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Abstract: The purpose of this study is to explore whether, in the U.S., there are associations between state-level variations in mortality among young children and state abortion restriction policies – such as parental-consent requirements, parental-notification requirements, mandatory delay laws, and restrictions on Medicaid funding for abortion. To investigate this, we used NCHS Multiple Cause of Deaths public-use data files for the period 1983–2002, and compiled data on children ages 0–4 identified as having died as a result of assault/homicide in each state and year. Medicaid funding of abortion, mandatory delay laws, and parental involvement laws for minors seeking abortions were included as the main predictor variables of interest. Multivariate count data models using pooled state-year-age cohort data, with state and time fixed effects and other state-level controls, were estimated. Results indicated that, between 1983 and 2002, the average increase in the number of homicide deaths for children under 5 years of age was 5.70 per state among states that implemented stricter abortion policies over that time, and 2.00 per state for states that did not. In the count data models, parental-consent laws were associated with a 13 percent increase in child homicide deaths; parental-notification laws were associated with an 8 percent increase in child homicide deaths though the results were less robust to alternate model specifications; mandatory delay requirements were associated with a 13 percent increase in child homicide deaths. While these data do not allow us to discern precise pathways via which state abortion-restrictions can lead to more child homicide deaths, we speculate that state restrictions on abortion may result in a disproportionate increase in children born into relatively high-risk environments. Additional research is called for to explore the association of state abortion-restrictions with other measures of infant/child health and well-being. [Copyright &y& Elsevier]

An increasing proportion of women in the US and other countries delay initiation of childbearing until their thirties. Little is known about their subsequent pregnancies, particularly with regard to pregnancy spacing. To determine interpregnancy interval (IPI) patterns, factors associated with IPI among women delaying initiation of childbearing until their thirties, and ascertain if delay in initiation of childbearing is associated with increased likelihood for short interpregnancy interval of less than 6 months. A retrospective cohort study was performed using the Missouri maternal linked file for 1978–1997, inclusive. Analysis was limited to mothers aged 20–50 years at first pregnancy, having a first and second pregnancy during the study period; the sample size included 242,559 mother–infant pairs. Analysis strategies included stratified analysis, and multivariable logistic regression. Interpregnancy interval was main outcome variable, and was grouped in seven categories: 0–5, 6–11, 12–17, 18–23, 24–59, 60–119, ≥120 months. The mean interpregnancy interval was significantly shorter for women delaying start of childbearing (≥30 years) compared to 20–29 year olds. Observed intervals are 31 (±24) months for mothers aged 20–29 years, 25 (±17) months for mothers aged 30–34 years, 21 (± 14) for 35–39 year olds, and 19 (±16) for 40–50 year olds ( P < 0.0001). A significant trend for shorter intervals was noted as maternal age at first pregnancy increased ( P < 0.0001). Factors associated with interpregnancy interval for women delaying initiation of childbearing included adverse outcome in preceding pregnancy, and low educational status. Mothers aged 35 and above at first pregnancy had increased odds for a second pregnancy following short IPI <6 months; (35–39 years OR = 1.26 95% CI 1.11–1.44; 40–50 OR = 1.91 95% CI 1.13–3.24). Mothers aged 30–34 years have lower odds for short IPI (OR = 0.93 95% CI 0.87–0.99). First time mothers aged 35 and above have higher odds of having a second pregnancy shortly after their first pregnancy. Given the increasing number of first time mothers aged 35 and above, these findings are of relevance for preconception counseling for this unique population of women. [ABSTRACT FROM AUTHOR]

Introduction Reducing racial/ethnic disparities is a key objective of the Healthy People 2010 initiative. Unfortunately, racial disparities among women delaying initiation of childbearing have received limited attention. As more women in the US are delaying initiation of childbearing, it is important to examine racial disparities in reproductive health outcomes for this subgroup of women. Objective To examine racial disparities in perinatal outcomes, interpregnancy interval, and to assess the risk for adverse outcomes in subsequent pregnancy for women delaying initiation of childbearing until age 30 or older compared to those initiating childbearing at age 20–29. Methods We conducted a retrospective cohort study using the Missouri maternally linked cohort files 1978–1997. Final study sample included 239,930 singleton sibling pairs (Whites and African Americans). Outcome variables included first and second pregnancy outcomes (fetal death, low birth weight, preterm delivery and small-for-gestational age) and interpregnancy interval between first and second pregnancy. Independent variables included maternal age at first pregnancy and race. Analysis strategies used involved stratified analyses and multivariable unconditional logistic regression; interactions between maternal race, age and interpregnancy interval were examined in the regression models. Results Compared to Whites, African American mothers initiating childbearing at age 30 or older had significantly higher rates of adverse outcomes in the first and second pregnancy ( P < 0.0001). Generally, African Americans had significantly higher rates of second pregnancy following intervals <6 months compared to Whites; however, no significant racial differences were noted in interpregnancy interval distribution pattern after controlling for maternal age at first pregnancy. African Americans delaying initiation of childbearing had significantly higher risk for adverse perinatal outcomes in the second pregnancy compared to Whites after controlling for potential confounders, however there were no significant interactions between maternal age at first pregnancy, race and short interpregnancy interval. Conclusion Although African Americans were less likely to delay initiation of childbearing than were White women, their risk for adverse perinatal outcomes was much greater. As health care providers strive to address racial disparities in birth outcomes, there is need to pay attention to this unique group of women as their population continues to increase. [ABSTRACT FROM AUTHOR]

Over the past few decades, the number of disasters, both natural and human initiated has increased. As a result, since the September 11, 2001 attacks on the World Trade Center and Pentagon, there has been a new emphasis on disaster preparedness. However, the preparedness emphasis has been primarily directed toward adults and little attention has been specifically given to the needs of children. One reason for the lack of attention to pediatric needs in disaster planning is that childhood is seldom viewed as a separate and special stage of growth, fundamentally different from adulthood. The expectation during emergencies is that the care provided for adults is appropriate for children. The purpose of this paper is to examine the types of and increase in disasters and discuss the importance of specifically addressing the special needs of children in disaster planning. Further the paper argues for a regional network approach to emergency pediatric care that would increase surge capacity for children during disasters and other emergencies. [ABSTRACT FROM AUTHOR]

Purpose: We investigate whether variations in infant mortality rates among racial/ethnic groups could be explained by variations in fetal mortality rates where relatively higher infant mortality rates may correspond to lower fetal mortality rates due to possible systematic differences in reporting of fetal death compared to live births. Methods: Using US perinatal data from 1995 to 1999, we calculated crude mortality rates, birth weight-specific fetal and hebdomadal mortality rates, risks of perinatal death, and the risk of being classified as a fetal death versus other period death among infants born to Non-Hispanic White, Non-Hispanic Black, and Hispanic mothers. Results: Two-fold disparities between Whites and Blacks persist for all mortality categories. Black low birth-weight deliveries, compared to Whites, have perinatal advantages in both fetal and hebdomadal periods. Hispanics were less likely than Whites to be reported as a fetal versus a hebdomadal death. Conclusions: While these data suggest some underreporting of Black fetal deaths, they provide little evidence that Black-White disparities in infant mortality are a function of variations in classifying a death occurring at delivery as either a fetal death or as a live birth-infant death. These data suggest that the lack of a White-Hispanic disparity in fetal mortality rates may be influenced by underreporting. [Copyright &y& Elsevier]

Background: Telehealth can improve access to evidence-based care at a lower cost for patients, especially those living in underserved and remote areas. The barriers to the widespread adoption of telehealth have been well documented in the literature. However, the barriers may not be the same for pediatric patients, who must rely on their parents or guardians to make healthcare decisions. This paper presents some of the leading barriers parents or guardians of pediatric patients report in using telehealth to meet their children's healthcare needs. Methods: This cross-sectional survey was conducted in a tertiary care pediatric Emergency Department (ED) at a children's hospital in Alabama between September 2020 to December 2020. The parents or guardians of pediatric patients were asked about their reasons for not using telehealth despite having healthcare needs for their children, whether they canceled or rescheduled healthcare provider visits and facility visits, and whether the child's health conditions changed over the past three months. Descriptive analyses were conducted that explored the distribution of telehealth use across the variables listed above. Results: Five hundred ninety-seven parents or guardians of pediatric patients participated in the survey, and 578 answered the question of whether they used telehealth or not over the past three months. Of them, 33.1% used telehealth, 54.3% did not, and 12.6% did not have healthcare needs for their child. The leading reason for not using telehealth was that the doctor or health provider did not give them a telehealth option, the second main reason was that they did not know what telehealth is, and the third leading reason was that the parents did not think telehealth would help meet healthcare needs for their child. Conclusions: This study highlights the telehealth utilization barriers among underserved pediatric populations, including the need for physicians to proactively offer telehealth options to parents or guardians of pediatric patients. Improving health literacy is of paramount importance, given that a substantial proportion of parents were not familiar with telehealth. Policymakers and healthcare organizations should raise awareness about the benefits of telehealth which can improve healthcare access for underserved pediatric patients. [ABSTRACT FROM AUTHOR]

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation. [ABSTRACT FROM AUTHOR]

Utilizing surveillance data from five sites participating in the Autism and Developmental Disabilities Monitoring Network, we investigated contributions of surveillance subject and census tract population sociodemographic characteristics on variation in autism spectrum disorder ascertainment and prevalence estimates from 2000 to 2008 using ordinal hierarchical models for 2489 tracts. Multivariable analyses showed a significant increase in ascertainment of autism spectrum disorder cases through both school and health sources, the optimal ascertainment scenario, for cases with college-educated mothers (adjusted odds ratio = 1.06, 95% confidence interval = 1.02-1.09). Results from our examination of sociodemographic factors of tract populations from which cases were drawn also showed that after controlling for other covariates, statistical significance remained for associations between optimal ascertainment and percentage of Hispanic residents (adjusted odds ratio = 0.93, 95% confidence interval = 0.88-0.99) and percentage of residents with at least a bachelor's degree (adjusted odds ratio = 1.06, 95% confidence interval = I.01 -- I.II). We identified sociodemographic factors associated with autism spectrum disorder prevalence estimates including race, ethnicity, education, and income. Determining which specific factors influence disparities is complicated; however, it appears that even in the presence of education, racial and ethnic disparities are still apparent. These results suggest disparities in access to autism spectrum disorder assessments and special education for autism spectrum disorder among ethnic groups may impact subsequent surveillance. [ABSTRACT FROM AUTHOR]

Prenatal and perinatal exposures to air pollutants have been shown to adversely affect birth outcomes in offspring and may contribute to prevalence of autism spectrum disorder (ASD). For this ecologic study, we evaluated the association between ASD prevalence, at the census tract level, and proximity of tract centroids to the closest industrial facilities releasing arsenic, lead or mercury during the 1990s. We used 2000 to 2008 surveillance data from five sites of the Autism and Developmental Disabilities Monitoring (ADDM) network and 2000 census data to estimate prevalence. Multi-level negative binomial regression models were used to test associations between ASD prevalence and proximity to industrial facilities in existence from 1991 to 1999 according to the US Environmental Protection Agency Toxics Release Inventory (USEPA-TRI). Data for 2489 census tracts showed that after adjustment for demographic and socio-economic area-based characteristics, ASD prevalence was higher in census tracts located in the closest 10th percentile compared of distance to those in the furthest 50th percentile (adjusted RR = 1.27, 95% CI: (1.00, 1.61), P = 0.049). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence. [ABSTRACT FROM AUTHOR]