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To investigate the relationship between gestational weight gain (GWG) and birthweight outcomes among a low-income population in Hawaii using GWG recommendations from the 2009 Institute of Medicine (IOM) guidelines. Data were analyzed for 19,130 mother-infant pairs who participated in Hawaii's Special Supplemental Nutrition Program for Women, Infants, and Children from 2003 through 2005. GWG was categorized as inadequate, adequate, or excessive on the basis of GWG charts in the guidelines. Generalized logit models assessed the relationship between mothers' GWG and their child's birthweight category (low birthweight [LBW: Keywords WIC * Gestational weight gain * LBW * HBW * IOM guideline, Introduction Low birthweight (LBW, < 2,500 g) is associated with infant mortality [1-3] and infant and childhood morbidity, including neurodevelopmental sequelae, mental retardation, and lower respiratory conditions [1-6]. LBW is [...]

Nearly a half million infants in the United States are born preterm or with low birth weight each year. Providing women who have had a prior adverse birth outcome with access to family planning can help reduce the incidence of subsequent high-risk pregnancies and adverse outcomes. One effective option to prevent unintended pregnancy for women with a prior adverse birth outcome who either do not use contraception consistently or whose contraception fails is emergency contraception (EC). The purpose of our study was to understand willingness to use EC among African-American women who recently had an adverse birth outcome. The Healthy Births Healthy Communities (HBHC) Interconceptional Care Project (ICCP) targeted high-risk African-American women from two low-income Chicago neighborhoods who recently had an adverse birth outcome. The aim of HBHC ICCP was to improve participants' future birth outcomes by providing medical and social services and helping women to clarify their reproductive life goals. Information about participants' pregnancy intentions and willingness to use EC was measured in an interview shortly after enrollment into the study. Over 90% of the 131 women in our study either did not want to become pregnant or did not know if they wanted to become pregnant within the next 2 years. These women had 4.4 times higher odds of reporting willingness to use EC as compared to women who reported a desire to become pregnant within the next 2 years (75.6 vs. 50.0%, respectively; AOR: 4.4; 95% CI 1.1, 17.6). EC is an essential part of the reproductive toolkit for women at high risk of adverse birth outcomes who are not intending pregnancy, along with reproductive life planning and use of effective contraception. Keywords Contraception * Unintended pregnancy * Emergency contraception * Plan B * Poor birth outcome, Introduction Nearly a half million infants in the United States--1 out of every 9--are born preterm or with low birth weight each year. Complications related to these adverse birth outcomes [...]

To assess whether a measure of prenatal case management (PCM) dosage is more sensitive than a dichotomous PCM exposure measure when evaluating the effect of PCM on low birthweight (LBW) and preterm birth (PTB). We constructed a retrospective cohort study (N = 16,657) of Iowa Medicaid-insured women who had a singleton live birth from October 2005 to December 2006; 28% of women received PCM. A PCM dosage measure was created to capture duration of enrollment, total time with a case manager, and intervention breadth. Propensity score (PS)-adjusted odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated to assess the risk of each outcome by PCM dosage and the dichotomous PCM exposure measure. PS-adjusted ORs of PTB were 0.88 (95% CI 0.70-1.11), 0.58 (95% CI 0.47-0.72), and 1.43 (95% CI 1.23-1.67) for high, medium, and low PCM dosage, respectively. For LBW, the PS-adjusted ORs were 0.76 (95% CI 0.57-1.00), 0.64 (95% CI 0.50-0.82), and 1.36 (95% CI 1.14-1.63), for high, medium, and low PCM dosage, respectively. The PCM dichotomous participation measure was not significantly associated with LBW (OR = 0.95, 95% CI 0.82-1.09) or PTB (0.97, 95% CI 0.87-1.10). The reference group in each analysis is No PCM. PCM was associated with a reduced risk of adverse pregnancy outcomes for Medicaid-insured women in Iowa. PCM dosage appeared to be a more sensitive measure than the dichotomous measure of PCM participation. Keywords Prenatal case management * Prenatal home visiting * Birth outcomes * Dose-response relationships, Introduction Over the years, numerous evaluations of prenatal case management (PCM) have been conducted. PCM is a community-based health related service offered to medically and/or socially vulnerable pregnant women to [...]

To improve the effectiveness of prenatal care, there is a need to understand the association between health promotion content and health behaviors during pregnancy. The purpose of this study was to determine the association between prenatal health promotion content and health behaviors during pregnancy among low-income African American and Mexican American women. Twenty-two recommended health promotion topics and their related health behaviors were measured. Structured interviews on health promotion topics and health behaviors were conducted with 159 pregnant women receiving prenatal care at a low-risk urban clinic. Wide variation was found in the number of health promotion topics discussed. Bivariate and regression analyses examined the association between content topics and behaviors. Healthier behaviors were associated with women's reports of discussing more health promotion topics, using fewer substances prepregnancy, and having a more positive attitude toward pregnancy. Data suggest that increasing prenatal health promotion content during routine visits might improve the effectiveness of prenatal care. Keywords: prenatal care; health promotion content; health behaviors; preventive health services; pregnant women

This project assessed the impact of a school-based AIDS prevention program on student participation in sexual risk and protective behaviors such as use of condoms and use of condoms with foam and intention to participate in such behaviors. The paper focuses on students who became sexually active for the first time between the seventh and eighth grade ('changers,' n = 312). The school-based intervention was developed using social cognitive theory and the social influences model of behavior change. Using an experimental, longitudinal design, 15 high-risk school districts were divided randomly into two treatment (10 districts) and one control (five districts) conditions. Students in both treatment conditions received a 10-lesson classroom program in the seventh grade with a five-lesson booster in the eighth grade, while control students received basic AIDS education (current practice in their districts) in compliance with state mandates. Results indicated classroom programs had an impact on certain protective behaviors and on frequency of sexual activity the past month. Post-intervention measures also indicated the program affected students' intentions to perform specific protective behaviors. (J Sch Health. 1995;65(4):145-151), One major challenge in the battle to slow the spread of HIV, the pathogen that causes AIDS, involves reducing the risk behaviors in young adolescents. However, because the number of [...]

This paper examines levels of participation in and correlates of AIDS-related risk behavior for young adolescents in high-risk communities as determined by proxy indicators such as rates of reported STDs and adolescent pregnancies. Seventh and eighth grade students from two middle schools and ninth grade students from the receiving high school were surveyed. Descriptive and inferential techniques examined grade, racial, behavioral, and gender differences in participation in risk (substance use and sexual activity) and protective (use of condoms and use of condoms and foam) behaviors. Grade, race, and sexual activity were significant correlates of both licit and illicit drug use. Gender, grade, race, and licit and illicit drug use were significant correlates of sexual activity. Results demonstrate that not only are adults and older teens at risk in these communities, but younger adolescents also are at risk. Findings indicate a need for comprehensive HIV prevention programs at younger ages. (J Sch Health. 1995;65(1):28-32), A compelling case has been made by researchers and health care providers that adolescents are a major risk group for transmission and spread of the human immunodeficiency virus (HIV).[1-4] Although [...]

Objectives: Objective 8.14 of the U.S. Healthy People 2000 objectives calls for 90% of the population to be served by a local health department (LHD) which is effectively carrying out the core functions of public health (assessment, policy development, assurance). This study seeks to describe the structural and service characteristics of an effective LHD. Methods: Data from a 1993 national random sample survey of LHD practice were merged with data from the 1991-1993 National Association of County and City Health Officials (NACCHO) profile of local health agencies. Using a definition of effectiveness related to the core functions of public health, the correlates of effectiveness were examined for 164 health departments in the matched sample. Results: Effectiveness of local health agencies was not related to jurisdiction size or type. Inputs (structural factors) associated with effectiveness included having a full-time agency head, a larger budget derived from a greater number of funding sources, and a larger number of staff. With respect to outputs (services), effective health departments were also more likely to provide a greater number of services directly, particularly personal preventive and treatment services. Conclusions: Only a few inputs are correlated with core-function related effectiveness. However, a profile of an effective health department emerges. Effective LHDs appear more likely to have full-time leadership which is able to tap diverse funding sources to provide the mix and match of community and personal prevention and treatment services needed to address community needs and improve the public's health. [ABSTRACT FROM AUTHOR]

Objectives: We performed a hospital-based case control study of African-American mothers to explore the relationship between maternal support by a significant other in the delivery room and very low birthweight (VLBW)., Methods: We administered a structured questionnaire to mothers of VLBW (less than 1,500 g; N=104) and normal birthweight (greater or equal to 2,500 g; N=208) infants., Results: The odds ratio for VLBW comparing women without social support in the delivery room to those with a companion was 3.5 (2.1-5.8). Several traditional risk factors were not associated with VLBW, but older maternal age and perceived racial discrimination were., Conclusions: Maternal support in the delivery room or factors closely associated with it significantly decreases the odds of delivering a VLBW infant for African-American women.