnant during or after hurricanes Irma and Maria struck Puerto Rico reported negative hurricane experiences, and most experiences were associated with an increased prevalence of PDS. Understanding the experiences of pregnant women during and after disasters and identifying risks for adverse mental health outcomes after pregnancy are important to inform emergency preparedness and prenatal and postpartum care.
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- 2023
17. Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020
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Amy Parker Fiebelkorn, Fiona Havers, Walter W. Williams, Angela Cheung, Hilda Razzaghi, Nicholas A. Ruther, Denise V. D’Angelo, Megan C. Lindley, Katherine E. Kahn, Tara C. Jatlaoui, and Carla L. Black
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Adult ,Health (social science) ,Vaccination Coverage ,Referral ,Adolescent ,Epidemiology ,Influenza vaccine ,Health, Toxicology and Mutagenesis ,Diphtheria-Tetanus-acellular Pertussis Vaccines ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health Information Management ,Pregnancy ,030225 pediatrics ,medicine ,Ethnicity ,Humans ,030212 general & internal medicine ,Full Report ,Healthcare Disparities ,Tetanus ,business.industry ,Racial Groups ,Toxoid ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Vaccination ,Immunization ,Influenza Vaccines ,Female ,Pregnant Women ,business ,Live birth ,Demography - Abstract
Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage.
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- 2020
18. Women and Infants Affected by Incarceration: The Potential Value of Home Visiting Program Engagement
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Rosalyn D. Lee, Denise V. D’Angelo, and Kim Burley
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- 2022
19. Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019
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Jean Y. Ko, Heather D Tevendale, Lee Warner, Andrea E Strahan, Denise V. D’Angelo, Sarah C. Haight, Wanda D. Barfield, Beatriz Salvesen von Essen, Shanna Cox, Leslie J.S. Harrison, Charlan D. Kroelinger, and Brian Morrow
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Adult ,medicine.medical_specialty ,Prescription Drugs ,Health (social science) ,Adolescent ,Prescription Drug Misuse ,Epidemiology ,Health, Toxicology and Mutagenesis ,Vital signs ,Risk Assessment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Health Information Management ,Pregnancy ,030225 pediatrics ,medicine ,Humans ,Full Report ,030212 general & internal medicine ,Medical prescription ,business.industry ,Public health ,Chronic pain ,Opioid use disorder ,General Medicine ,medicine.disease ,United States ,Analgesics, Opioid ,Opioid ,Health Care Surveys ,Prenatal Exposure Delayed Effects ,Family medicine ,Female ,Self Report ,Chronic Pain ,business ,medicine.drug - Abstract
Background Prescription opioid use during pregnancy has been associated with poor outcomes for mothers and infants. Studies using administrative data have estimated that 14%-22% of women filled a prescription for opioids during pregnancy; however, data on self-reported prescription opioid use during pregnancy are limited. Methods CDC analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in 32 jurisdictions and maternal and infant health surveys in two additional jurisdictions not participating in PRAMS to estimate self-reported prescription opioid pain reliever (prescription opioid) use during pregnancy overall and by maternal characteristics among women with a recent live birth. This study describes source of prescription opioids, reasons for use, want or need to cut down or stop use, and receipt of health care provider counseling on how use during pregnancy can affect an infant. Results An estimated 6.6% of respondents reported prescription opioid use during pregnancy. Among these women, 21.2% reported misuse (a source other than a health care provider or a reason for use other than pain), 27.1% indicated wanting or needing to cut down or stop using, and 68.1% received counseling from a provider on how prescription opioid use during pregnancy could affect an infant. Conclusions and implications for public health practice Among respondents reporting opioid use during pregnancy, most indicated receiving prescription opioids from a health care provider and using for pain reasons; however, answers from one in five women indicated misuse. Improved screening for opioid misuse and treatment of opioid use disorder in pregnant patients might prevent adverse outcomes. Implementation of public health strategies (e.g., improving state prescription drug monitoring program use and enhancing provider training) can support delivery of evidence-based care for pregnant women.
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- 2020
20. Disability and Pregnancy: A Cross-Federal Agency Collaboration to Collect Population-Based Data About Experiences Around the Time of Pregnancy
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Lee Warner, Suzanne G. Folger, Denise V. D’Angelo, Leslie Harrison, Alison N. Cernich, JoAnn M. Thierry, and Katie Kortsmit
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Adult ,medicine.medical_specialty ,Adolescent ,Health Status ,Maternal Health ,Population ,Risk Assessment ,Young Adult ,Report from the CDC ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Intervention (counseling) ,Agency (sociology) ,medicine ,Humans ,Disabled Persons ,030212 general & internal medicine ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Data collection ,business.industry ,National Institute of Child Health and Human Development (U.S.) ,Postpartum care ,Prenatal Care ,General Medicine ,medicine.disease ,United States ,Breast Feeding ,Population Surveillance ,Family medicine ,Population based data ,Female ,Centers for Disease Control and Prevention, U.S ,business ,Live birth - Abstract
Many reproductive-aged women with a disability can achieve successful healthy pregnancies; however, they may face challenges accessing prenatal and postpartum care and finding providers who are knowledgeable about their specific condition. Depending on the nature of the disability, some women may also be at increased risk for adverse maternal and infant outcomes such as pre-eclampsia, infection, anemia, primary cesarean delivery, or preterm birth. Population-based data are needed to better understand the pregnancy and postpartum experiences of women living with disability. The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) collaborated to address these data gaps by leveraging CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) to gather information about disability among women who have had a recent live birth. Data collection began in 2019. Information gathered through PRAMS can be used to guide the development of clinical practices guidelines, intervention programs, and other initiatives of federal, state, and local agencies to improve services and the health of women of reproductive age living with disability.
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- 2020
21. Preventing Sexual Transmission of Zika Virus Infection during Pregnancy, Puerto Rico, USA, 20161
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Wanda D. Barfield, Aspy J. Taraporewalla, Denise J. Jamieson, Denise V. D’Angelo, Beatriz Salvesen von Essen, Ruben A. Smith, Sascha R. Ellington, Patricia Garcia Díaz, Shanna Cox, Lee Warner, Karen Pazol, Beatriz Rios Herrera, Carrie K. Shapiro-Mendoza, Manuel I. Vargas Bernal, Holly B. Shulman, Katie Kortsmit, Wanda Hernández Virella, and Leslie J.S. Harrison
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Microbiology (medical) ,medicine.medical_specialty ,Pregnancy ,Sexual transmission ,biology ,Epidemiology ,business.industry ,virus diseases ,Outbreak ,medicine.disease ,biology.organism_classification ,law.invention ,Zika virus ,Infectious Diseases ,Condom ,law ,Family medicine ,medicine ,Consistent condom ,business ,Healthcare providers ,ZIKA PREVENTION - Abstract
We examined condom use throughout pregnancy during the Zika outbreak in Puerto Rico during 2016. Overall
- Published
- 2019
22. Vital Signs: Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants — United States
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Tami H. Skoff, Rebecca V. Fink, Megan C. Lindley, Fatimah S. Dawood, Barbara H. Bardenheier, Denise V. D’Angelo, Fiona Havers, and Katherine E. Kahn
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Adult ,Pediatrics ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Whooping Cough ,Epidemiology ,Influenza vaccine ,Health, Toxicology and Mutagenesis ,Vital signs ,chemical and pharmacologic phenomena ,Diphtheria-Tetanus-acellular Pertussis Vaccines ,complex mixtures ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Pregnancy ,030225 pediatrics ,Influenza, Human ,medicine ,Humans ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Whooping cough ,Vital Signs ,Tetanus ,business.industry ,Vaccination ,Infant, Newborn ,Toxoid ,Infant ,food and beverages ,virus diseases ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Influenza Vaccines ,Female ,business - Abstract
Introduction Vaccinating pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can reduce influenza and pertussis risk for themselves and their infants. Methods Surveillance data were analyzed to ascertain influenza-associated hospitalization among pregnant women and infant hospitalization and death associated with influenza and pertussis. An Internet panel survey was conducted during March 27–April 8, 2019, among women aged 18–49 years who reported being pregnant any time since August 1, 2018. Influenza vaccination before or during pregnancy was assessed among respondents with known influenza vaccination status who were pregnant any time during October 2018–January 2019 (2,097). Tdap receipt during pregnancy was assessed among respondents with known Tdap status who reported a live birth by their survey date (817). Results From 2010–11 to 2017–18, pregnant women accounted for 24%–34% of influenza-associated hospitalizations per season among females aged 15–44 years. From 2010 to 2017, a total of 3,928 pertussis-related hospitalizations were reported among infants aged
- Published
- 2019
23. Response to 'The Time has Come for All States to Measure Racial Discrimination: A Call to Action for the Pregnancy Risk Assessment Monitoring System (PRAMS)'
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Denise V, D'Angelo, Ada, Dieke, Letitia, Williams, Holly B, Shulman, Martha, Kapaya, Suzanne, Folger, and Lee, Warner
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Pregnancy Complications ,Racism ,Pregnancy ,Population Surveillance ,Humans ,Female ,Risk Assessment ,United States - Abstract
We respond to a recent call to action for the Pregnancy Risk Assessment Monitoring System (PRAMS) to include a "core" question or validated measure on discrimination to allow for systematic assessment of the impact of racial discrimination on adverse birth outcomes among a large population-based sample in the United States. We outline activities of the CDC PRAMS project that relate to this call to action.
- Published
- 2021
24. Workplace Leave and Breastfeeding Duration Among Postpartum Women, 2016-2018
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Craig F. Garfield, Wanda D Barfield, Rui Li, Lee Warner, Cria G Perrine, Holly B Shulman, Shanna Cox, Carrie K. Shapiro-Mendoza, Katherine Kortsmit, and Denise V D'Angelo
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Adult ,business.industry ,Postpartum Period ,Public Health, Environmental and Occupational Health ,Breastfeeding ,MEDLINE ,United States ,Article ,Parental Leave ,Breast Feeding ,Pregnancy ,Population Surveillance ,Medicine ,Humans ,Female ,Duration (project management) ,business ,Demography ,Women, Working - Abstract
Objectives. To examine associations of workplace leave length with breastfeeding initiation and continuation at 1, 2, and 3 months. Methods. We analyzed 2016 to 2018 data for 10 sites in the United States from the Pregnancy Risk Assessment Monitoring System, a site-specific, population-based surveillance system that samples women with a recent live birth 2 to 6 months after birth. Using multivariable logistic regression, we examined associations of leave length ( Results. Among 12 301 postpartum women who planned to or had returned to the job they had during pregnancy, 42.1% reported taking unpaid leave, 37.5% reported paid leave, 18.2% reported both unpaid and paid leave, and 2.2% reported no leave. Approximately two thirds (66.2%) of women reported taking less than 3 months of leave. Although 91.2% of women initiated breastfeeding, 81.2%, 72.1%, and 65.3% of women continued breastfeeding at 1, 2, and 3 months, respectively. Shorter leave length ( Conclusions. Women with less than 3 months of leave reported shorter breastfeeding duration than did women with 3 or more months of leave. (Am J Public Health. 2021;111(11):2036–2045. https://doi.org/10.2105/AJPH.2021.306484 )
- Published
- 2021
25. Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth — Oklahoma and Texas, 2015
- Author
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Denise V. D’Angelo, Ayesha Lampkins, Tanya Guthrie, Shanna Cox, Jennifer M. Bombard, Van T. Tong, Lee Warner, Nan Ruffo, Lucinda J. England, Martha Kapaya, and Brian A. King
- Subjects
Adult ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Time Factors ,Health (social science) ,Pregnancy risk ,Epidemiology ,Health, Toxicology and Mutagenesis ,Population ,Electronic Nicotine Delivery Systems ,Risk Assessment ,01 natural sciences ,Nicotine ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Cigarette smoking ,Pregnancy ,medicine ,Humans ,Full Report ,030212 general & internal medicine ,0101 mathematics ,education ,education.field_of_study ,business.industry ,Obstetrics ,Smoking ,010102 general mathematics ,Oklahoma ,Monitoring system ,General Medicine ,medicine.disease ,Texas ,Prenatal Exposure Delayed Effects ,Female ,Pregnant Women ,Risk assessment ,Live birth ,business ,Live Birth ,medicine.drug - Abstract
Electronic vapor products (EVPs) comprise a diverse group of devices, including electronic cigarettes (e-cigarettes). EVP users inhale an aerosol that typically contains nicotine, flavorings, and other additives (1). Nicotine is a developmental toxicant that adversely affects pregnancy and infant outcomes (2). Data from the 2015 Pregnancy Risk Assessment Monitoring System (PRAMS) for Oklahoma and Texas were analyzed to estimate population-based EVP use among women with a recent live birth. EVP use before pregnancy (defined as >3 months before pregnancy) and around the time of pregnancy (defined as any time during the 3 months before pregnancy, the last 3 months of pregnancy, or 2-6 months after delivery), reasons for EVP use, and dual use of EVPs and cigarettes were assessed. Prevalence of EVP use was 10.4% before pregnancy and 7.0% around the time of pregnancy, including 1.4% during the last 3 months of pregnancy. Among women using EVPs during the last 3 months of pregnancy, 38.4% reported use of EVPs containing nicotine, and 26.4% were unsure of nicotine content. Among women who had used EVPs and cigarettes, dual use prevalence was 38.0% in the 3 months before pregnancy, 7.7% during the last 3 months of pregnancy, and 11.8% in the 2-6 months after delivery. The most frequently reported reasons for EVP use around the time of pregnancy were curiosity (54.0%), the perception that EVPs might help with quitting or reducing cigarette smoking (45.2%), and the perception of reduced harm to the mother, when compared with cigarette smoking (45.2%). Clear messages that EVP use is not safe during pregnancy are needed, and broad, barrier-free access to evidence-based tobacco cessation strategies need to be made available.
- Published
- 2019
26. Prevalence of Alcohol Use, Screening, and Counseling Among Postpartum Persons: Six U.S. States, 2019 [A290]
- Author
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Amy Board, Youngjoo Park, Clark H. Denny, Beatriz Salveson von Essen, Kathryn Miele, and Denise V. D'Angelo
- Subjects
Obstetrics and Gynecology - Published
- 2022
27. Opportunities to Address Men's Health During the Perinatal Period - Puerto Rico, 2017
- Author
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Lee Warner, Wanda Hernández Virella, Clarissa D. Simon, Katherine Kortsmit, Denise V. D’Angelo, Beatriz Salvesen von Essen, Ruben A. Smith, Manuel I. Vargas Bernal, and Craig F. Garfield
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,Prenatal care ,Health Promotion ,Health outcomes ,Young Adult ,Health Information Management ,Pregnancy ,Health care ,medicine ,Humans ,business.industry ,Public health ,Puerto Rico ,Infant, Newborn ,General Medicine ,medicine.disease ,Perinatal Care ,Emergency response ,Family medicine ,Female ,Substance use ,business ,Men's Health ,Perinatal period - Abstract
Decreased use of health care services (1), increased exposure to occupational hazards, and higher rates of substance use (2) might contribute to men's poorer health outcomes when compared with such outcomes for women (3). During the transition to fatherhood, paternal health and involvement during pregnancy might have an impact on maternal and infant outcomes (4-6). To assess men's health-related behaviors and participation in fatherhood-related activities surrounding pregnancy, the Puerto Rico Department of Health and CDC analyzed data from the paternal survey of the Pregnancy Risk Assessment Monitoring System-Zika Postpartum Emergency Response (PRAMS-ZPER)* study. Fewer than one half (48.3%) of men attended a health care visit for themselves in the 12 months before their newborn's birth. However, most fathers attended one or more prenatal care visits (87.2%), were present at the birth (83.1%), and helped prepare for the newborn's arrival (e.g., by preparing the home [92.4%] or purchasing supplies [93.9%]). These findings suggest that opportunities are available for public health messaging directed toward fathers during the perinatal period to increase attention to their own health and health behaviors, and to emphasize the role they can play in supporting their families' overall health and well-being.
- Published
- 2020
28. The Impact of Dental Insurance and Medical Insurance on Dental Care Utilization During Pregnancy
- Author
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Valerie, Robison, Brenda, Bauman, Denise V, D'Angelo, Lorena, Espinoza, Gina, Thornton-Evans, and Mei, Lin
- Subjects
Insurance, Dental ,Insurance, Health ,Medicaid ,Pregnancy ,Humans ,Infant ,Female ,Oral Health ,Dental Care ,Risk Assessment ,United States - Abstract
To measure the association between dental and medical insurance with the receipt of dental cleaning during pregnancy.We analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2015 on 145,051 women with a recent live birth from 36 states. We used adjusted prevalence ratios [aPR] from multivariable regression to examine the association of dental and medical insurance with receipt of dental cleaning during pregnancy, controlling for selected covariates that influence dental care utilization.Seventy-seven percent (77%) of all women reported having dental insurance during pregnancy. Receipt of dental cleaning before pregnancy was strongly associated with dental cleaning during pregnancy. Among women without pre-pregnancy dental cleaning who had dental insurance, those with Medicaid medical insurance had a significantly higher prevalence of dental cleaning during pregnancy [aPR = 1.42, 95% CI (1.32 - 1.52)], compared to those private medical insurance. Among women without pre-pregnancy dental cleaning, those without dental insurance but with Medicaid medical insurance were about 70% less likely to have dental cleaning during pregnancy compared to those with dental and private medical insurance.With or without dental insurance, pre-pregnancy dental cleaning was strongly associated with dental cleaning during pregnancy. Dental insurance was an important determinant of dental utilization. Medical insurance had an independent and positive effect. This effect varied by private versus Medicaid medical insurance. Programs which provide women with dental insurance both before and during pregnancy could improve the oral health of maternal and infant populations.
- Published
- 2020
29. Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2018
- Author
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Rebecca V. Fink, Denise V. D’Angelo, Peng-jun Lu, Katherine E. Kahn, Carla L. Black, Walter W. Williams, Rebecca Devlin, Amy Parker Fiebelkorn, Helen Ding, Fiona Havers, and Sarah Ball
- Subjects
Adult ,medicine.medical_specialty ,Vaccination Coverage ,Health (social science) ,Adolescent ,Epidemiology ,Influenza vaccine ,Health, Toxicology and Mutagenesis ,Diphtheria-Tetanus-acellular Pertussis Vaccines ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Pregnancy ,030225 pediatrics ,medicine ,Humans ,Full Report ,030212 general & internal medicine ,business.industry ,Tetanus ,Toxoid ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Vaccination ,Immunization ,Influenza Vaccines ,Health Care Surveys ,Family medicine ,Female ,Pregnant Women ,Seasons ,business ,Live birth - Abstract
Vaccinating pregnant women with influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines can reduce the risk for influenza and pertussis for themselves and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered any time during pregnancy (1). The ACIP also recommends that women receive Tdap during each pregnancy, preferably from 27 through 36 weeks' gestation (2). To assess influenza and Tdap vaccination coverage among women pregnant during the 2017-18 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 10, 2018. Among 1,771 survey respondents pregnant during the peak influenza vaccination period (October 2017-January 2018), 49.1% reported receiving influenza vaccine before or during their pregnancy. Among 700 respondents who had a live birth, 54.4% reported receiving Tdap during their pregnancy. Women who reported receiving a provider offer of vaccination had higher vaccination coverage than did women who received a recommendation but no offer and women who did not receive a recommendation. Reasons for nonvaccination included concern about effectiveness of the influenza vaccine and lack of knowledge regarding the need for Tdap vaccination during every pregnancy. Provider offers or referrals for vaccination in combination with patient education could reduce missed opportunities for vaccination and increase vaccination coverage among pregnant women.
- Published
- 2018
30. Preconception Health Indicators for Public Health Surveillance
- Author
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Jennifer Farfalla, Alys Adamski, Cheryl L. Robbins, Lauren B. Zapata, Sheree L. Boulet, Caroline Stampfel, Andrea J. Sharma, Denise V. D’Angelo, Charlan D. Kroelinger, and Sarah Verbiest
- Subjects
Adolescent ,Health Status ,Preconception Care ,Article ,Behavioral Risk Factor Surveillance System ,03 medical and health sciences ,0302 clinical medicine ,Public health surveillance ,Environmental health ,Health Status Indicators ,Humans ,Medicine ,Public Health Surveillance ,030212 general & internal medicine ,Reproductive health ,030219 obstetrics & reproductive medicine ,business.industry ,General Medicine ,United States ,Preconception health ,Reproductive Health ,Folic acid intake ,Female ,Systematic process ,business ,Alcohol consumption - Abstract
OBJECTIVES: In response to an expressed need for more focused measurement of preconception health, we identify a condensed set of preconception health indicators for state and national surveillance. METHODS: We used a systematic process to evaluate, prioritize, and select 10 preconception health indicators that maternal and child health programs can use for surveillance. For each indicator, we assessed prevalence, whether it was included in professional recommendations, Healthy People 2020 objectives, Centers for Disease Control and Prevention winnable battles, measurement simplicity, data completeness, and stakeholders’ input. RESULTS: A total of 50 preconception health indicators were evaluated and prioritized. The condensed set includes indicators that rely on data from the Pregnancy Risk Assessment Monitoring System (n=4) and the Behavioral Risk Factor Surveillance System (n=6). The content encompasses heavy alcohol consumption, depression, diabetes, folic acid intake, hypertension, normal weight, recommended physical activity, current smoking, unwanted pregnancy, and use of contraception. CONCLUSIONS: Having a condensed set of preconception health indicators can facilitate surveillance of reproductive-aged women’s health status that supports monitoring, comparisons, and benchmarking at the state and national levels.
- Published
- 2018
31. Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015
- Author
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Wanda D. Barfield, Sharyn E. Parks, Deborah L. Dee, Lee Warner, Carrie K. Shapiro-Mendoza, Katherine Kortsmit, Kim Burley, Jennifer M. Bombard, Denise V. D’Angelo, Leslie J.S. Harrison, Carri Cottengim, Christine K. Olson, Brian Morrow, Holly B. Shulman, Ruben A. Smith, Shanna Cox, and Charlan D. Kroelinger
- Subjects
Adult ,medicine.medical_specialty ,Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,Vital signs ,Mothers ,Poison control ,Occupational safety and health ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,030225 pediatrics ,Injury prevention ,medicine ,Humans ,030212 general & internal medicine ,Vital Signs ,business.industry ,Infant Care ,Infant ,Health Status Disparities ,General Medicine ,Sudden infant death syndrome ,United States ,Infant mortality ,Socioeconomic Factors ,Accidental ,Emergency medicine ,Female ,Sleep ,business ,Sudden Infant Death - Abstract
There have been dramatic improvements in reducing infant sleep-related deaths since the 1990s, when recommendations were introduced to place infants on their backs for sleep. However, there are still approximately 3,500 sleep-related deaths among infants each year in the United States, including those from sudden infant death syndrome, accidental suffocation and strangulation in bed, and unknown causes. Unsafe sleep practices, including placing infants in a nonsupine (on side or on stomach) sleep position, bed sharing, and using soft bedding in the sleep environment (e.g., blankets, pillows, and soft objects) are modifiable risk factors for sleep-related infant deaths.
- Published
- 2018
32. Measures Taken to Prevent Zika Virus Infection During Pregnancy — Puerto Rico, 2016
- Author
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Karen Pazol, Carrie K. Shapiro-Mendoza, Brenda Rivera, Carmen Deseda, Shanna Cox, Tanya Williams, Holly B. Shulman, Leslianne Soto, Sascha R. Ellington, Ruben A. Smith, Aspy J. Taraporewalla, Lisa Romero, Margaret A. Honein, Beatriz Salvesen von Essen, Wanda D. Barfield, Denise J. Jamieson, Lee Warner, Denise V. D’Angelo, Aurea Rodriguez, Mark J. Lamias, Wanda I. Hernandez-Virella, Manuel I. Vargas, Deborah L. Dee, Marion E. Rice, Eva Lathrop, and Leslie Harrison
- Subjects
Adult ,medicine.medical_specialty ,Health (social science) ,Mosquito Control ,Epidemiology ,Health, Toxicology and Mutagenesis ,Risk Assessment ,Zika virus ,Condoms ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health Information Management ,Protective Clothing ,Pregnancy ,030225 pediatrics ,Medicine ,Infection control ,Humans ,Mass Screening ,030212 general & internal medicine ,Full Report ,Pregnancy Complications, Infectious ,Mass screening ,Sexual Abstinence ,biology ,business.industry ,Obstetrics ,Zika Virus Infection ,Public health ,Puerto Rico ,General Medicine ,biology.organism_classification ,medicine.disease ,Mosquito control ,Sexual abstinence ,Insect Repellents ,Public Health Practice ,Female ,Pregnant Women ,business ,Live birth - Abstract
Zika virus infection during pregnancy remains a serious health threat in Puerto Rico. Infection during pregnancy can cause microcephaly, brain abnormalities, and other severe birth defects (1). From January 1, 2016 through March 29, 2017, Puerto Rico reported approximately 3,300 pregnant women with laboratory evidence of possible Zika virus infection (2). There is currently no vaccine or intervention to prevent the adverse effects of Zika virus infection during pregnancy; therefore, prevention has been the focus of public health activities, especially for pregnant women (3). CDC and the Puerto Rico Department of Health analyzed data from the Pregnancy Risk Assessment Monitoring System Zika Postpartum Emergency Response (PRAMS-ZPER) survey conducted from August through December 2016 among Puerto Rico residents with a live birth. Most women (98.1%) reported using at least one measure to avoid mosquitos in their home environment. However, only 45.8% of women reported wearing mosquito repellent daily, and 11.5% reported wearing pants and shirts with long sleeves daily. Approximately one third (38.5%) reported abstaining from sex or using condoms consistently throughout pregnancy. Overall, 76.9% of women reported having been tested for Zika virus by their health care provider during the first or second trimester of pregnancy. These results can be used to assess and refine Zika virus infection prevention messaging and interventions for pregnant women and to reinforce measures to promote prenatal testing for Zika.
- Published
- 2017
33. Trends in Repeat Births and Use of Postpartum Contraception Among Teens — United States, 2004–2015
- Author
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Leslie J.S. Harrison, Charlan D. Kroelinger, Katherine Bower, Ruben A. Smith, Wanda D. Barfield, Martha Kapaya, Deborah L. Dee, Shanna Cox, Denise V. D’Angelo, Lee Warner, Ayanna Harrison, Karen Pazol, Amy M. Fasula, Emilia H. Koumans, and Nikki Mayes
- Subjects
Pediatrics ,medicine.medical_specialty ,Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,education ,Population ,Fertility ,Prenatal care ,Birth rate ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Medicine ,030212 general & internal medicine ,media_common ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,General Medicine ,Family planning ,business ,Live birth ,human activities ,Developed country ,Postpartum period ,Demography - Abstract
Teen* childbearing (one or more live births before age 20 years) can have negative health, social, and economic consequences for mothers and their children (1). Repeat teen births (two or more live births before age 20 years) can constrain the mother's ability to take advantage of educational and workforce opportunities (2), and are more likely to be preterm or of low birthweight than first teen births (3). Despite the historic decline in the U.S. teen birth rate during 1991-2015, from 61.8 to 22.3 births per 1,000 females aged 15-19 years (4), many teens continue to have repeat births (3). The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recommend that clinicians counsel women (including teens) during prenatal care about birth spacing and postpartum contraceptive use (5), including the safety and effectiveness of long-acting reversible methods that can be initiated immediately postpartum. To expand upon prior research assessing patterns and trends in repeat childbearing and postpartum contraceptive use among teens with a recent live birth (i.e., 2-6 months after delivery) (3), CDC analyzed data from the National Vital Statistics System natality files (2004 and 2015) and the Pregnancy Risk Assessment Monitoring System (PRAMS; 2004-2013). The number and proportion of teen births that were repeat births decreased from 2004 (82,997; 20.1%) to 2015 (38,324; 16.7%); in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among sexually active teens with a recent live birth, postpartum use of the most effective contraceptive methods (intrauterine devices and contraceptive implants) increased from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three reported using either a least effective method (15.7%) or no method (17.2%). Strategies that comprehensively address the social and health care needs of teen parents can facilitate access to and use of effective methods of contraception and help prevent repeat teen births.
- Published
- 2017
34. Prevalence and Factors Associated With Safe Infant Sleep Practices
- Author
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Denise V. D’Angelo, Sharyn E. Parks, Marion Koso-Thomas, Lorena Kaplan, Lee Warner, Katherine Kortsmit, Maureen Perkins, Erin Reiney, Ashley H. Hirai, and Carrie K. Shapiro-Mendoza
- Subjects
Adult ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Poison control ,Mothers ,Beds ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,Health care ,Injury prevention ,medicine ,Prevalence ,Supine Position ,Humans ,business.industry ,Co-sleeping ,Bedding and Linens ,Infant ,Confidence interval ,Socioeconomic Factors ,Pediatrics, Perinatology and Child Health ,Infant Care ,Physical therapy ,Female ,Sleep (system call) ,business ,Sleep ,Sudden Infant Death - Abstract
OBJECTIVES: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. METHODS: Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bed-sharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice. RESULTS: Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10–20 percentage points) than receipt of advice (∼5–10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09–1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21–1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics. CONCLUSIONS: Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices.
- Published
- 2019
35. Affordable Care Act-dependent Insurance Coverage and Access to Care Among Young Adult Women With a Recent Live Birth
- Author
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Wanda D. Barfield, Denise V. D’Angelo, Leslie Harrison, Lee Warner, Rui Li, Shanna Cox, and Brenda L. Bauman
- Subjects
Postnatal Care ,Adult ,medicine.medical_specialty ,Prenatal care ,Health Services Accessibility ,Insurance Coverage ,Treatment and control groups ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Patient Protection and Affordable Care Act ,Medicine ,Humans ,030212 general & internal medicine ,Receipt ,Insurance, Health ,business.industry ,Medicaid ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,Pregnancy Outcome ,Prenatal Care ,medicine.disease ,United States ,Family medicine ,Female ,0305 other medical science ,business ,Live birth ,Live Birth - Abstract
Background The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26. Objectives To examine the impact of the ACA Provision on insurance coverage and care among women with a recent live birth. Research design, subjects, and outcome measures We conducted a difference-in-difference analysis to assess the effect of the Provision using data from the Pregnancy Risk Assessment Monitoring System among 22,599 women aged 19-25 (treatment group) and 22,361 women aged 27-31 years (control group). Outcomes include insurance coverage in the month before and during pregnancy, and at delivery, and receipt of timely prenatal care, a postpartum check-up, and postpartum contraceptive use. Results Compared with the control group, the Provision was associated with a 4.7-percentage point decrease in being uninsured and a 5.9-percentage point increase in private insurance coverage in the month before pregnancy, and a 5.4-percentage point increase in private insurance coverage and a 5.9-percentage point decrease in Medicaid coverage during pregnancy, with similar changes in insurance coverage at delivery. Findings demonstrated a 3.6-percentage point increase in receipt of timely prenatal care, and no change in receipt of a postpartum check-up or postpartum contraceptive use. Conclusions Among women with a recent live birth, the Provision was associated with a decreased likelihood of being uninsured and increased private insurance coverage in the month before pregnancy, a shift from Medicaid to private insurance coverage during pregnancy and at delivery, and an increased likelihood of receiving timely prenatal care.
- Published
- 2018
36. Factors associated with postpartum use of long-acting reversible contraception
- Author
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Polly A. Marchbanks, Maura K. Whiteman, Denise V. D’Angelo, Maegan E. Boutot, Titilope Oduyebo, Naomi K. Tepper, Lauren B. Zapata, and Kathryn M. Curtis
- Subjects
Adult ,medicine.medical_specialty ,Population ,Long-acting reversible contraception ,White People ,Article ,Odds ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,medicine ,Contraceptive Agents, Female ,Ethnicity ,Odds Ratio ,Humans ,030212 general & internal medicine ,education ,Drug Implants ,Long-Acting Reversible Contraception ,education.field_of_study ,Medically Uninsured ,030219 obstetrics & reproductive medicine ,Insurance, Health ,Obstetrics ,business.industry ,Postpartum Period ,Age Factors ,Obstetrics and Gynecology ,Pregnancy, Unplanned ,Hispanic or Latino ,medicine.disease ,Black or African American ,Hormonal contraception ,Educational Status ,Female ,business ,Live birth ,Unintended pregnancy ,Postpartum period ,Intrauterine Devices - Abstract
Background Contraception use among postpartum women is important to prevent unintended pregnancies and optimize birth spacing. Long-acting reversible contraception, including intrauterine devices and implants, is highly effective, yet compared to less effective methods utilization rates are low. Objectives We sought to estimate prevalence of long-acting reversible contraception use among postpartum women and examine factors associated with long-acting reversible contraception use among those using any reversible contraception. Study Design We analyzed 2012–2015 data from the Pregnancy Risk Assessment Monitoring System, a population-based survey among women with recent live births. We included data from 37 sites that achieved the minimum overall response rate threshold for data release. We estimated the prevalence of long-acting reversible contraception use in our sample (n = 143,335). We examined maternal factors associated with long-acting reversible contraception use among women using reversible contraception (n = 97,013) using multivariable logistic regression (long-acting reversible contraception vs other type of reversible contraception) and multinomial regression (long-acting reversible contraception vs other hormonal contraception and long-acting reversible contraception vs other nonhormonal contraception). Results The prevalence of long-acting reversible contraception use overall was 15.3%. Among postpartum women using reversible contraception, 22.5% reported long-acting reversible contraception use, which varied by site, ranging from 11.2% in New Jersey to 37.6% in Alaska. Factors associated with postpartum long-acting reversible contraception use vs use of another reversible contraceptive method included age ≤24 years (adjusted odds ratio = 1.43; 95% confidence interval = 1.33–1.54) and ≥35 years (adjusted odds ratio = 0.87; 95% confidence interval = 0.80–0.96) vs 25–34 years; public insurance (adjusted odds ratio = 1.15; 95% confidence interval = 1.08–1.24) and no insurance (adjusted odds ratio = 0.73; 95% confidence interval = 0.55–0.96) vs private insurance at delivery; having a recent unintended pregnancy (adjusted odds ratio = 1.44; 95% confidence interval = 1.34–1.54) or being unsure about the recent pregnancy (adjusted odds ratio = 1.29; 95% confidence interval = 1.18–1.40) vs recent pregnancy intended; having ≥1 previous live birth (adjusted odds ratio = 1.40; 95% confidence interval = 1.31–1.48); and having a postpartum check-up after recent live birth (adjusted odds ratio = 2.70; 95% confidence interval = 2.35–3.11). Hispanic and non-Hispanic black postpartum women had a higher rate of long-acting reversible contraception use (26.6% and 23.4%, respectively) compared to non-Hispanic white women (21.5%), and there was significant race/ethnicity interaction with educational level. Conclusion Nearly 1 in 6 (15.3%) postpartum women with a recent live birth and nearly 1 in 4 (22.5%) postpartum women using reversible contraception reported long-acting reversible contraception use. Our analysis suggests that factors such as age, race/ethnicity, education, insurance, parity, intendedness of recent pregnancy, and postpartum visit attendance may be associated with postpartum long-acting reversible contraception use. Ensuring all postpartum women have access to the full range of contraceptive methods, including long-acting reversible contraception, is important to prevent unintended pregnancy and optimize birth spacing. Contraceptive access may be improved by public health efforts and programs that address barriers in the postpartum period, including increasing awareness of the availability, effectiveness, and safety of long-acting reversible contraception (and other methods), as well as providing full reimbursement for contraceptive services and removal of administrative and logistical barriers.
- Published
- 2018
37. Prevalence and maternal characteristics associated with receipt of prenatal care provider counseling about medications safe to take during pregnancy
- Author
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Leslie Harrison, Denise V. D’Angelo, Jean Y. Ko, Cheryl S. Broussard, Van T. Tong, Brenda L. Bauman, Martha Kapaya, and Indu B. Ahluwalia
- Subjects
Adult ,Counseling ,medicine.medical_specialty ,Prescription Drugs ,Epidemiology ,Health Behavior ,Prenatal care ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Diabetes mellitus ,Medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Medical prescription ,Maternal Behavior ,Depression (differential diagnoses) ,Asthma ,Receipt ,business.industry ,Obstetrics ,010102 general mathematics ,Public Health, Environmental and Occupational Health ,Prenatal Care ,medicine.disease ,Confidence interval ,Socioeconomic Factors ,Population Surveillance ,Female ,Patient Safety ,Self Report ,business - Abstract
Use of some medications during pregnancy can be harmful to the developing fetus, and discussion of the risks and benefits with prenatal care providers can provide guidance to pregnant women. We used Pregnancy Risk Assessment Monitoring System data collected for 2015 births aggregated from 34 US states (n = 40,480 women) to estimate the prevalence of self-reported receipt of prenatal care provider counseling about medications safe to take during pregnancy. We examined associations between counseling and maternal characteristics using adjusted prevalence ratios (aPR). The prevalence of counseling on medications safe to take during pregnancy was 89.2% (95% confidence interval [CI]: 88.7–89.7). Women who were nulliparous versus multiparous (aPR 1.03; 95% CI: 1.02–1.04), who used prescription medications before pregnancy versus those who did not, (aPR 1.03; 95% CI: 1.02–1.05), and who reported having asthma before pregnancy versus those who did not, (aPR 1.05; 95% CI: 1.01–1.08) were more likely to report receipt of counseling. There was no difference in counseling for women with pre-pregnancy diabetes, hypertension, and/or depression compared to those without. Women who entered prenatal care after the first trimester were less likely to report receipt of counseling (aPR 0.93; 95% CI: 0.91–0.96). Overall, self-reported receipt of counseling was high, with some differences by maternal characteristics. Although effect estimates were small, it is important to ensure that information is available to prenatal care providers about medication safety during pregnancy, and that messages are communicated to women who are or might become pregnant.
- Published
- 2018
38. The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of Design and Methodology
- Author
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Denise V. D’Angelo, Leslie Harrison, Holly B. Shulman, Lee Warner, and Ruben A. Smith
- Subjects
Adult ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Sample (statistics) ,Birth certificate ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Pregnancy ,medicine ,Ethnicity ,Birth Weight ,Humans ,030212 general & internal medicine ,Postal Service ,Program Development ,Reproductive health ,Response rate (survey) ,030219 obstetrics & reproductive medicine ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Prenatal Care ,medicine.disease ,United States ,Telephone ,AJPH Pregnancy Risk Assessment Monitoring System ,Sample size determination ,Family medicine ,Birth Certificates ,Population Surveillance ,Residence ,Female ,Centers for Disease Control and Prevention, U.S ,business ,Psychology ,Maternal Age - Abstract
Data System. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state-based surveillance system of maternal behaviors, attitudes, and experiences before, during, and shortly after pregnancy. PRAMS is conducted by the Centers for Disease Control and Prevention’s Division of Reproductive Health in collaboration with state health departments. Data Collection/Processing. Birth certificate records are used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. PRAMS is a mixed-mode mail and telephone survey. Annual state sample sizes range from approximately 1000 to 3000 women. States stratify their sample by characteristics of public health interest such as maternal age, race/ethnicity, geographic area of residence, and infant birth weight. Data Analysis/Dissemination. States meeting established response rate thresholds are included in multistate analytic data sets available to researchers through a proposal submission process. In addition, estimates from selected indicators are available online. Public Health Implications. PRAMS provides state-based data for key maternal and child health indicators that can be tracked over time. Stratification by maternal characteristics allows for examinations of disparities over a wide range of health indicators.
- Published
- 2018
39. Contraceptive Use Among Nonpregnant and Postpartum Women at Risk for Unintended Pregnancy, and Female High School Students, in the Context of Zika Preparedness — United States, 2011–2013 and 2015
- Author
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Wanda D. Barfield, Denise J. Jamieson, Lisa Romero, Sheree L. Boulet, Sascha R. Ellington, Brian Morrow, Margaret A. Honein, Leslie Harrison, Denise V. D’Angelo, Meghan T. Frey, Karen Pazol, Shanna Cox, Lee Warner, Howard I. Goldberg, Maria Rivera, Erin Berry-Bibee, Eva Lathrop, Lauren B. Zapata, Charlan D. Kroelinger, and Tanya Williams
- Subjects
Adult ,Gerontology ,Health (social science) ,Sexual transmission ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,Population ,Risk Assessment ,Zika virus ,Behavioral Risk Factor Surveillance System ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Pregnancy ,Environmental health ,Humans ,Medicine ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Students ,education ,Contraception Behavior ,education.field_of_study ,030219 obstetrics & reproductive medicine ,biology ,Zika Virus Infection ,business.industry ,Postpartum Period ,Pregnancy, Unplanned ,General Medicine ,biology.organism_classification ,medicine.disease ,United States ,Cross-Sectional Studies ,Family planning ,Female ,business ,Unintended pregnancy ,Postpartum period - Abstract
Zika virus infection during pregnancy can cause congenital microcephaly and brain abnormalities (1,2). Since 2015, Zika virus has been spreading through much of the World Health Organization's Region of the Americas, including U.S. territories. Zika virus is spread through the bite of Aedes aegypti or Aedes albopictus mosquitoes, by sex with an infected partner, or from a pregnant woman to her fetus during pregnancy.* CDC estimates that 41 states are in the potential range of Aedes aegypti or Aedes albopictus mosquitoes (3), and on July 29, 2016, the Florida Department of Health identified an area in one neighborhood of Miami where Zika virus infections in multiple persons are being spread by bites of local mosquitoes. These are the first known cases of local mosquito-borne Zika virus transmission in the continental United States.(†) CDC prevention efforts include mosquito surveillance and control, targeted education about Zika virus and condom use to prevent sexual transmission, and guidance for providers on contraceptive counseling to reduce unintended pregnancy. To estimate the prevalence of contraceptive use among nonpregnant and postpartum women at risk for unintended pregnancy and sexually active female high school students living in the 41 states where mosquito-borne transmission might be possible, CDC used 2011-2013 and 2015 survey data from four state-based surveillance systems: the Behavioral Risk Factor Surveillance System (BRFSS, 2011-2013), which surveys adult women; the Pregnancy Risk Assessment Monitoring System (PRAMS, 2013) and the Maternal and Infant Health Assessment (MIHA, 2013), which surveys women with a recent live birth; and the Youth Risk Behavior Survey (YRBS, 2015), which surveys students in grades 9-12. CDC defines an unintended pregnancy as one that is either unwanted (i.e., the pregnancy occurred when no children, or no more children, were desired) or mistimed (i.e., the pregnancy occurred earlier than desired). The proportion of women at risk for unintended pregnancy who used a highly effective reversible method, known as long-acting reversible contraception (LARC), ranged from 5.5% to 18.9% for BRFSS-surveyed women and 6.9% to 30.5% for PRAMS/MIHA-surveyed women. The proportion of women not using any contraception ranged from 12.3% to 34.3% (BRFSS) and from 3.5% to 15.3% (PRAMS/MIHA). YRBS data indicated that among sexually active female high school students, use of LARC at last intercourse ranged from 1.7% to 8.4%, and use of no contraception ranged from 7.3% to 22.8%. In the context of Zika preparedness, the full range of contraceptive methods approved by the Food and Drug Administration (FDA), including LARC, should be readily available and accessible for women who want to avoid or delay pregnancy. Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available.
- Published
- 2016
40. Tetanus, Diphtheria, and Acellular Pertussis and Influenza Vaccinations among Women With a Live Birth, Internet Panel Survey, 2017-2018
- Author
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Helen Ding, Denise V. D’Angelo, Katherine E. Kahn, Amy Parker Fiebelkorn, Rebecca V. Fink, Carla L. Black, Neil Chandra Murthy, Rebecca Devlin, and Sarah Ball
- Subjects
Panel survey ,Pediatrics ,medicine.medical_specialty ,01 natural sciences ,Influenza vaccinations ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,lcsh:RC109-216 ,030212 general & internal medicine ,0101 mathematics ,Original Research ,health care providers ,Pregnancy ,business.industry ,Tetanus ,Diphtheria ,Vaccination ,010102 general mathematics ,medicine.disease ,Tdap ,OB/GYN ,pregnancy ,influenza ,Live birth ,business ,Acellular pertussis - Abstract
Objectives: Pregnant women are at increased risk of complications from influenza, and infants are at increased risk of pertussis. Maternal influenza and Tdap (tetanus, diphtheria, and acellular pertussis) vaccination can reduce risk of these infections and related complications. Our objective was to estimate vaccination coverage with influenza and Tdap vaccines during pregnancy among women with a recent live birth. Methods: An opt-in Internet panel survey was conducted from March 28 to April 10, 2018 among pregnant and recently pregnant women. Respondents with a live birth from August 1, 2017 through the date in which the participant completed the survey were included in the analysis. Receipt of influenza vaccination since July 1, 2017 and Tdap vaccination during pregnancy were assessed by sociodemographic characteristics, receipt of a health care provider (HCP) recommendation and/or offer of vaccination, and vaccination-related knowledge, attitudes, and beliefs. Results: Less than a third (30.3%) of women with a live birth were unvaccinated during their pregnancy with both Tdap and influenza vaccines. Almost a third (32.8%) of the women reported being vaccinated with both vaccines. The majority (73.0%) of women reported receiving an HCP recommendation for both vaccines, and 54.2% of women were offered both vaccines by an HCP. Reasons for nonvaccination included negative attitudes toward influenza vaccine and lack of awareness about Tdap vaccination during pregnancy. Conclusions: Maternal Tdap and influenza vaccinations can prevent morbidity and mortality among infants and their mothers, yet many pregnant women are unvaccinated with either Tdap or influenza vaccines. Clinic-based education, along with interventions, such as standing orders and provider reminders, are strategies to increase maternal vaccination.
- Published
- 2020
41. Disparities in Preconception Health Indicators - Behavioral Risk Factor Surveillance System, 2013-2015, and Pregnancy Risk Assessment Monitoring System, 2013-2014
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Denise V. D’Angelo, Charlan D. Kroelinger, Cheryl L. Robbins, Andrea J. Sharma, Lauren B. Zapata, Brian Morrow, Isabel Morgan, and Sheree L. Boulet
- Subjects
Adult ,Postnatal Care ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,Population ,Preconception Care ,Risk Assessment ,03 medical and health sciences ,Behavioral Risk Factor Surveillance System ,Young Adult ,0302 clinical medicine ,Health Information Management ,Pregnancy ,Environmental health ,Health care ,medicine ,Ethnicity ,Health Status Indicators ,Humans ,030212 general & internal medicine ,education ,education.field_of_study ,Surveillance Summaries ,030219 obstetrics & reproductive medicine ,Insurance, Health ,business.industry ,Public health ,Racial Groups ,Health Status Disparities ,Vitamins ,medicine.disease ,Pregnancy, Unwanted ,Infant mortality ,United States ,Contraception ,Reproductive Health ,Population Surveillance ,Female ,business ,Risk assessment - Abstract
Problem/condition Preconception health is a broad term that encompasses the overall health of nonpregnant women during their reproductive years (defined here as aged 18-44 years). Improvement of both birth outcomes and the woman's health occurs when preconception health is optimized. Improving preconception health before and between pregnancies is critical for reducing maternal and infant mortality and pregnancy-related complications. The National Preconception Health and Health Care Initiative's Surveillance and Research work group suggests ten prioritized indicators that states can use to monitor programs or activities for improving the preconception health status of women of reproductive age. This report includes overall and stratified estimates for nine of these preconception health indicators. Reporting period 2013-2015. Description of systems Survey data from two surveillance systems are included in this report. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing state-based, landline and cellular telephone survey of noninstitutionalized adults in the United States aged ≥18 years that is conducted by state and territorial health departments. BRFSS is the main source of self-reported data for states on health risk behaviors, chronic health conditions, and preventive health services primarily related to chronic disease in the United States. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing U.S. state- and population-based surveillance system administered collaboratively by CDC and state health departments. PRAMS is designed to monitor selected maternal behaviors, conditions, and experiences that occur before, during, and shortly after pregnancy that are self-reported by women who recently delivered a live-born infant. This report summarizes BRFSS and PRAMS data on nine of 10 prioritized preconception health indicators (i.e., depression, diabetes, hypertension, current cigarette smoking, normal weight, recommended physical activity, recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method) for which the most recent data are available. BRFSS data from all 50 states and the District of Columbia were used for six preconception health indicators: depression, diabetes (excluded if occurring only during pregnancy or if limited to borderline/prediabetes conditions), hypertension (excluded if occurring only during pregnancy or if limited to borderline/prehypertension conditions), current cigarette smoking, normal weight, and recommended physical activity. PRAMS data from 30 states, the District of Columbia, and New York City were used for three preconception health indicators: recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method by women or their husbands or partners (i.e., male or female sterilization, hormonal implant, intrauterine device, injectable contraceptive, oral contraceptive, hormonal patch, or vaginal ring). Heavy alcohol use during the 3 months before pregnancy also was included in the prioritized set of 10 indicators, but PRAMS data for each reporting area are not available until 2016 for that indicator. Therefore, estimates for heavy alcohol use are not included in this report. All BRFSS preconception health estimates are based on 2014-2015 data except two (hypertension and recommended physical activity are based on 2013 and 2015 data). All PRAMS preconception health estimates rely on 2013-2014 data. Prevalence estimates of indicators are reported for women aged 18-44 years overall, by age group, race-ethnicity, health insurance status, and reporting area. Chi-square tests were conducted to assess differences in indicators by age group, race/ethnicity, and insurance status. Results During 2013-2015, prevalence estimates of indicators representing risk factors were generally highest and prevalence estimates of health-promoting indicators were generally lowest among older women (35-44 years), non-Hispanic black women, uninsured women, and those residing in southern states. For example, prevalence of ever having been told by a health care provider that they had a depressive disorder was highest among women aged 35-44 years (23.1%) and lowest among women aged 18-24 years (19.2%). Prevalence of postpartum use of a most or moderately effective method of contraception was lowest among women aged 35-44 years (50.6%) and highest among younger women aged 18-24 years (64.9%). Self-reported prepregnancy multivitamin use and getting recommended levels of physical activity were lowest among non-Hispanic black women (21.6% and 42.8%, respectively) and highest among non-Hispanic white women (37.8% and 53.8%, respectively). Recent unwanted pregnancy was lowest among non-Hispanic white women and highest among non-Hispanic black women (5.0% and 11.6%, respectively). All but three indicators (diabetes, hypertension, and use of a most or moderately effective contraceptive method) varied by insurance status; for instance, prevalence of current cigarette smoking was higher among uninsured women (21.0%) compared with insured women (16.1%), and prevalence of normal weight was lower among women who were uninsured (38.6%), compared with women who were insured (46.1%). By reporting area, the range of women reporting ever having been told by a health care provider that they had diabetes was 5.0% (Alabama) to 1.9% (Utah), and women reporting ever having been told by a health care provider that they had hypertension ranged from 19.2% (Mississippi) to 7.0% (Minnesota). Interpretation Preconception health risk factors and health-promoting indicators varied by age group, race/ethnicity, insurance status, and reporting area. These disparities highlight subpopulations that might benefit most from interventions that improve preconception health. Public health action Eliminating disparities in preconception health can potentially reduce disparities in two of the leading causes of death in early and middle adulthood (i.e., heart disease and diabetes). Public health officials can use this information to provide a baseline against which to evaluate state efforts to improve preconception health.
- Published
- 2018
42. Pregnancy Risk Assessment Monitoring System and the W.K. Kellogg Foundation Joint Project to Enhance Maternal and Child Health Surveillance: Focus on Collaboration
- Author
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Martha Kapaya, Wako E, Helms Shealy K, Simpson P, Leslie J.S. Harrison, Williams T, Williams L, Indu B. Ahluwalia, and Denise V. D’Angelo
- Subjects
Postnatal Care ,Pregnancy risk ,Adolescent ,Inequality ,media_common.quotation_subject ,Health Behavior ,Population ,Child Welfare ,Health outcomes ,Risk Assessment ,Risk-Taking ,Pregnancy ,Environmental health ,Humans ,Medicine ,Cooperative Behavior ,Maternal Behavior ,education ,media_common ,education.field_of_study ,Maternal and child health ,business.industry ,Infant, Newborn ,Infant ,Foundation (evidence) ,Prenatal Care ,Monitoring system ,General Medicine ,United States ,Perinatal Care ,Socioeconomic Factors ,Child, Preschool ,Population Surveillance ,Infant Care ,Female ,business ,Developed country - Abstract
Maternal and child health (MCH) surveillance data are important for understanding gaps in services and disparities in burden of disease, access to care, risk behaviors, and health outcomes. However, national and state surveillance systems are not always designed to gather sufficient data for calculating reliable estimates of the health conditions among high-risk or underrepresented population subgroups living in smaller geographic areas. The Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) has conducted surveillance for over 25 years in collaboration with state and city health departments. In 2012, PRAMS embarked on a multiyear collaboration with the W.K. Kellogg Foundation (WKKF) to include oversampling of minority and low-income women in selected geographic areas in four states (Louisiana, Michigan, Mississippi, and New Mexico) where the WKKF funded extensive place-based initiatives are located. The PRAMS-WKKF collaboration has broad implications for promoting meaningful collaboration between public, private, local, state, and federal organizations to address MCH data gaps on disparities, and for improving the availability of information needed for MCH programs, policy makers, and women.
- Published
- 2015
43. Implementation Science and the Pregnancy Risk Assessment Monitoring System
- Author
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Violanda Grigorescu, Holly B. Shulman, Leslie Harrison, Aspy J. Taraporewalla, Denise V. D’Angelo, and Ruben A. Smith
- Subjects
Postnatal Care ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Process management ,Restructuring ,Health Personnel ,MEDLINE ,Prenatal care ,Risk Assessment ,Report from the CDC ,Pregnancy ,Surveys and Questionnaires ,Environmental health ,Health care ,Humans ,Medicine ,Maternal Behavior ,Reproductive health ,Data collection ,business.industry ,Data Collection ,Public health ,Pregnancy Outcome ,Prenatal Care ,General Medicine ,United States ,Pregnancy Complications ,Perinatal Care ,Population Surveillance ,Practice Guidelines as Topic ,Female ,business ,Risk assessment - Abstract
This paper describes the restructuring of the Pregnancy Risk Assessment Monitoring System (PRAMS), a surveillance system of the Centers for Disease Control and Prevention (CDC)'s Division of Reproductive Health conducted for 25 years in collaboration with state and city health departments. With the ultimate goal to better inform health care providers, public health programs, and policy, changes were made to various aspects of PRAMS to enhance its capacity on assessing and monitoring public health interventions and clinical practices in addition to risk behaviors, disease prevalence, comorbidities, and service utilization. Specifically, the three key PRAMS changes identified as necessary and described in this paper are questionnaire revision, launching the web-based centralized PRAMS Integrated Data Collection System, and enhancing the access to PRAMS data through the web query system known as Centers for Disease Control and Prevention's PRAMS Online Data for Epidemiologic Research/PRAMStat. The seven action steps of Knowledge To Action cycle, an illustration of the implementation science process, that reflect the milestones necessary in bridging the knowledge-to-action gap were used as framework for each of these key changes.
- Published
- 2014
44. State-specific estimates of complete smoke-free home rules among postpartum women, 2010
- Author
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Denise V. D’Angelo, Sherry L. Farr, Stephen Babb, Yalonda L. Hutchings, and Van T. Tong
- Subjects
Adult ,Adolescent ,Epidemiology ,Health Behavior ,Population ,Breastfeeding ,Prenatal care ,Risk Assessment ,Article ,Young Adult ,Pregnancy ,Environmental health ,parasitic diseases ,medicine ,Humans ,education ,Reproductive health ,education.field_of_study ,business.industry ,Postpartum Period ,Smoking ,Public Health, Environmental and Occupational Health ,Infant ,medicine.disease ,United States ,Population Surveillance ,Housing ,Female ,Smoking Cessation ,Tobacco Smoke Pollution ,business ,Risk assessment ,Unintended pregnancy ,Postpartum period ,Environmental Monitoring - Abstract
article i nfo Background: Secondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules. Methods: Data were analyzed from 26 states and New York City (n = 37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics. Results: Overall, 93.6% (95% CI: 93.1-94.1) of women with recent live births had complete smoke-free home rules (86.8% (West Virginia) to 98.6% (Utah)). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), b20 years of age (87.1%), b$15,000 annual income (87.6%), b12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%). Conclusions: Prevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free
- Published
- 2014
45. Influenza Vaccination Coverage Among Pregnant Women - United States, 2016-17 Influenza Season
- Author
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Denise V. D’Angelo, Katherine E. Kahn, Stacie M. Greby, Amy Parker Fiebelkorn, Rebecca Devlin, Sarah Ball, Walter W. Williams, Rebecca V. Fink, Helen Ding, Peng-jun Lu, and Carla L. Black
- Subjects
Adult ,Health (social science) ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,Advisory committee ,Ethnic group ,Influenza season ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health Information Management ,Pregnancy ,030225 pediatrics ,Influenza, Human ,Medicine ,Humans ,030212 general & internal medicine ,Full Report ,Young adult ,Pregnancy Complications, Infectious ,business.industry ,Vaccination ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Immunization ,Influenza Vaccines ,Vaccination coverage ,Health Care Surveys ,Female ,Medical emergency ,Seasons ,business ,Demography - Abstract
Pregnant women and their infants are at increased risk for severe influenza-associated illness (1), and since 2004, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination for all women who are or might be pregnant during the influenza season, regardless of the trimester of the pregnancy (2). To assess influenza vaccination coverage among pregnant women during the 2016-17 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 7, 2017. Among 1,893 survey respondents pregnant at any time during October 2016-January 2017, 53.6% reported having received influenza vaccination before (16.2%) or during (37.4%) pregnancy, similar to coverage during the preceding four influenza seasons. Also similar to the preceding influenza season, 67.3% of women reported receiving a provider offer for influenza vaccination, 11.9% reported receiving a recommendation but no offer, and 20.7% reported receiving no recommendation; among these women, reported influenza vaccination coverage was 70.5%, 43.7%, and 14.8%, respectively. Among women who received a provider offer for vaccination, vaccination coverage differed by race/ethnicity, education, insurance type, and other sociodemographic factors. Use of evidence-based practices such as provider reminders and standing orders could reduce missed opportunities for vaccination and increase vaccination coverage among pregnant women.
- Published
- 2017
46. Risks of Preterm Delivery and Small for Gestational Age Infants: Effects of Nondaily and Low-Intensity Daily Smoking During Pregnancy
- Author
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Karilynn Rockhill, Lucinda J. England, Van T. Tong, and Denise V. D’Angelo
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Population ,Prenatal care ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Smoking ,medicine.disease ,United States ,Premature birth ,Pediatrics, Perinatology and Child Health ,Infant, Small for Gestational Age ,Marital status ,Gestation ,Small for gestational age ,Premature Birth ,Female ,business ,Body mass index - Abstract
Background Few studies have examined the effects of nondaily smoking or low-intensity daily smoking and infant outcomes. We examined the associations between preterm delivery and small for gestational age (SGA) infants in relation to both nondaily and daily smoking. Methods We used population-based data on women who delivered live singleton infants using the 2009–11 Pregnancy Risk Assessment Monitoring System. Women's smoking status in the last 3 months of pregnancy was categorised as nonsmokers, quitters, nondaily smokers (
- Published
- 2017
47. Current Cigarette Smoking, Access, and Purchases from Retail Outlets Among Students Aged 13-15 Years - Global Youth Tobacco Survey, 45 Countries, 2013 and 2014
- Author
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Lazarous Mbulo, Denise V. D’Angelo, Shaoman Yin, Indu B. Ahluwalia, Eugene Pun, and Krishna Palipudi
- Subjects
Male ,Health (social science) ,Tobacco use ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,Vital signs ,Global Health ,World health ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Cigarette smoking ,Environmental health ,Medicine ,Humans ,030212 general & internal medicine ,Students ,business.industry ,Tobacco control ,Smoking ,Commerce ,General Medicine ,Tobacco Products ,Health Surveys ,Audience measurement ,Eastern mediterranean ,Smoking initiation ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Tobacco use is a leading preventable cause of morbidity and mortality, with nearly 6 million deaths caused by tobacco use worldwide every year (1). Cigarette smoking is the most common form of tobacco use in most countries, and the majority of adult smokers initiate smoking before age 18 years (2,3). Limiting access to cigarettes among youths is an effective strategy to curb the tobacco epidemic by preventing smoking initiation and reducing the number of new smokers (3,4). CDC used the Global Youth Tobacco Survey (GYTS) data from 45 countries to examine the prevalence of current cigarette smoking, purchase of cigarettes from retail outlets, and type of cigarette purchases made among school students aged 13-15 years. The results are presented by the six World Health Organization (WHO) regions: African Region (AFR); Eastern Mediterranean Region (EMR); European Region (EUR); Region of the Americas (AMR); South-East Asian Region (SEAR); and Western Pacific Region (WPR). Across all 45 countries, the median overall current cigarette smoking prevalence among students aged 13-15 years was 6.8% (range = 1.7% [Kazakhstan]-28.9% [Timor-Leste]); the median prevalence among boys was 9.7% (2.0% [Kazakhstan]-53.5% [Timor-Leste]), and among girls was 3.5% (0.0% [Bangladesh]-26.3% [Italy]). The proportion of current cigarette smokers aged 13-15 years who reported purchasing cigarettes from a retail outlet such as a store, street vendor, or kiosk during the past 30 days ranged from 14.9% [Latvia] to 95.1% [Montenegro], and in approximately half the countries, exceeded 50%. In the majority of countries assessed in AFR and SEAR, approximately 40% of cigarette smokers aged 13-15 years reported purchasing individual cigarettes. Approximately half of smokers in all but one country assessed in EUR reported purchasing cigarettes in packs. These findings could be used by countries to inform tobacco control strategies in the retail environment to reduce and prevent marketing and sales of tobacco products to youths (5).
- Published
- 2016
48. Assessment of Assisted Reproductive Technology Use Questions: Pregnancy Risk Assessment Monitoring System Survey, 2004
- Author
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Victoria C. Wright, Wanda D. Barfield, Danielle T. Barradas, Susan E. Manning, Denise V. D’Angelo, and Laura A. Schieve
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Pregnancy risk ,Reproductive Techniques, Assisted ,medicine.medical_treatment ,Birth weight ,media_common.quotation_subject ,Fertility ,Risk Assessment ,Pregnancy ,Surveys and Questionnaires ,Utah ,Health care ,Prevalence ,medicine ,Birth Weight ,Humans ,media_common ,Assisted reproductive technology ,Maryland ,business.industry ,Research ,Public health ,Pregnancy Outcome ,Public Health, Environmental and Occupational Health ,medicine.disease ,Health Surveys ,Parity ,Population Surveillance ,Family medicine ,Florida ,Female ,Pregnancy, Multiple ,business ,Risk assessment ,Maternal Age - Abstract
Objective. Women who conceive with the assistance of fertility treatments are at increased risk for multiple-gestation pregnancies and accompanying adverse pregnancy outcomes. The Pregnancy Risk Assessment Monitoring System (PRAMS) can be used to assess outcomes associated with fertility treatments, but a previous study suggested that PRAMS questions about fertility treatments overestimated use of assisted reproductive technology (ART) by 2.6 times. These PRAMS ART questions were revised in 2004. We compared prevalence estimates based on revised questions with counts from the National ART Surveillance System (NASS), the standard for describing ART prevalence. Methods. We compared weighted PRAMS prevalence estimates of births conceived by using ART with corresponding counts from NASS for three states (Florida, Maryland, and Utah) for 2004. We also compared these data by age, parity, plurality, and infant birthweight. Results. Estimated ART births determined from PRAMS totaled 3,672 (95% confidence interval 2,210, 5,134), compared with 2,939 ART births reported to NASS. PRAMS estimates and NASS counts differed by maternal age ( p=0.02) and parity ( pConclusions. Revised PRAMS questions better estimate numbers of ART births than earlier PRAMS questions. PRAMS data are useful to describe behaviors and outcomes associated with ART use.
- Published
- 2012
49. Postpartum Smoking Relapse After Quitting During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2000-2011
- Author
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Van T. Tong, Denise V. D’Angelo, Sherry L. Farr, Karilynn Rockhill, Lucinda J. England, and Cheryl L. Robbins
- Subjects
Adult ,medicine.medical_specialty ,Pregnancy risk ,Time Factors ,medicine.medical_treatment ,Logistic regression ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Recurrence ,Risk Factors ,030225 pediatrics ,medicine ,Ethnicity ,Prevalence ,Humans ,030212 general & internal medicine ,Gynecology ,biology ,business.industry ,Obstetrics ,Postpartum Period ,Smoking ,Monitoring system ,General Medicine ,biology.organism_classification ,medicine.disease ,Health Surveys ,Logistic Models ,Smok ,Population Surveillance ,Smoking cessation ,Female ,Smoking Cessation ,Risk assessment ,business ,Postpartum period - Abstract
Relapsing to smoking postpartum jeopardizes a woman's health and her infant's health. Our study estimated the proportion and identified characteristics associated with postpartum relapse using a large population-based sample.We analyzed Pregnancy Risk Assessment Monitoring System data among women with live births. Relapse was defined as smoking at survey completion among those who quit by the last 3 months of pregnancy. We assessed linear trends for relapse during 2000-2011 in 40 sites overall and individually using logistic regression. Adjusted prevalence ratios (aPRs) were calculated to assess characteristics associated with relapse during 2009-2011 (n = 13,076).During 2000-2011, the proportion of women who relapsed postpartum remained unchanged overall (p = 0.84) and by site (p ≥ 0.05 for each), ranging in 2011 from 30.8% to 52.2% (Wyoming-Arkansas). Characteristics associated with relapse compared with reference groups were prepregnancy daily smoking (aPR = 1.80; 95% confidence interval (CI): 1.59-2.04); age20 years (aPR = 1.51; 1.24-1.84), 20-24 years (aPR = 1.39; 1.17-1.65), or 25-34 years (aPR = 1.26; 1.07-1.48); not initiating breastfeeding (aPR = 1.34; 1.24-1.44); not having a complete home smoking ban (aPR = 1.27; 1.14-1.42); being black non-Hispanic (aPR = 1.25; 1.14-1.38); being multiparous (aPR = 1.20; 1.11-1.28); experiencing 3-5 stressors during pregnancy (aPR = 1.12; 1.01-1.24); having an unintended pregnancy (aPR = 1.11; 1.03-1.19); and having 12 years of education (aPR = 1.09; 1.01-1.17).There was no change in the proportion of women relapsing postpartum during 2000-2011. In 2011, nearly half (42%) of women relapsed after quitting smoking during pregnancy. Disparities exist by site and by maternal characteristics. A comprehensive approach maximizing tobacco control efforts and developing effective clinical interventions delivered across sectors is necessary for long-term tobacco abstinence among women.
- Published
- 2015
50. Associations Between Preconception Counseling and Maternal Behaviors Before and During Pregnancy
- Author
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Lauren B. Zapata, Denise V. D’Angelo, Brian Morrow, Letitia Williams, and Leslie Harrison
- Subjects
Adult ,Counseling ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Alcohol Drinking ,Epidemiology ,medicine.medical_treatment ,Health Behavior ,Population ,Poison control ,Prenatal care ,Risk Assessment ,Preconception Care ,Young Adult ,Pregnancy ,Surveys and Questionnaires ,Environmental health ,Confidence Intervals ,Odds Ratio ,Humans ,Medicine ,Maternal Behavior ,education ,education.field_of_study ,business.industry ,Obstetrics ,Smoking ,Pregnancy Outcome ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Prenatal Care ,medicine.disease ,United States ,Pregnancy Complications ,Self Care ,Cross-Sectional Studies ,Socioeconomic Factors ,Population Surveillance ,Pediatrics, Perinatology and Child Health ,Smoking cessation ,Female ,Live birth ,business ,Unintended pregnancy - Abstract
Preconception counseling (PCC) is a vital component of preconception care. Through counseling, providers educate and recommend strategies to improve health and birth outcomes for women of reproductive age. The objective of our analysis was to assess the associations between receipt of PCC and positive maternal behaviors before and during pregnancy. We analyzed 2004-2008 Pregnancy Risk Assessment Monitoring System data from Maine, New Jersey, Utah, and Vermont. Multivariable logistic regression was used to investigate the associations between receipt of PCC and prepregnancy daily multivitamin consumption, first-trimester entry into prenatal care, and cessation of smoking and drinking before pregnancy among women who smoked/drank in the 2 years preceding the survey, adjusting for a wide range of maternal characteristics. Overall, 32% of women reported receipt of PCC, with particularly low rates reported among women with an unintended pregnancy (14%) and no health insurance prior to pregnancy (14%). Receipt of PCC was associated with daily prepregnancy multivitamin consumption (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 4.0, 4.7), first-trimester entry into prenatal care for women with an intended pregnancy (AOR = 2.1; 95% CI = 1.8, 2.4), and drinking cessation before pregnancy among women who drank in the 2 years preceding the survey (AOR = 1.3; 95% CI = 1.2, 1.5). PCC was associated with positive maternal behaviors that increase the likelihood of a healthy woman, pregnancy, and infant. Unfortunately, less than one-third of women with a recent live birth reported receiving PCC. These data provide population-based evidence suggesting the value of PCC in the promotion of healthy maternal behaviors for women with intended or unintended pregnancies.
- Published
- 2011
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