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Studies examining the relationship between young maternal age and maternal outcomes are often cross-sectional or short term. We review birth cohort studies that investigate life course outcomes of teen mothers past age 25. Strengths of birth cohort studies include a focus on a complete cohort, rather than a sample, and prospective data collection beginning before or at birth. Limitations are high cost, attrition and unmeasured background factors. Some 20 studies from six countries met study criteria. This narrative review describes how teenage mothers fare as adults, identifies factors that modify outcomes and examines whether outcomes reflect specific time periods or cohorts. Childhood disadvantage was a greater marker of teen mothering in more recent cohorts, even in countries with strong social welfare programmes. The effects of young maternal age on all outcomes diminished when strong controls adjusted for selectivity into teen mothering.

It is well documented that war trauma inflicts serious damage on the mental health of populations affected. Despite having experienced near constant conflict for more than six decades, the paucity of studies assessing the prevalence of trauma-associated disorders among adult South Sudanese resettled in the USA, numbering over 30,000, is concerning. This study was designed to contribute to the literature on the mental health of this group of resettled refugees. The sample consisted of 76 Dinka and Nuer women in Nebraska and Tennessee. On average, participants experienced 9.8 traumatic events during the war, ranging from one to seventeen. Approximately 40%, 29%, and 26% of the women scored above threshold for diagnosis of current anxiety, depression, and PTSD, respectively. Factors including advanced age, i.e., >35 years old, (aOR = 4.76; 95% CI 1.29, 17.51), having elementary education or less (aOR = 6.21; 1.19, 32.27), and middle to secondary education (aOR = 5.65; 1.13, 28.19) were associated with scoring above threshold for diagnosis of current anxiety. By contrast, being divorced/widowed/separated and having annual household income over $40,000 were associated with 88% and 86% reduction in odds of meeting diagnostic threshold for depression, respectively. This study identifies high level of traumatization among a group of Dinka and Nuer women during the Second Sudanese Civil War (1983–2005). Consequently, there are high rates of trauma-associated psychiatric disorders in this sample. More research is needed in this community to gain better understanding of risk and protective factors for trauma-associated psychiatric disorders.

Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW

Background and purpose Multiple sclerosis (MS) is a progressive neurological disorder, characterized by exacerbations and remissions, often resulting in disability affecting multiple neurological functions. The purpose of this article was (1) to describe the frequencies of self-reported symptoms in a natural environment and (2) to determine characteristics and associations between self-reported symptoms and home gait parameters (speed, stride time, and stride length) at baseline and at 3 months in patients with MS. Methods Participants completed the self-report MS-Related Symptom Scale to measure symptoms. A three-dimensional depth imaging system (Foresite Healthcare) was used to measure gait parameters in the home environment. Results These data show significant correlations between the following symptoms: knee locking or collapsing, difficulty sleeping, depression, and anxiety with decreased number of average walks per day; however, the symptoms including trouble-making toilet: day and difficulty in starting urine were positively correlated with average walks per day. The symptom numbness was significantly correlated with decreased speed and decreased stride length. Discussion and conclusions Our findings suggest that certain groups of symptoms were more frequently reported with certain gait parameters (stride time/speed) in persons with MS. Rehabilitation nurses can provide optimal care to prevent future decline in symptoms and gait.

Background In individuals with multiple sclerosis (MS) comorbidities and quality of life (QOL) may be affected by tobacco use. Objective To evaluate the associations between smoking status, in particular quit attempts, and comorbidities among individuals with MS. Methods We used a web-based survey to obtain cross-sectional data from 335 individuals with MS who were members of the Gateway Chapter of the National MS Society email registry. We then examined the associations between smoking variables (current use, frequency, and quit attempts) and comorbidities. Results The prevalence of participants who ever smoked was 50%, which is greater than that reported for the general population; 20% were current smokers. Migraine headaches were associated with current use and everyday smoking, and those with recent failed quit attempts had a higher prevalence of depression than those who were current smokers but who did not attempt to quit or had successfully quit in the past year. Conclusion Given the associations between smoking and comorbidities in individuals with MS, health care providers should both (1) assess smoking history and quit attempts, and (2) encourage individuals with MS who smoke to become non-smokers and refer for treatment, as indicated. In order to increase the chances that individuals will be successful in becoming non-smokers, clinicians would do well to also assess and treat depression in their patients who smoke and are also depressed.

Study Objective To investigate the racial/ethnic differences in the correlates of spontaneous and medically-indicated late preterm birth (LPTB), defined as deliveries between 34 0/7 and 36 6/7 weeks gestation, among US adolescents. Design Population-based, retrospective cohort study. Setting Births in the United States to adolescents in 2012. Participants Adolescents (younger than 20 years; n = 171,573) who delivered nonanomalous singleton first births between 34 and 44 weeks of gestation. Interventions and Main Outcome Measures Bivariate and multivariable logistic regression were used to evaluate the associations between maternal risk factors and spontaneous and medically-indicated LPTB, stratified according to maternal race/ethnicity. Results Risk factors for spontaneous LPTB included single marital status among Asian adolescents; no insurance coverage among whites, Asian, and Hispanic adolescents; inadequate prenatal care among all racial/ethnic groups except American Indian, and adequate plus prenatal care among all races/ethnicities; prenatal smoking among whites and black adolescents; insufficient gestational weight gain among all racial/ethnic groups except American Indian; and prepregnancy underweight among white, black, and Hispanic adolescents. Risk factors for medically-indicated LPTB included inadequate prenatal care among white, black, and Hispanic adolescents, and adequate plus prenatal care among all racial/ethnic groups except Asian; insufficient gestational weight gain among white, black, and Hispanic adolescents; and prepregnancy overweight and obesity among white, black, and Hispanic adolescents. Conclusion Our results show racial/ethnic differences in the correlates of spontaneous and medically-indicated LPTB among US adolescents and support the need for risk-specific interventions among different racial/ethnic groups.

To examine racial differences in the association between gestational weight gain and preterm birth subtypes among adolescents. We conducted a retrospective cohort study of 211 403 adolescents using 2012 United States natality data. The outcome was preterm birth and the primary exposure was gestational weight gain. Multinomial logistic regression analyses were used to estimate adjusted odds ratios, stratified by race and body mass index (BMI). Black and White mothers who gained below the recommendations had increased risks for spontaneous preterm birth in all BMI categories, except obese. All Hispanic mothers who gained below the recommendations had increased risks of spontaneous preterm birth. White normal and overweight mothers and Black, Hispanic and Other normal weight mothers who exceeded the recommendations had decreased risks of spontaneous preterm birth. The effect of gestational weight gain on spontaneous and medically indicated preterm birth is modified by race and BMI.

Background The prevalence of macrosomia has risen markedly worldwide, including in China, during the past two decades. Few epidemiological studies, however, have investigated the risk factors for macrosomia in China. This study was designed to investigate the associations between parental anthropometric characteristics, gestational weight gain (GWG), and risk of macrosomia in China. Methods This population-based, case–control study in Wuhan, China, included a total of 6341 subjects (870 cases and 5471 controls). Multivariable logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). Results Mothers or fathers who were overweight or obese before pregnancy had an elevated risk of giving birth to a macrosomic infant compared with their normal weight counterparts. Women with GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 6.09 [95% CI 5.04, 7.35] for delivering a macrosomic infant compared with women who had GWG within the IOM recommendation. When stratified by maternal pre-pregnancy body mass index (BMI), women who were underweight or normal weight before pregnancy were observed to have a higher risk of macrosomia birth associated with greater GWG. Conclusions Parental pre-pregnancy overweight/obesity and excessive GWG during pregnancy were highly associated with macrosomia. The association with GWG was most pronounced in mothers who had a normal or underweight pre-pregnancy BMI. Weight control efforts before pregnancy for mothers and fathers as well as control of maternal gain during pregnancy may reduce the risk of macrosomia.

This secondary analysis describes the additional psychological symptoms experienced by women in substance abuse treatment who have an alcohol use disorder (AUD) in addition to a drug use disorder (DUD). Results show high levels of certain patterns of psychological symptoms, which include Paranoid Ideation, Phobic Anxiety, Anxiety, and Psychoticism, on the Brief Symptom Inventory (BSI) subscales. Also, age had an adverse effect, with Depression and Psychoticism scores higher with increasing age. Nurse practitioners are ideally situated to assess and screen for patterns of co-occurring psychological symptoms in women with an AUD, which can complicate treatment and lead to practice implications.

Background We examined the birthweight threshold for increased odds of neonatal death among second births based on their elder sibling's birthweight category. Methods This population-based cohort study included 190 575 women who delivered their first two non-anomalous singleton live births in Missouri (1989-2005). We examined the birthweight distribution and neonatal mortality curves of second births whose elder sibling had low versus adequate/high birthweight. We determined the optimal cut-off point for the classification of low birthweight among infants in each group based on the Youden index. Results Infants whose elder sibling had low birthweight had a lower mean birthweight and a higher percentage of low birthweight infants versus those whose elder sibling had adequate/high birthweight, but low birthweight infants in the former group had a lower rate of neonatal mortality. Upon standardizing the birthweight distribution to a Z-scale, neonatal mortality rates became comparable between the two groups at every rescaled birthweight for Z-scores ≥-3.7. The optimal cut-off point for low birthweight was 2500 and 3000 g among infants whose elder sibling had low and adequate/high birthweight, respectively. Conclusions Using sibling data for the classification of LBW may enable the identification of average-sized infants who may be at increased risk of neonatal mortality.

Sleep disorders often co-occur with autism spectrum disorder. They further exacerbate autism spectrum disorder symptoms and interfere with children’s and parental quality of life. This study examines whether gastrointestinal dysfunctions increase the odds of having sleep disorders in 610 children with idiopathic autism spectrum disorder, aged 2–18 years, from the Autism Genetic Resource Exchange research program. The adjusted odds ratio for sleep disorder among those with gastrointestinal dysfunctions compared to those without was 1.74 (95% confidence interval: 1.22–2.48). In addition, the odds of having multiple sleep disorder symptoms among children with gastrointestinal dysfunctions, adjusted for age, gender, behavioral problems, bed wetting, current and past supplements, and current and past medications for autism spectrum disorder symptoms were 1.75 (95% confidence interval: 1.10–2.79) compared to children without gastrointestinal dysfunctions. Early detection and treatment of gastrointestinal dysfunctions in autism spectrum disorder may be means to reduce prevalence and severity of sleep problems and improve quality of life and developmental outcomes in this population.

Gait impairment represents one of the most common and disabling symptoms of multiple sclerosis (MS). To identify which temporal or spatial parameters of gait could be used as outcome measures in interventional studies of individuals with MS with different levels of disability, we evaluated characteristics of these parameters in a case study of 3 participants with MS, using 1 case as an exemplar and the other participants as validation. A case study of an exemplar participant was conducted with a 67-year-old woman with secondary progressive MS served as exemplar, with 2 other participants (52 and 55 years old) as validation. The primary outcome measures we used were stride time, stride length, gait velocity, and daily symptoms. Stride length and velocity of gait decreased with increasing pain and fatigue. The step time was significantly longer later in the day, whereas the step length remained the same. Stride length and velocity are associated with the level of fatigue and pain, as well as the time of day. These characteristics and parameters of gait need to be considered in future studies of gait in MS, with particular attention to temporality of occurrence in persons with MS.

Background Gestational Weight Gain (GWG) below or above the Institute of Medicine (IOM) recommendations increases the risk of adverse pregnancy outcomes. However, it remains unknown whether the risk of adverse outcomes is affected by GWG in a previous pregnancy. We examined associations between GWG in the index (second) pregnancy and pregnancy outcomes, including preterm delivery and small for gestational age (SGA), while taking into consideration GWG in the first pregnancy. Methods In a population-based cohort study (n = 210 564), using the Missouri maternally-linked birth registry (1989–2005), we used multivariable Poisson regression with robust error variance stratified by prepregnancy body mass index (BMI) to evaluate associations between GWG in the index pregnancy and a composite indicator of GWG in the first and second pregnancies and our outcomes of interest, after controlling for sociodemographic and pregnancy-related confounders. Results Associations between GWG in the index pregnancy and pregnancy outcomes were moderated by GWG in the first pregnancy. Despite having GWG within recommendations in the index pregnancy, women had increased risk of preterm delivery and SGA if they had suboptimal GWG in their first pregnancy. Also, women having suboptimal GWG in the index pregnancy had increased risk of preterm delivery only if their GWG in the first pregnancy was also suboptimal. Conclusions The observation that women who have GWG within recommendations in a current pregnancy may still have increased risk of adverse outcomes if they had suboptimal GWG in the first pregnancy has considerable clinical and public health implications.

Objective The association between air pollution and the prevalence of overweight and obesity is evaluated. Methods The population consisted of 30,056 children (aged 2-14 years), randomly selected from 25 districts in Northeast China. Child weight and height were measured, and exposures to particulate matter with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and Ozone (O3) were estimated from the data collected at monitoring stations in the 25 districts. Using two-level logistic models, we examined the association between the exposure and the prevalence of overweight and obesity. Results Among the study children, 12.3% (3,704) were overweight and 14.1% (4,233) were obese. After adjusting for confounding factors, an increased prevalence of obesity was associated with an interquartile range increase in PM10 (31 μg/m3 ; odds ratio [ORs] = 1.19; 95% confidence interval [CI]: 1.11-1.26), SO2 (7.4 ppb; ORs = 1.11; 95% CI: 1.03-1.20), NO2 (5.3 ppb; ORs = 1.13; 95% CI: 1.04-1.22), and O3 (11.5 ppb; ORs = 1.14; 95% CI: 1.04-1.24). Prevalence of overweight increased with an interquartile range increase in O3 (11.5 ppb; ORs = 1.09; 95% CI: 1.03-1.15). Conclusions This study suggests that air pollution is positively associated with an increased likelihood of obesity or overweight in children.

Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem.

It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization (PCU) and preterm birth (PTB), and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System (EPHCIS) and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization (APNCU) index. Logistic regression models were used to estimate odds ratios (OR) and the 95% confidence interval (95% CI). Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695 (10.5%) women experienced inadequate prenatal care, and 5131 (77.1%) received adequate plus prenatal care. Inadequate PCU was associated with PTB (adjusted OR: 1.41, 95% CI: 1.32-1.84); the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.

Several recent studies have suggested that maternal exposures to air pollution and temperature extremes might contribute to low birth weight (LBW), preterm birth (PTB), and other outcomes that can adversely affect infant health. At the time the current study began, most other studies had been conducted in the United States or Europe. Dr. Zhengmin Qian proposed to extend work he had done on ambient particulate air pollution and daily mortality in Wuhan, China (Qian et al. 2010), as part of the HEIsponsored Public Health and Air Pollution in Asia program, to study adverse birth outcomes. Wuhan is the capital city of Hubei province, has a large population of about 6.4 million within the urban study area, experiences temperature extremes, and generally has higher air pollution levels than those observed in the United States and Europe, thus providing a good opportunity to explore questions about air pollution and health.Qian and colleagues planned a cohort and nested case–control design with four specific aims, examining whether increased exposures to air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) during vulnerable pregnancy periods were associated with increased rates of PTB, LBW (2500 g), or intrauterine growth retardation (IUGR, defined as having a birth weight below the 10th percentile of singleton live births in Wuhan) after adjusting for major risk factors and whether the associations were confounded by copollutant exposures, affected by residual confounding, or modified by temperature extremes, socioeconomic status (SES), or secondhand smoke (SHS) exposure. The cohort study included 95,911 births that occurred from June 10, 2011, to June 9, 2013, and met typical prespecified inclusion criteria used in other birth outcome studies. The case–control study included 3146 cases (PTB, LBW, or both, but not IUGR) and 4263 controls (matched to the cases by birth month) for whom investigators were able to complete home visits and questionnaires. The investigators obtained air pollution and daily weather data for August 2010 to June 2013 from nine monitoring stations representing background air pollution sites in seven Wuhan inner-city districts. Only two of these stations provided PM2.5 data. For the cohort study, the investigators assigned exposures to mothers according to the daily mean concentrations from the monitor nearest the residential community in which the mother lived at the time of the birth. For the case–control study, they assigned exposures based on the inverse distance weighted average of daily mean concentrations from the three nearest monitors, for all but PM2.5 for which the method was not specified. They also collected data on various factors that might confound or modify the impact of the pollutants on the adverse outcomes, including data collected in the cohort from mothers at the time of delivery and, in the case–control study, from questionnaires administered to mothers. In the case–control study, covariates representing SES (as indicated by the mother’s educational attainment and household income) and SHS exposures were of particular interest. The primary statistical analyses of the pollutant associations with PTB, LBW, and IUGR were conducted using logistic regression models. In the cohort study, exposures during the pregnancy period of interest (full term, trimesters, and selected months) were included as continuous variables. In the case–control study, the exposures were modeled as binary variables (i.e., above or below the median pollutant concentrations). Numerous sensitivity analyses were conducted.Although originally planning a nested case–control study, the investigators encountered challenges that led them to analyze the cohort and case–control studies using different ways of assigning exposures and characterizing them in their statistical models. These decisions precluded direct comparisons between the sets of results, making it difficult to answer the questions about residual confounding that nested case–control studies are designed to answer. The odds ratios from the two study designs using different exposures also have different interpretations. Still, one can ask whether the sets of findings were qualitatively consistent with each other or with those of similar studies. There were some similarities. Both studies suggested that increased PM(2.5), PM(10), CO, and O(3) exposures over the full pregnancy were associated with small increases in the odds of PTB (the case–control study also showed an association with NO2) and that increased PM(2.5) exposures were associated with significantly increased odds of LBW. However, most of the other pollutants had no effect on LBW, except CO in the cohort study and O(3) in the case–control study, both of which increased the odds of LBW. The exposures over the entire pregnancy were generally associated with decreased odds of IUGR. Adjustments for potential confounders were greatest for the delivery covariates. The investigators found no systematic association of any of these outcomes with particular trimesters or months, another result that differed from those of some other studies. They found little evidence that their main results were confounded or modified by the presence of copollutants, although with the exception of O3, most of the pollutants were highly correlated, making it difficult to disentangle the effects of individual pollutants. Could the two sets of data be analyzed in a more comparable way, as in a standard nested case–control study? At the Committee’s request, the investigators reanalyzed the case–control data using the same exposures and models as in the cohort study. The results were strikingly different from those using the inverse distance weighted exposures, modeled as binary variables — the pollutants had either no effect or an apparent beneficial effect on PTB and LBW. The Committee was not convinced by the explanations offered for these differences, leaving the reasons for them unresolved.This study set out to answer important questions about the effects of air pollution exposure on three measures of adverse birth outcomes — LBW, PTB, and IUGR — in a large cohort of mothers and newborns in Wuhan, China. Given the cohort size, high pollution levels and temperatures, and detailed covariate data, the investigators were well poised to address these questions. They sought to pattern their work on other studies of birth outcomes, were very responsive to Committee questions, and provided many additional analyses and explanations. In the Committee’s view, however, the study was unable to address with confidence several of its specific aims. Most important, the differences in results when the case–control data were analyzed with different exposure metrics remain unexplained, raising concerns about the ability to draw conclusions from subsequent analyses assessing residual confounding and effect modification by temperature extremes, SES, and SHS exposure. Consequently, any individual findings from the cohort and case–control studies should be considered suggestive rather than conclusive, and should be interpreted carefully together.

Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations between CMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB.

Young maternal age at first birth has been associated with poor mental health. However, few studies directly compared the prevalence of psychiatric disorders among adolescent versus adult mothers at first birth using a comprehensive diagnostic tool. This study examined the association between age at first birth and 22 current and lifetime psychiatric disorders in a cohort of low-income pregnant women.The sample consisted of 744 low-income currently pregnant women who were Medicaid-eligible and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Saint Louis City and 5 rural counties in Southeastern Missouri. Current (previous 12 months) and lifetime psychiatric disorders were assessed using the Diagnostic Interview Schedule IV (DIS-IV). Logistic regression analyses tested the association between women's age at first birth and psychiatric disorders, controlling for potential confounders, including relative poverty.When adjusting for confounders, mothers giving birth in their teens had 2.5 times the odds of having a lifetime behavior disorder (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.35-5.24) and current posttraumatic stress disorder (PTSD) (OR 2.54, 95% CI 1.38-4.70) and almost twice the odds of having at least one anxiety disorder compared to older women at first birth (OR 1.78, 95% CI 1.10-2.85).Low-income women who have their first birth in adolescence have higher odds of psychiatric disorders and should be the target of psychiatric screening during their pregnancy. Mothers beginning childbearing before age 19 should be screened during pregnancy for anxiety disorders, including PTSD, and behavior disorders.

Objectives To examine correlates of lifetime mental health services (MHS) use among pregnant women reporting prenatal depressive symptoms by race/ethnicity. Methods This cross-sectional population-based study included 81,910 pregnant women with prenatal depressive symptoms using data from the Florida Healthy Start prenatal screening program (2008–2012). Multivariable logistic regression was conducted to ascertain adjusted odds ratios and corresponding 95 % confidence intervals for racial/ethnic differences in the correlates of lifetime MHS use. Results Findings of this study revealed racial/ethnic differences in MHS use among women with prenatal depressive symptoms, the highest rates being among non-Hispanic Whites and the lowest rates among Mexicans and other Hispanics. Most need for care factors, including illness, tobacco use, and physical or emotional abuse, consistently predicted MHS use across racial/ethnic groups after adjusting for covariates. Adjusted associations between predisposing and enabling/restricting factors and MHS use were different for different racial/ethnic groups. Conclusions Racial/ethnic differences in MHS use were found, with pregnant Hispanic women reporting prenatal depressive symptoms being the least likely to use MHS. Our study findings have significant public health implications for targeted intervention for pregnant women with prenatal depressive symptoms.

Background Autism spectrum disorder (ASD) is a heterogeneous disorder characterized not only by deficits in communication and social interactions but also a high rate of co-occurring disorders, including metabolic abnormalities, gastrointestinal and sleep disorders, and seizures. Seizures, when present, interfere with cognitive development and are associated with a higher mortality rate in the ASD population. Methods To determine the relative prevalence of non-febrile seizures in children with idiopathic ASD from multiplex and simplex families compared with the unaffected siblings in a cohort of 610 children with idiopathic ASD and their 160 unaffected siblings, participating in the Autism Genetic Resource Exchange project, the secondary analysis was performed comparing the life-time prevalence of non-febrile seizures. Statistical models to account for non-independence of observations, inherent with the data from multiplex families, were used in assessing potential confounding effects of age, gender, and history of febrile seizures on odds of having non-febrile seizures. Results The life-time prevalence of non-febrile seizures was 8.2% among children with ASD and 2.5% among their unaffected siblings. In a logistic regression analysis that adjusted for familial clustering, children with ASD had 5.27 (95%CI: 1.51–18.35) times higher odds of having non-febrile seizures compared to their unaffected siblings. In this comparison, age, presence of gastrointestinal dysfunction, and history of febrile seizures were significantly associated with the prevalence of non-febrile seizures. Conclusion Children with idiopathic ASD are significantly more likely to have non-febrile seizures than their unaffected siblings, suggesting that non-febrile seizures may be ASD-specific. Further studies are needed to determine modifiable risk factors for non-febrile seizures in ASD.

Multiple sclerosis is a chronic neurological disease with a myriad of symptoms. Because most work has been quantitative, it is important to capture symptoms as described by patients who experience them, using a qualitative approach. The purpose of our study was to describe and identify symptoms, with emphasis on co-occurrence, using focus groups. Three focus groups were conducted (N = 16) with relapsing-remitting multiple sclerosis patients. Common symptoms, described as both singular and co-occurring, were problems with balance, cognition, vision, and heat intolerance. These findings augment past characterizations of symptoms experienced in persons with relapsing-remitting multiple sclerosis and provide evidence for future studies.

Women living in poverty are at increased risk for depression, especially during their childbearing years. Whereas poverty has known adverse effects on children's cognitive, social, and communication development, maternal depression may place these children at additional risk of developmental delays. The maternal sensitivity of mothers with and without depression and its relationship to maternal–child communicative patterns was investigated. We analyzed cross-sectional data on a sample of 23 African American and Caucasian mother–child dyads (13 with and 10 without depression) living in poverty, drawn from a prospective cohort study. Maternal depression was identified using the Diagnostic Interview Schedule–IV based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Language samples of maternal–child interaction were analyzed using measures of maternal sensitivity, speech acts, and mother–child interchanges. Significant differences in maternal sensitivity, as well as different patterns of relationships between sensitive and communicative behaviors, were found between the groups. Early childhood professionals need to be aware of the effects maternal depression has on communicative interactions and children's development.

Background: The impact of tobacco on the multiple sclerosis (MS) disease process and symptoms is complex and not clearly understood. Tobacco may be used to self-treat some symptoms but also seems to intensify others. Studies to date have not characterized co-occurring symptoms (symptom patterns) and their association with tobacco use. Methods: This study describes tobacco use in patients with relapsing-remitting MS and associated symptoms and symptom co-occurrences. In this cross-sectional study, 101 participants with an average age of 43 years completed a survey adapted from the Behavioral Risk Factor Surveillance System and the revised MS-Related Symptom Checklist. Data reduction was performed using factor analysis on the 43 items of the checklist, and linear regression was used to detect associations between symptom clusters (factors) and smoking. Results: Using the factor analysis result, the linear regression analysis found that tobacco use is positively associated with co-occurring symptoms and symptoms of factor 1: Mental/Emotional (anxiety, loneliness, depression, and difficulty sleeping) and factor 4: Neuro/Autonomic (urinary). Conclusions: Smoking is associated with patterns of symptoms. The study of MS and tobacco use over time will allow determination of the temporal pattern of tobacco use and MS symptoms.

Objective This study examined the effect of body mass index (BMI) before a first uncomplicated pregnancy on maternal and fetal outcomes in a subsequent pregnancy, including preterm births, preeclampsia, cesarean delivery, small for gestational age, large for gestational age, and neonatal deaths. Study Design We conducted a population-based cohort study (n = 121,092) using the Missouri maternally linked birth registry (1989 through 2005). Multivariable binary logistic regression models were fit to estimate odds ratios and 95% confidence intervals for the parameters of interest after controlling for sociodemographic and pregnancy-related confounders in the second pregnancy. Results Compared to women with a normal BMI in their first pregnancy, those who were underweight prepregnancy had increased odds for preterm birth by 20% and small for gestational age by 40% in their second pregnancy, while those with prepregnancy obesity had increased odds for large for gestational age, preeclampsia, cesarean delivery, and neonatal deaths in their second pregnancy by 54%, 156%, 85%, and 37%, respectively. Conclusion Women starting a first pregnancy with suboptimal BMI may be at risk of adverse maternal and fetal outcomes in a subsequent pregnancy, even if their first pregnancy was uncomplicated or if they reached a normal weight by their second pregnancy. The long-term consequences of suboptimal BMI carry considerable public health implications.

This study evaluated the impact ofan extended shelter-based child development/family therapy intervention, called Building Blocks, on the development of children of substance- abusing homeless mothers. The homeless children had greater than expected percentages ofdevelopmental deficits in a number of the developmental domains. Those children who participated in the extended child development/family therapy services were one fourth as likely to have a developmental deficit at 12 months compared to children who did not receive these services. Interventions must be intensive and long-term to improve the developmental outcomes of children with multiple risks ofpoverty, homelessness, and family substance abuse.

The purpose of this study was to investigate the pregnancy outcomes and services available to adolescent women in Missouri, comparing rural and urban residents. A secondary analysis of a large public use data set obtained from the Missouri Department of Health was done for the 5-year period 1992 to 1996. Data were collected by county, with each of the 114 counties of the state classified as rural or urban. The SAS program was used for analysis. Results demonstrated definite patterns of similarity and dissimilarity among the teen mothers based on residence, when age and race were controlled. There were over 54,000 births to adolescent mothers in the 5-year study period. Among the outcomes of pregnancy studied were: abortion rates, inadequate weight gain, intrauterine growth retardation, and low-birthweight (LBW) infants. Among the services available to the young mothers that were studied were fertility services, WIC (women, infants, and children supplemental nutrition) program, food stamps, and Medicaid coverage for pregnancy and infant care. The outcomes are probably generalizable to Midwestern, rural/urban states similar to Missouri.

Patients with multiple sclerosis (MS) experience a myriad of symptoms. There is some evidence that symptoms may co-occur, or happen in particular combinations. Yet most existing studies focus on single symptoms and practitioners make a priori care decisions based on individual symptoms alone. We examined symptom co-occurrences in patients with relapsing–remitting MS (RRMS), collecting qualitative and quantitative data (mixed methods; N = 140). Content analysis revealed fatigue, heat intolerance, numbness, balance problems, and leg weakness as the most common symptoms. Factor analysis revealed the following factors: urinary, problems with balance, vision, heat, depression, and sleep. These preliminary findings indicate co-occurrence of several disabling symptoms from the overall self-report MS-Related Symptom Scale and 3-month recall. This information will guide health care professionals in developing targeted interventions and improve outcomes.

Background Recent research indicates that sexual minority women are at increased risk for cardiovascular disease (CVD) compared with heterosexual women; however, few studies of CVD risk exist for sexual minority men (SMM). This study aimed to determine whether disparities in CVD risk exist for SMM and if CVD risk is consistent across subgroups of SMM. Methods This study utilised publicly available data from the National Health and Nutrition Examination Survey (NHANES), pooled from 2001 to 2010. CVD risk was calculated using the Framingham General CVD Risk Score and operationalised as the ratio of a participant9s vascular and chronological age. Differences in this ratio were examined between heterosexual and SMM as a whole, and within subgroups of SMM. Results SMM had vascular systems that were, on average, 4% (95% CI −7.5% to −0.4%) younger than their heterosexual counterparts; however, adjustment for education and history of hard drug use rendered this difference statistically insignificant. Analysis of SMM subgroups revealed increased CVD risk for bisexual men and decreased CVD risk for both gay and homosexually experienced heterosexual men when compared with heterosexual men. Differences in CVD risk persisted for only bisexual and homosexually experienced heterosexual men after adjustment for education and history of hard drug use. Conclusions Subgroups of SMM are at increased risk for CVD compared with heterosexual men, and this increased risk cannot be completely attributed to differences in demographic characteristics or negative health behaviours.

Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's Belief Scale was translated into Thai and cultural items were added. The Thai Breast Cancer Belief Scale (TBCBS), the Suinn-Lew Self-Identification Acculturation, and the Asian Values Scale-Revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the Health Belief Model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population. Keywords: Thai immigrants; Asian Americans; breast cancer; mammograms; Health Belief Model The National Cancer Institute (NCI) estimates that one in eight women will be diagnosed with breast cancer at some point during their lives (Jemal et al., 2008). Fortunately, the increase in mammography screening and effective treatments has contributed to a decrease in the overall mortality rate for breast cancer by 2.1% per year from 1992 to 2006 (Horner et al, 2009). However, this decline did not occur among all ethnic minorities. Asian Americans continue to show a low rate of mammography screening and showed no change in the mortality rate over the last decade (American Cancer Society [ACS], 2011; Surveillance Epidemiology and End Results [SEER], 2009). About 61.9% of Asian Americans received mammograms within 2 years and 47.7% within 1 year compared to 67% and 51.5% respectively for Whites, 65.9% and 50.6% respectively for African Americans, and 64.4% and 46.5% respectively for Hispanics. When focusing on the use of mammography screening within immigrants, 51.6% of those who were born in the United States received mammography screening within 1 year and 67.1% within 2 years compared to 26.8% and 37.4% respectively for women living in the United States fewer than 10 years (ACS, 2011). These rates suggest low mammography use among Asian American women making the need for increasing mammography use particularly important. The ACS advises all women age 40 years and older to have mammography screening every year, whereas the NCI (2009) recommends mammography screening every 1-2 years for women age 40 years and older. Promoting culturally appropriate programs is a promising approach to increase the use of mammography screening among Thai immigrants, a growing subgroup of Asian Americans, but first we must develop culturally appropriate measures to assess their understanding about mammograms and breast cancer. In this study, we built on Victoria Champion's work to develop a culturally specific scale to measure breast cancer beliefs and mammography use among Thai immigrants. BACKGROUND AND CONCEPTUAL FRAMEWORK We used the Health Belief Model (HBM) to guide this study. This model focuses on beliefs related to breast cancer and mammography behaviors including individual perceptions of the targeted health problem, modifying factors, and the likelihood of action (Janz, Champion, & Strecher, 2002). Individual perceptions are affected by one's beliefs and attitudes toward health and the severity of the given disease. Modifying factors include demographic characteristics, perceived threat, and cues to action. Perceived health threat is influenced by three factors: general health values (ones' interest and concern about health), specific health beliefs about vulnerability to a particular health threat, and beliefs about the health problem. Individuals who perceive a threat to their health and are cued to action, who also perceive that the benefits of the action outweigh the perceived barriers to action, are those most likely to undertake the recommended preventive action. …

Background The prevalence of both unintended pregnancy and psychiatric disorders in pregnancy is high. Each is associated with compromised birth outcomes and challenges in child-rearing. This study examines the relationship between mental illness and unintended pregnancy in seeking to improve the care provided to women and our ability to minimize the number of children born unwanted or ill-cared for. Methods The sample consisted of 744 pregnant Women, Infants, and Children (WIC) participants with a stratified enrollment design by residence and representative by race for each WIC county. Analysis consisted of post-stratification by developmental age group with logistic regression models estimating odds of unintended pregnancy among women with and without a psychiatric disorder. Covariates included race, education, and marital status. Findings Almost one third (30.9%) had at least one psychiatric disorder with over two thirds (67.3%) reporting their pregnancy as unintended. No grouped psychiatric disorder was associated with unintended pregnancy with all ages combined. However, adolescents (ages 15–19) with a substance disorder were less likely to have an unintended pregnancy (adjusted odds ratio [aOR], 0.3; 95% confidence interval [CI], 0.1–0.7) than women without a substance disorder and emerging adult women (ages 20–23) with an anxiety disorder were less likely to have an unintended pregnancy (aOR, 0.4; 95% CI, 0.2–1.0) compared with those without the targeted disorder. Conclusion The prevalence of unintended pregnancy is not associated with having a psychiatric disorder, although substance use disorders and anxiety disorders were associated with a decreased likelihood for an unintended pregnancy in a specific age group. Importantly, targeted efforts are needed to identify and counsel women with mental illness about pregnancy planning.

Objectives. We examined the association between psychiatric disorders and tobacco use during pregnancy. Methods. Data were derived from a population-based cohort of 744 pregnant African American and White low-income women living in urban and rural areas. The Diagnostic Interview Schedule was used to assess women for 20 different psychiatric disorders. Results. In comparison with nonusers, persistent tobacco users (women who had used tobacco after confirmation of their pregnancy) and nonpersistent users (women who had used tobacco but not after pregnancy confirmation) were 2.5 and 2 times as likely to have a psychiatric disorder. Twenty-five percent of persistent users had at least 1 of the following diagnoses: generalized anxiety disorder, bipolar I disorder, oppositional disorder, drug abuse or dependence, and attention deficit–hyperactivity disorder. Conclusions. In this cohort study, 5 diagnoses were more prevalent among persistent tobacco users than among nonusers, suggesting that several psychiatric disorders contribute to difficulty discontinuing tobacco use during pregnancy. Smoking cessation efforts focusing on pregnant women may need to address co-occurring psychiatric disorders if they are to be successful.

The purpose of this study was to examine the psychometric properties of Thai versions of the Maternal Behavior Q-Sort (MBQS), Caldwell's HOME, and the Attachment Q-set (AQS). A sample of 110 Thai mother-infant dyads were studied. The Content Validity Index (CVIs) of the Thai MBQS, HOME and AQS were between 91% and 99%. Internal consistency of the HOME was .71. Interobserver reliability of the MBQS, HOME, and AQS were .95, .87, and .87, respectively. Convergent validity was supported by finding a positive correlation between the MBQS and the HOME (r = .29, p Keywords: attachment; cross-cultural validation; mother-infant interaction; psychometric properties; sensitivity; Thailand Attachment has been the focus of research on mother-child relationships. It refers to a special relationship between infant and caregiver (usually the mother) that evolves over the first year of life and beyond, and it is reciprocal. Infant attachment and maternal sensitivity are concepts of universal relevance that scientists are interested in measuring in many cultures. However, measures of maternal sensitivity and attachment security are not readily available in all cultures. The focus of this study was the translation and cross-cultural validation of three well-known Western measures of maternal sensitivity and attachment security for use in Thailand. BACKGROUND Attachment is the theoretical base of this study. The principle of attachment theory holds that attachment develops within the context of early infant-mother interaction and that it is important for healthy social and emotional development later in life (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969). It has focused on the emotional, social, and cognition bonds that parents form with their children whereby infants and young children develop confidence in their parents' protection. Attachment theorists have stressed maternal sensitivity, comprised of awareness and accurate interpretation of and appropriate and prompt response to an infant's signals, as a significant variable in the establishment of secure attachment (Thompson, 1999). In other words, secure attachment is seen more often in the context of parenting that is dependable and sensitive to the child's needs, enabling the child to count on the caregiver's future availability and assistance. Many studies have indicated that children's attachment security is related to the mother's sensitivity and responsiveness, especially when observed in the natural setting of the home, and to her overall positive psychological adjustment (Ainsworth et al., 1978; Belsky, 1999; De Wolff & van IJzendoorn, 1997). Traditionally, the extended family was the normative form in Thailand, a developing non-Western country. The male or the father is the head of the family, but as a rule fathers tend to leave the task of rearing children to the mothers or to the female member of the family. However, the preference for separate nuclear households has been increasing among young, newly married Thai couples in recent decades (Educational Development and Child Care Practicing Committee, 2000). Insofar as social and economic necessity affects everyone in the family, both parents may need to work outside the home. As a result, Thai women fill a variety of roles in addition to that of motherhood. Mothers with young children are engaged in the labor force in greater numbers. Over three-fifths of all families in Thailand have working mothers (National Statistic Office, 2004). This is an important social change that affects the family socialization function and also may decrease the quality of mother-child interactions. …

Background Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study. Methods We conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997–1999. Infant mortality rates for all singleton births to adolescent women (12–17 years, n = 10,131; 18–19 years, n = 18,954) were compared to those for older women (20–35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations. Results The risk of infant (OR 1.95, CI 1.54–2.48), neonatal (1.69, 1.24–2.31) and post-neonatal mortality (2.47, 1.70–3.59) were significantly higher for younger adolescent (12–17 years) than older (20–34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14–2.64) but not neonatal mortality (1.43, 0.98–2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18–19 years) mothers. Conclusion Socioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.

To estimate the prevalence of posttraumatic stress disorder and its treatment in economically disadvantaged pregnant women.The sample included 744 pregnant Medicaid-eligible women from Women, Infants and Children Supplemental Nutrition Program sites in 5 counties in rural Missouri and the city of St. Louis. Race (black and white) was proportional to clients seen at each site. Women were assessed by using standardized measures of posttraumatic stress disorder, 18 other psychiatric disorders, environmental stressors, and pregnancy characteristics. Logistic regression identified risk factors associated with posttraumatic stress disorder.Posttraumatic stress disorder prevalence was 7.7% (n = 57/744). Comorbid disorders were common. Women with posttraumatic stress disorder were 5 times more likely to have a major depressive episode (odds ratio 5.17; 95% confidence interval 2.61, 10.26) and more than 3 times as likely to have generalized anxiety disorder (odds ratio 3.25; 95% confidence interval 1.22, 8.62). Besides these comorbid disorders, risk factors for posttraumatic stress disorder included a history of maternal separation for 6 months and multiple traumatic events. Although most women with posttraumatic stress disorder reported moderate impairment in their daily lives, only 7 of the 57 women with this disorder reported speaking with any health professional about it in the last 12 months.The prevalence of posttraumatic stress disorder in pregnancy and low treatment rates suggest that screening for this disorder should be considered in clinical practice.II-2

Background Most maternal deaths occur in developing countries and most maternal deaths are avoidable. China has made a great effort to reduce MMR by three quarters to meet the fifth Millennium Development Goal (MDG5). Methods This retrospective study reviewed and analyzed maternal death data in Wuhan from 2001 to 2012. Joinpoint regression and multivariate Poisson regression was conducted using the log-linear model to measure the association of the number of maternal deaths with time, cause of death, where the death occurred, and cognitive factors including knowledge, attitude, resource, and management stratified. Results The MMR declined from 33.41 per 100,000 live births in 2001 to 10.63 per 100,000 live births in 2012, with a total decline of 68.18% and an average annual decline of 9.89%. From 2001–2012, the four major causes of maternal death were obstetric hemorrhage (35.16%), pregnancy complications (28.57%), amniotic fluid embolism (16.48%) and gestational hypertension (8.79%). Multivariate Poisson regression showed on average the MMR decreased by.17% each year from 2001–2006 and stayed stagnant since 2007–2012. Conclusions With the reduction in MMR in obstetric death (e.g. obstetric hemorrhage), there had been a remarkable reduction in MMR in Wuhan in 2001–2012, which may be due to (1) the improvement in the obstetric quality of perinatal care service on prevention and treatment of obstetric hemorrhage and emergency care skills, and (2) the improvement in the maternal health management and quality of prenatal care. Interventions to further reduce the MMR include several efforts such as the following: (1) designing community-based interventions, (2) providing subsidies to rural women and/hospitals for hospital delivery, (3) screening for pregnancy complications, and (4) establishing an emergency rescue system for critically ill pregnant women.

To describe beliefs about infant sleep position among African American grandmothers and other older caregivers (senior caregivers [SCGs]) and to measure the incremental effect on the rates of prone sleep after educating a group of African American SCGs.Survey of sleep practices and beliefs. Randomized, controlled trial of a teaching intervention.Managed care prenatal clinic for normal risk obstetrics patients.Low-income pregnant women, self-identified as African American. An SCG is an older family member or friend to whom they would go for advice about routine child care. Pregnant women randomly assigned to the control group (educated about safe sleep practices) or the experimental group (education for both pregnant women and their SCG).During the third trimester, 2 teaching sessions for pregnant women (both control and experimental groups) and for the experimental group's SCGs. One-on-one teaching emphasizing that infants should sleep supine.During the third trimester, description of rate of preference for prone sleep for infants among pregnant women and SCGs. Effects of teaching SCGs on (1) SCGs' postnatal beliefs about sleep position as a means to reduce the risk of sudden infant death syndrome, and (2) the eventual rate of prone sleeping among study infants.One hundred twenty-five women were in the control group; 98 pregnant women and SCG pairs were in the experimental group. Senior caregivers were 47.1 +/- 12.4 years old (mean +/- SD). Most were grandmothers (either maternal, 72.5%, or paternal, 14.3%) or aunts or sisters (10.2%). No differences were noted in the prenatal rates of the prone preference (controls, 36.3%; experimental group, 35.7%; and SCGs, 34.7%). Teaching SCGs did not increase the rate of the usual prone sleep in the experimental vs the control group (13.3% vs 17.3%, chi(2) = 0.59, P =.44, 95% confidence interval for difference from -5.8% to +13.8%). After the teaching and during the pregnancy, the SCGs became less worried that the infant was susceptible to sudden infant death syndrome (chi(2) = 16.6, P =.003) or likely to die of sudden infant death syndrome (chi(2) = 24.7, P.001). Their concerns about sudden infant death syndrome were significantly less postnatally, in particular when the infant was placed supine (chi(2) = 19.4, P.001).Most African American women and SCGs endorsed the supine sleeping position for infants. Among a group of African American infants, prenatal teaching of their grandmothers and other SCGs did not have a statistically significant incremental effect on the rates of the usual prone sleeping position. Contrary to our starting hypothesis, the SCGs of pregnant women who receive prenatal care seemed responsive to messages about supine sleeping. The Back-to-Sleep message should be delivered prenatally, but special prenatal interventions should attempt to reach women who do not receive prenatal care and SCGs who persist in their opposition to the supine sleeping position.

Soft bedding increases the risk for death among prone infants. We compared the softness of beds and bedding and infant sleep position for infants sleeping alone and for those bed sharing. Study design: Questionnaires were used to record the bedding and sleep practices of 218 consecutive African American infants. Enrollment was prospective. Mechanical models were used in the homes of a subgroup to measure the softness of bedding and its propensity to cause rebreathing. Results were compared by using the Student t test, Mann-Whitney U test, and χ2 analysis. Results: In a cross-sectional sample of infants, at 8.2 ± 3.3 weeks of age, 61% (133 of 218) had bed shared ≥1 of the previous 14 nights and 48.6% (106 of 218) had bed shared the night before. Breast-feeding rates were not different for bed sharers and those sleeping alone. The rates of maternal smoking for both groups were low (13.6% vs 11.8%). Comforters, pillows, and waterbeds were more commonly used beneath bed-sharing infants. Bed sharers were twice as likely to habitually be placed prone for sleep (18% vs 9%). In the subgroup studied in their homes (13 bed sharing, 19 alone), the shared beds were softer (P

Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.

This article presents two case studies highlighting the role of community conflict in the process of community empowerment. A graduate program for community health nurses (CHNs) in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the community's capacity to improve its own health and teaching CHNs community organizing as a means to improve health. Central to the partnership are a broad definition of health, trust developed through long-term involvement, a commitment to reciprocity, social justice, and Freire's model of adult learning. Two initiatives that gave rise to major conflicts between community groups are analyzed. Conflicts, external and internal to the community, proved to be both powerful catalysts and potential barriers to the use of Freirian themes in community organization. Both university and community participants report needing better skills in the early recognition and management of conflict. We conclude that conflict management theory must be integrated with empowerment education theory, particularly when empowerment education is applied in a diverse community.

Three methods of recording mother-child interaction were compared in a sample of 136 adolescent mothers with children ranging in age from 8 to 27 months. Mother-child interaction was rated during in-home observations using Barnard's Teaching Scale, Schaefer's Attachment Inventory, and Clarke-Stewart's Rating Scales. The results indicate that each measure complements the other two, and that their interrelationships support the validity of the dimensions each describes. Yet, analyses indicate that they do not share common underlying factors. The findings suggest that each measure contributes to a more complete description of mother-child interaction.